Saturday, March 31, 2012

Chronic Pain and Temporal Mandibular Dysfunction

When people get whiplashes their jaw can be involved. This can lead to chronic pain in face and neck or complicate whiplash pain. Dentists and othodontists have noted this.  Today at the Trial Lawyer's Association of BC Essential Soft Tissue Injury conference a physiotherapist presented on this covering the topic neatly and succinctly with relevant and useful slides.  These are the notes I took and of course they don't cover all the material. The conference offered a CD with the various lecturers notes on that my own notes tend to remind me of what I thought was useful clinically and give a glimpse of what kind of information this conference covered clinically.
Essential Soft Tissue Injury Conference
March 31, 2012
Physical Therapy Treatments for TMD: Giving Hope to your Patients and Clients, Angelica Reeve, MSc,PT, BSc PT MACP
19th Street Physiotherapy Clinica
TMD - Temporalmandibular Dysfunction
TMJ is the jaw joint
connect mandible to temporal bone of skull by articular disc
Opening mouth requires mandible to slide forward and rotate - makes the disc very vulnerable
Muscles of mastication
temporalis - one of the reasons people complain of headaches
lateral and medial pterygoid
Temporal mandibular dysfunction
-collective term
  • intra-articular (inside joint)
  • Combination
5 categories of very minimal to very severe
trauma -direct trauma, derangement, adhesions
micro trauma -indirect blow, whiplash, bruxism, adhesion
Mechanical dysfunction - trauma, bruxism, muscle imbalance, posture
Osteoarthritis - any of the above
Signs and symptons
loss of range of movement or locking
joint noises
pain - tmj, fascial,earache
pain ful neck
sudden change in bite
decreased hearing, blocked ear
Whiplash - hyperextension and hyperflexion
High incidence of TMD with cervical spine disorders
Five times more likely to develop TMD
20% of recorded cases TMD main complaint
Deep cervical spine muscles can be involved  in whiplash and contribute type i fibers versus type ii more common in superficial muscles
Muscle imbalance
-loss of spatial awareness
posture changes
forward head posture has been found to be correlated to TMD
involves positive retraining
deep neck re posturing
Need to taught how to sit upright
Chronic pain
-provides more of a challenge
-change in hard wiring of brain
-increased sensitization
-anxiety and depression
Homunculus in Somatosensory Cortex
Homuncular Man = more face and hand
Chronic TMJ Pain can be associated with problems
  • fascial expression recognition
-two point discrimination
-loss of expression

No comments: