TMJ

Masseter guarding 3 top S/S

1) Pain with biting down or MMT of masseter 2) Limited contralateral lateral deviation due to tightness 3) Limited Mouth opening

Top 3 S/S for TMJ capsulitis

1) ipsilateral lateral deviation with opening (C-Curve) 2) Limited lateral deviation towards contralateral side 3) Painful an limited opening

Lateral Deviaiton AROM

10-15 mm

Retrusion AROM

3-4 mm

Jaw opening AROM

35-55 mm

Protrusion AROM

>7mm

Patient presents to PT with current clicking with opening and closing of the jaw. There is pain and crepitus as well. No lateral deviations noted, and no tenderness to the masseter. What is the pathology suspected?

Anterior disc displacement with reduction.

Patient has had a hx of clicking, no present clicking, and normal ROM. What is the pathology?

Anterior disc displacement without reduction (chronic phase)

Patient has had a hx of clicking, no present clicking, and limited mouth opening. What is the pathology?

Anterior disc displacement without reduction (early phase) or Close lock jaw

Patient has had a hx of clicking, no present clicking, and the mouth will not close. What is the pathology?

Anterior disc displacement without reduction (early phase) or OPEN LOCK

How will forward head posture affect the TMJ?

Can cause the mandible to become posteriorly displaced due to weak and lengthened muscles in the front.

TMJ openers

Hyoid Anterior Digastric Lateral Pterygoid

Describe a the opening of a jaw with someone who has TMJ capsulitis. (2)

Ipsilateral deviation when opening. Limited contralateral deviation

Pt opens mouth and has limited AROM with right lateral deviation. Which muscles on what side are the problem?

Left masseter/temporalis is tight!

Protrusion

Masseter Medial Pterygoid Temporalis Lateral Pterygoid

Ipsilateral lateral Deviation

Masseter Temporalis

Contralateral lateral deviation

Medial Pterygoid Lateral Pterygoid

How does protrusion look for someone with R TMJ capsulitis?

Protrusion deviates towards right side

Pt comes in with Right sided Jaw pain. Bite Down test, stick on the right side: pain on the right

Right Masseter Problem

Pt comes in with Right sided Jaw pain. Bite Down test, stick on the left side: Pain on the right

Right anterior disc displacement

Pt comes in with Right sided Jaw pain. Bite Down test, stick on the right side: Relief of pain on the right

Right anterior disc displacement

Pt opens mouth and gets a lateral deviation to the right... which side has an anterior disc displacement?

Right side! (Because the right can only spin in place)

S curve vs C curve

S curve: As jaw open, it goes to one side then comes back to neutral. C curve: As jaw opens, it goes to one side and stays there for the rest of the ROM.

Mobilization to treat a patient with limited mouth opening?

inferior glide/distraction with an anterior glide

TMJ closers

medial pterygoid masseter temporalis