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Temporomandibular Joint

TMJ Disorders

Jessica Thai

on 8 April 2011

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Transcript of Temporomandibular Joint

Joint Anatomy synovial Ginglymoarthrodial load bearing Articulation between: Mandibular condyle (Convex) Articular Disc Mandibular fossa (concave) Articular tubercle (convex) The temporomandibular joint allows opening and closing of the mouth as well as chewing or side to side movements of the lower jaw. Fibrocartilage/Biconcave Disc divides joint into two parts: Superior compartment:
Convex articular eminence
Concave mandibular fossa of the temporal bone
Superior suface of the disc Inferior Compartment:
Convex surface of mandibular condyle
concave inferior surface of disc Superior Compartment is larger than inferior compartment. 3 bands of disc according to thickness: posterior > anterior > intermediate (aneural and avascular)
Temporal Bone Not articulate. serves as a border for soft tissue Anterior Joint Border Articular Eminence:
Main area of translation
Convex Anterior/Posterior
Concave Medial/Lateral Disc Attachments: Anterior
Capsule & superior lateral pterygoid
influences disc movement Medial & Lateral
Medial & lateral collateral ligaments
attach disc to medial & lateral poles of condyle Posterior
continuous with posterior attachement (superior and inferior lamina with retrodiscal pad lying between) Osteokinematics Depression Elevation Protrusion Retraction Lateral excursion / rotation TMJ Capsule
Fibrous Connection Tissue
Highly innervated TMJ Ligament (Lateral)
Continuous with the capsule
Protect posterior attachment
Restrains max cond movement
Assist transition rotation to trans. Accessory Ligaments
Joint protection from extreme movement Major Innervation:
Trigeminal Nerve Primary Artery:
External Carotid
Masseter Temporalis Medial Pterygoid Medial
Superior & Inferior Lateral Pterygoid What is TMD and what are the treatment options from a physical therapy standpoint? Temporomandibular Disorder Refers to a variety of conditions
in which pain or dysfunction occurs
at the TMJ and/or masticatory muscles 20% of population has TMD 10-20% of those with TMD seek treatment Also called
“Temporomandibular dysfunction”
“Mandibular dysfunction” Signs and Symptoms Intermittent or persistent pain around TMJ and masticator muscles Limitations in mandibular movements
TMJ sounds- clicking/popping Other Diagnosing TMD Performed by a physician
Can use the TMJ scale
A valid/reliable test is still unknown
Difficult due to overlapping symptoms in other disorders/pathologies
Self report
Screening tool Evaluates both physiological and psychosocial symptoms of TMD Outcome measure More research is needed http://www.tmjscale.com/examplereport.txt TEAM APPROACH

“For maximum patient benefit, each member of the dental, medical and physical therapy teams needs to understand what the other can offer in the management of TMD.” Treatment Options Physical Therapy- Focus is…
- Education
- Evaluation and treatment of TMJ, muscles of mastication, and cervical spine tissues
- Pain management & functional improvement
*Don’t focus on symmetry Arthrocentesis
irrigation of the joint; non-invasive Arthroplasty- refers to any open surgery
- Disk reposition
- Discectomy
- Articular eminence recountouring
- TMJ Replacement Physical Therapy
- Manual Therapy
- Electrotherapy
- Jaw Exercises
- Relaxation/Biofeedback
- Postural Education
- Greatest improvement seen when interventions are combined Post-arthroscopy PT Post-operative rehab program to re-establish functional mandibular mobility, reduction of pain, and prevention of further injury
Goal= 1-2 months
4- stage rehabilitation protocol
Each stage consist of different exercises/interventions to complete a goal Stage 1 Stage 2 Stage 3 Goal: maintain mandibular mobility while minimizing further joint inflammation Patients instructed to perform at home exercises 20 minutes 3 X day Exercises designed to maintain vertical, lateral, and protrusion of mandible Patient actively moves through mandibular movements Patient performs mandibular stretching to gain ROM Physical therapist performs intraoral manipulation and soft tissue manipulation to guide TMJ into correct position Goal= improve function by performing smooth mandibular movements
Advanced muscle reeducation PNF and movement awareness Isotonic and Isometric exercises stage 4 Continued loading of masticatory muscles
Pre-morbid diet Education to reduce incidence of further injury Posture education
4 stage rehabiliation protocol Hot or cold packs
Electric Stimulation
Goal is to decrease inflammation
Patients will respond differently to each modality Disc Displacement Moffet’s System:
Stage I
Stage II
Stage III
The displacement is seen when the pt’s back teeth are together.
Treating TMJ inflammation Treatment for Disc Displacement - Same for all stages
- Oral appliance
- Surgery
- Physical Therapy- Alone or Post-arthroscopic -Not known to reduce disc
-Used mainly to decrease pain/ improve function
Types of TMJ Disorders Derangement disorders
Degenerative disorders Etiology multifactoral
Abnormal occlusion
Parafunctional habits
Abnormalities of intra-articular disc
Degenerative changes due to disc displacements
Recent studies show that malocclusion is equally common in persons with and without TMD References Buescher, Jennifer. “Temporomandibular Joint Disorders." American Family Physician 15 (2007): Pages 1477-1482.

Kraus, Steven L. “Temporomandibular Disorders.” Evaluation, Treatment and Prevention of Musculoskeletal Disorders 4 (2004): Pages 173 – 200.

LIST,T. , & AXELSSON,S. (2010). Management of tmd: Evidence from systematic reviews and meta-analyses. Journal of Oral Rehabilitation, 37(6), 430-451.

Norkin CC, White DJ. Measurement of Joint Motion: A guide to goniometry. Philadelphia, PA. F A Davis, 2002.

“Temporomandibular Joint Disorders.” The Patient Education Institute. www.x-plain.com. 2008.

Usmez,S. , Oz,F. , & Guray,E. (2004). Comparison of clinical and magnetic resonance imaging diagnoses in patients with tmd history. Journal of Oral Rehabilitation, 31(1), 52-56.

Wilk,B. , Stenback,J. , & McCain,J. (1993). Postarthroscopy physical therapy management of a patient with temporomandibular joint dysfunction. Journal of Orthopaedic & Sports Physical Therapy, 18(3), 473-478. Muscle Disorder We declare on this 8th day of the month of April of 2011:
TMJ Appreciation Day!!!

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