OMM 13: TMJ Evaluation and Treatment
mm. responsible for lateral deviation of TMJ
(L/R) -contraction of lateral pterygoid => CONTRA-lateral deviation
attachments of lateral pterygoid
(recall responsible for protrusion and contralateral deviation of TMJ) -superior head = greater wing of sphenoid to articular disc of TMJ -inferior head = lateral pterygoid plate to condylar head
attachments of medial pterygoid
(recall responsible for protrusion and contralateral deviation of TMJ) -superficial head = tuberosity of maxilla/palatine to medial pterygoid tuberosity of mandibular angle -deep head = lateral pterygoid plate to medial pterygoid tuberosity of mandibular angle
components of TMJ
(temporomandibular joint) -hinge joint involving... -head of mandible -articular tubercle of temporal -mandibular fossa of temporal -covered by fibrocartilage capsule -divided into superior/inferior joint spaces by articular disc
components of masticatory mm. sling
-1' mm. of mastication including... -temporalis -masseter -medial pterygoid -lateral pterygoid
joint spaces involved in TMJ depression (opening)
-1st 1/2 (~25 mm) = inferior joint space -2nd 1/2 (>25 mm) = superior joint space (ie yawning, big bites, etc) -this is usually when pain occurs
medial/internal pterygoid counterstrain point and tx position
-TP = posterior surface of ascending ramus -~2 cm above angle of mandible pressing anteriorly -position = jaw slightly open then moved AWAY from TP side
masseter mm. counterstrain point and tx position
-TP = superficial/deep fibers of masseter -posterior towards anterior border of ascending ramus of mandible -position = jaw slightly open then moved TOWARDS TP side
TMJ joint spaces
-articular disc divides superior/inferior joint spaces -superior = btwn intraarticular disc and temporal fossa -inferior = btwn mandibular condyle and intraarticular disc
clinical characteristics of upper cross syndrome
-caused by poor posture leading to.... -forward head -inc C-lordosis + T-kyphosis -elevated/protracted shoulders -rotation/ABD/winging of scapula -may cause TMJ pain
TMJ lateral deviation ME
-contact dysfxn side mandible and apply gentle force towards barrier -pt tries to push chin opposite direction against resistance -hold, relax, take up slack, etc
steps for medial/lateral pterygoid release
-cradle occiput and insert gloved pinky into mouth -run along bottom gum line/teeth until at region of medial pterygoid (straight back) -gentler pressure/run along direction of fibers => softening -move superior and repeat over lateral pterygoid
inhibited/weak mm. in upper cross syndrome
-deep cervical flexors -mid trap -low trap -these require retraining
naming of deviation TMJ dysfxn's
-deviation to L/R w/ jaw movement can be in C or S shape -side of final deviation = side of dysfxn
mm. responsible for elevation/depression of TMJ
-elevation = closing mouth from rest involving contraction of... -temporalis -masseter -medial pterygoid -depression = opening mouth from rest involving... -GRAVITY assisted by... -digastric -geniohyoid -mylohyoid
tx of occipitomastoid suture restrictions
-gently try to spread OM sutures apart and compare both sides -compressed suture has "no give" = dysfxn side -make V w/ index on mastoid and middle on occiput -apply spreading tension to pull OM suture apart
jaw dislocation defn
-head of mandible sliding past articular tubercle -leads to locked protruded position = mouth can't close -requires EMERGENT reduction due to risk to vasculature/nerves
ME for hypertonic mm. of mastication
-hypertonicity of masseter/temporalis => restricted jaw opening -2x fingers on anterior surface of chin -gently open mouth to edge of restrictive barrier -pt tries to close mouth against resistance -hold, relax, take up slack etc
3 ligaments of TMJ
-lateral = temporomandibular -connects mandible to zygomatic arch -sphenomandibular -connects mandible to spine of sphenoid -stylomandibular -connects mandible to styloid process of temporal
steps to dx TMJ somatic dysfxn
-monitor TMJ just anterior to tragus -palpate as pt opens/closes mouth assessing for crepitus/ROM -watch chin for deviation (recall R/L C vs S curve)
steps for temporal rocking
-once in temporal hold will either encourage flexion/extension depending on restriction -encouraging flexion involves.... -ring/little finger exert medial pressure on lower mastoid process -thumb/index exert cephalad "lifting" of zygomatic arch -this encourages ER -resist motion of IR during extension phase (visa versa for encouraging extension/IR)
sx's of TMJ dysfxn
-pain/clicking w/ mandibular motion -TTP over TMJ -anterior displacement = doesn't close well -posterior displacement = doesn't open well
mm. responsible for protrusion/retraction of TMJ
-protrusion = mandible forward from rest involving contraction of... -lateral pterygoid -retraction = mandible back from rest involving contraction of... -posterior fibers of temporalis
steps for sphenopalatine release
-support frontal bone along coronal suture and insert gloved pinky into mouth -run along alveolar ridge past tuberosity of maxilla -hold w/ firm pressure vs run finger in soft tissue tx
nerves at risk w/ TMJ pathology
-those innervating TMJ capsule including.... -auriculotemporal -mesenteric -mandibular -deep temporal
joint spaces involved in retraction/protraction/lateral deviation of TMJ
-upper joint space
tight mm. in upper cross syndrome
-upper trap -levator scapula -pec major -pec minor -these require stretching
temporal hold position defn
-used for temporal rocking -thumb/index grasps zygomatic part of temporal bone -middle rests on EAM -ring/little rest on inferior portion of mastoid process