PTAT I

Temporomandibular Joint

Kalkidan Nigussie (MPT)

UOG, department of physiotherapy
Oct., 2018

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 Objectives
By the end of this session students will be able:
• To review anatomy of TMJ
• To perform general assessment of TMJ
• To identify common dysfunctions of TMJ
• To develop treatment plan for TMJ
dysfunctions

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 Introduction

• Most frequently used joint

• Palpate the TMJ anterior to the ear
(each students)

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 Applied anatomy
• The Temporomandibular joint
– Formed b/n mandibular fossa of temporal bone
and condyle of the mandible
– Synovial ,hinge joint
– Articular disk/ meniscus

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Figure TMJ notice that the disc divides the
joint in to two.

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Movements occurred in TMJ joints
• Gliding and translation (sliding)
– Occurred in upper cavity of TMJ
• Rotation/ hinge
– Occurred in lower cavity

Opening and closing is combination of the two

movements

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• Both rotation and gliding are essential for full
mouth opening and closing.
• Resting position
– Mouth slightly open .lips together ,teeth not in
contact
• Closed pack position
– Teeth tightly clenched
• Capsular pattern
– Limitation of mouth opening
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 Ligaments
• The capsule of TMJ is loose
• Lateral ligament (temporomadibular)
– (zygomatic fossa to neck of the condyle)
• Accessory ligaments
– Stylomandibular ligament
• Styloid process to angle of the mandible
– Sphenomandibular ligament
• Sphenid bone to ramus of madibule

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 Muscles
• Usually called muscles of mastication
• Temporalis
• Masseter Elevator of the jaw
• Medial Pteryigoid (Mouth closure )

Lateral Pteryigoid
Superahyoid (digastrics Depressors of the jaw
and stylohyoid ) (Mouth opening )

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 Functional movements of TMJ
• Opening and Closure
• Protraction and retraction
• Lateral motion (lateral and medial)

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• Video: anatomy of TMJ

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 Assessment
• Patient history
• Any pain
– Closing opening
– In eating (rt or lt chewing )
– When is the pain
• Weakening and disappear pain when day goes on indicates
osteoarthritis
• Do any of the following actions cause pain
– Yawning, biting, chewing, swallowing, speaking,
shouting
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• Does the patient breathes through nose or
mouth
• Does the patient complains clicking
– Abnormal movement b/n the disc and condyle could
make clicking sound during opening and closing
– Adhesion with people clenching the teeth
• Bruxism: closed lock that opens with clicking
– Soft clicking :ligament and muscle in coordination
– Hard clicking :joint surface pathology

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• Has the mouth or jaw ever locked?
– Locking may imply that the mouth does not fully
open or it does nor fully close and is often related
to problems of the disk or joint degeneration
– Closed lock
• Disc moves forward ahead of condyle
– Open lock
• Reciprocal clicking
• It locks after complete opening
– Disc displaced posteriorly

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• Patients habit which places additional stress
to the joint
– Leaning on the chin
– chewing gum
– Biting the nails
– Pursing or chewing the lips
– Head posture/holding of the telephone

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• Grinding of teeth or hold them tightly
– Bruxism is forced clenching and grinding of the
teeth especially during at night
• Cause facial, jaw ,tooth ,and head ache at the morning
– Malocclusion :if the front teeth contacts but not
the posterior
• Cause facial and TMJ pain
• If any teeth missing, painful or sensitive

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 Observation
• Face symmetry
– Eye brow,
– Eye,
– Nose
– Ear
• Under/cross bite
• Over bite

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 Examination
• Active movement of the neck
– Flexion
• Mandible up and forward
– Extension
• Mandible dawn and backward
– Side flexion (right and left )

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• Active movements of the TMJ
• Opening and closing of the mouth
– Test slowly
– Tongue over the roof in the beginning of opening
– Observe any asymmetry and side movements
Note that if deviation occurred ,hypo mobility to the
side of deviation

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• To determine the functional opening
– 2 0r 3 flexed interphalgial joints (knuckle test)
– Measurement 25-35 mm
• Passive movement if necessarily
• Isometric resisted exercise
– Depression (opening)
– Occlusion (Closing)
– Lateral deviation

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 Joint Play Movements
• Pain on performing these tests may indicate
articular problems or pathology to the
retrodiscal tissues
o Longitudinal Cephalad and Anterior Glide.
o Lateral Glide of the Mandible.
o Medial Glide of the Mandible.
o Posterior Glide of the Mandible.

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 Joint Play Movements
• Longitudinal Cephalad and Anterior Glide.
• Lateral Glide of the Mandible.

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 Joint Play Movements
• Medial Glide of the Mandible.
• Posterior Glide of the Mandible.

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 Temporomandibular disorders (TMDs)
1. orofacial pain
2. restricted jaw motion and
3. joint noise
• The disorder may be
• Intra articular
– due to inflammation,
– internal structural changes (internal derangement)
– degeneration, or it may be
• Extra articular
– imbalance or over-activity of the jaw muscles, 30
 Assignment
• Definition ,Clinical symptoms and Management
of the following conditions of TMJ
1. Degenerative joint diseases (osteoarthritis)
2. Trauma ( mandibular fracture and/or
whiplash injury)
3. Hyper mobility syndrome (dislocation)
4. Myofacial pain syndrome
5. Fibromyalgia syndrome

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 References
• David J Magee ,Orthopedic physical
assessment, fourth edition ,2006
• M Kessler and Hertling, Management of
common musculoskeletal disorders physical therapy
principles and methods ,third edition ,1996

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