Ortho

Musculoskeletal Pathology

Temporomandibular Joint (TMJ) Tests

TMJ AUSCULTATION: Used to identify poor joint kinematics or joint/disk damage; place stethoscope over TMJ, just anterior to tragus of ear, clinician listens for presence of joint sounds; very sensitive to finding a problem but not specific in the identification of the structure

Interpretation:

• Opening click = click as condyle moves over posterior aspect of disk in an effort to restore normal relationship; disk is anterior to condyle; the later the click, the more anterior the disk

• Reciprocal click = in opening, the disk reduces as the condyle moves under the disk & in closing, a second click is heard as the condyle slips posteriorly & the disk becomes displaced anteriorly

LATERAL POLE

Purpose: Assess soft tissues of TMJ

Position: Face client with clinician's index fingers palpating lateral pole of TMJ

Technique: Open & close mouth several times

Interpretation: + test = ↑ or reproduction of symptoms incriminating LCL or TMJ ligament

EXTERNAL AUDITORY MEATUS

Purpose: Assess posterior disk

Position: Face client, clinician inserts little fingers into client's ears

Technique: While applying forward pressure with fingers, client opens & closes mouth repeatedly

Interpretation: + test = ↑ or reproduction of symptoms

DYNAMIC LOADING

Purpose: To mimic TMJ loading to differentiate between TMJ & muscle pain

Position: Sitting with roll of gauze between molars on 1 side

Technique: Client bites down on gauze roll

Interpretation: Compression occurs on contralateral side & distraction on ipsilateral side of gauze; + test = ↑ or reproduction of symptoms @ TMJ

Upper Limb Neurodynamic Tests

MEDIAN NERVE TEST

Position: Supine or sitting with contralateral cervical SB & ipsilateral shoulder depressed

Technique: Extend UE in plane of scapula with elbow extended, forearm supinated, & wrist/fingers extended

Interpretation: + test = pain or paresthesia into median ...