Orthopedic Exam / Special Tests for Physical Therapy: HEAD & NECK
TMD TEST/ TMJ TEST: (Procedure Below)
The temporomandibular joint is the joint of the jaw and is frequently referred to as TMJ. The TMJ is a bilateral synovial articulation between the mandible and temporal bone. The name of the joint is derived from the two bones which form the joint: the upper temporal bone which is part of the cranium, and the lower jawbone or mandible
The six components of the TMJ are the (1) the Mandibular condyles, (2) the Articular surface of the temporal bone, (3) the joint Capsule, (4) the Articular disc, (5) the Ligaments and (6) the Lateral pterygoid.
Problems with the jaw and the muscles in the face that control it are known as temporomandibular disorders (TMD). The causes of TMD are unkown but dentists believe symptoms arise from problems with the muscles of the jaw or with the parts of the joint itself. Injury to the jaw, the joint, or the muscles of the head and neck – like from a heavy blow or whiplash – can lead to TMD. Other causes include grinding or clenching of the teeth, arthritis in the TMJ, and stress, which can cause patients to tighten facial and jaw muscles or clench the teeth.
Common include pain or tenderness in the face, jaw joint area, neck and shoulders, and in or around the ear when the patient chews, speaks, or open their mouth wide. The jaws could also get “stuck” or “lock” in the open- or closed-mouth position. There may be clicking, popping, or grating sounds in the jaw joint when the patient opens or closes their mouth or chew. This may or may not be painful. There may also be swelling on the affected side of the patient’s face. The patient may also have toothaches, headaches, neck aches, dizziness, earaches, hearing problems, upper shoulder pain, and ringing in the ears (tinnitus).
TMD TEST/ TMJ TEST:
- Testing For: TMJ mobility.
Video Demo Instructions, Procedure, Positive Test:
Special Test: TMD TEST/ TMJ TEST: Video Demo
Special Test: TMJ Mobility Test: PROCEDURE
• Palpate the patient’s TMJ (anterior to the earlobe)
• Ask for the patient to open and close their mouth as you palpate their TMJ
• Observe patient’s TMJ and mouth as the open and close their mouth
Special Test: TMJ Mobility Test: POSITIVE SIGNS:
• Deviation when the patient opens or closes their mouth (C deviation or S deviation) – TMJ muscle imbalance.
• Restriction when patient opens their mouth – TMJ hypomobility
TMJ Test: Three-Knuckle Test:
- Testing For: The available active range of depression of the mandible or TMJ hypomobility.
Procedure: ( Three Knuckle Test)
• Ask patient to open their jaw.
• Ask them to insert as many of their own
flexed proximal interphalangeal joints of the non-dominant hand into their mouth.
Positive Sign: (Three Knuckle Test)
• Patient can only get one knuckle or two knuckles between their teeth.