TMJ versus cervical spine pathology

TMJ versus cervical spine pathology

1. TMJ

   • Sign & symptoms
     • Pain/tenderness at TMJ
     • Popping/clicking or crepitus sound from jt
     • headache
     • ROM limitation - cant close or open fully
     • malalignment of upper and lower jaw
     • tenderness of masticatory muscles
     • excessive teeth grinding
     • can have pain behind eyes, neck pain, ear pain
     • Tinnitus
     • difficulty with swallowing and voice changes
   • Important Feature
     • Females are 2x more likely to suffer from TMD
     • more common btw ages 15-45 yo
     • Pt Hx indicate orthodontics
     • Hx of emotional disorder or domestic violence
     • Recent long hour dental procedure
     • recent MVA with airbag deployment
     • Subluxation and dislocation
       • Dislocation - disc is displace of the disc and require manipulation to push it back in place
       • Subluxation - jt can move around a bit and possibly go back on it won
   • Diagnosis/Test
     • listen to and feel the jaw with opening and closing the mouth
     • postural observation
     • pain provocation testing around the jaw
     • Thorough pt interview + physical examination
     • Imaging
       • Radiograph
       • CT
       • MRI
       • Ultrasound
     • Palpation
     • measurement of the TMJ
   • Reduction vs w/out redcution
     • Reduction - clicking sound during opening and close. Condyle is able get on top of the disc. Often have normal or greather than normal ROM in opening
       • Click again when get off the disc during closing
     • W/out reduction - no clicking sound. Pt have trouble opening b/c the disc can't get on top of the disc. Often observe jaw deviate to the side that is affected.
   • can be muscle disorder, disc disorder, and jt disorder
     • overused m.
     • disc displacemnent
     • Degeneration or osteoarthritis of the jt
   • Treatment
     • pain medication
     • avoid hard food, extreme ROM, overuse of the jaw
     • jaw stretching and strengthing
     • botox injection
     • If other options fail, then surgery or implant

2. cervical spine

   • Sign & symptoms
     • Cervical arterial dysfunction
       • severe HA - w/ overlapping oattern
       • hearing disturbance
       • hemianesthesia or hemiplegia
     • Myelopathy
       • pain in shoulder, upper trap, and neck region
       • clumsiness in UE
       • sensory changes
       • CNS & PNS sign
       • non specific weakness + stiffness in UE/LE
     • cervical instability
       • damaged or weaken ligaments
       • 5Ds and 3Ns + ataxia gait
     • headache
     • neck pain
     • Cervical radiculopathy
       • pain, numbness, and tingling in dermatomal pattern
       • weakness in mytomal pattern
       • reduced reflex
       • acute vs chronic
   • Important Feature
     • cervical joint disease or cervical disc disc disease
     • stenosis
     • Fx
     • DDD
     • DJD
     • cervical radiculopathy
       • involvement of nerve root
   • Diagnosis/Test
     • PAVIMs
     • Instability testing
     • AROM/PROM
     • Hoffman test
     • Segmental testing
       • dermatome test
       • myotome test
     • Palpation
     • Spurling's test
     • postural examination
     • Cervical traction
     • PPVIMs
     • Upglide+downglide
   • Treatment
     • Cervical arterial dysfunction
       • anticoagulants
       • endarterectomy
     • Compression Fx
       • halo immobilization
       • cervical fusion
     • ligament injury
       • fusion
       • braces
     • DJD
       • similar to DDD, but also epidural injection
       • Surgery - anterior approach
     • DDD
       • pain/NASIDs medication
       • imaging
       • physical therapy
       • Surgery
     • Cervical radiculopathy
       • Oral prednisone taper, so pt can tolerate physical therapy
       • m. relaxant
   • Referred pain pattern is often not directly over the TMJ
     • TMJ - directly over the masticator m., in the jaw, or around zygomatic bone
     • Cervical - pain is around the occiput region, posterior to neck, in the suboccipital space
     • **TMJ should not be examined alone, instead also assess the cervical spine to rule our the possibility