Chapter 4 Temporomandibular Joint 249

CASE STUDIES

When doing these case studies, the examiner should list the appropriate questions to be asked and why they are
being asked, what to look for and why, and what things should be tested and why. Depending on the answers of
the patient (and the examiner should consider different responses), several possible causes of the patient’s problem
may become evident (examples are given in parentheses). A differential diagnosis chart should be made up (see Table 4-
5 as an example). The examiner can then decide how different diagnoses may affect the treatment plan.

1. A 49-year-old woman comes to you
complaining of neck and left
temporomandibular joint pain. The pain is
worse when she eats, especially if she chews on
the left. Describe your assessment plan for this
patient (cervical spondylosis versus
temporomandibular dysfunction; see Table 4-
5).
2. A 33-year-old woman comes to you complaining
of pain and clicking when opening her mouth,
especially when the mouth is open wide. She
states that there is a small click on closing but
minimal pain. Describe your assessment plan for
this patient (temporomandibular joint arthritis
versus temporomandibular disc dysfunction).
3. An 18-year-old male hockey player comes to
you stating that he was hit in the jaw while
playing. He is in severe pain and has difficulty
speaking. Describe your assessment plan for
this patient (cervical sprain versus
temporomandibular joint dysfunction).
4. A 35-year-old man comes to you with his jaw
locked open. Describe your assessment plan for
this patient (temporomandibular disc dysfunction
versus temporomandibular arthritis).
5. A 42-year-old woman comes to you
complaining of jaw pain and headaches. She
slipped on some wet stairs 3 days ago and fell,
hitting her chin on the stairs. Describe your
assessment plan for this patient
(temporomandibular joint dysfunction versus
head injury).
6. A 27-year-old nervous woman with long hair
comes to you complaining of jaw pain. She has
recently had a new dental plate installed.
Describe your assessment plan for this patient
(cervical sprain versus temporomandibular joint
dysfunction).

TABLE 4-5

Differential Diagnosis of Spondylosis and Temporomandibular Joint nction

Cervical Dysfu
Cervical Spondylosis TMJ Dysfunction
History Insidious onset Insidious onset
May complain of referred pain into shoulder, May be related to biting something hard
arm, or head
Stiff neck Pain may be referred to neck or head
Observation Muscle guarding of neck muscles Minimal or no muscle guarding
Active movements Cervical spine movements limited Cervical movements may be limited if
they
compress or stress TMJ
TMJ movements normal TMJ movements may or may not be
painful but range of motion is altered
Passive movements Restricted Restricted
May have altered end feel: muscle spasm
or bone-to-bone
Resisted isometric movements Relatively normal Normal
Myotomes may be affected
Special tests Spurling’s test may be positive None
Distraction test may be positive
Reflexes and cutaneous Deep tendon reflexes may be hyporeflexic No effect
distribution See history for referred pain See history for referred pain

TMJ, Temporomandibular joint.