140


PART II THE VERTEBRAL COLUMN


TEMPOROMANDIBULAR JOINT DYSFUNCTION RELATED TO AGING AND DISEASE


TM joint dysfunction is a blanket term that covers a wide variety of conditions related to the joint and its malfunction. There are three cardinal signs of TM joint dysfunction:


● Pain in the region of the TM joint that worsens with movement


Posterior portion of digastric muscle


Hyoid bone


Anterior portion of digastric muscle


● Joint noise that occurs during joint movement ● Limited range of motion of the TM joint, joint locking,


and decreased movement on chewing, talking, or other functional activities.


Figure 7.12 The anterior portion of the digastric muscle arises from the mandible, and the posterior portion arises from the mastoid process. The two portions are joined by a fibrous loop to the hyoid bone. (From Levangie P, Norkin C. Joint Structure and Function: A Comprehensive Analysis, 5th ed. Philadelphia, PA: F. A. Davis Company, 2011: p. 220, with permission.)


TABLE 7.1 Synergistic Muscle Action at the TM Joint


Mandibular Action


Depression Elevation Muscles and Action Involved


Concentric contraction of bilateral digastric muscles and inferior lateral pterygoid


Concentric contraction of bilateral masseter, temporalis, and medial pterygoid muscles


Eccentric contraction of bilateral lateral pterygoid muscles controls the discs as the mandible elevates


Protrusion Retrusion


Bilateral contraction of masseter and medial and lateral pterygoid muscles


Bilateral contraction of posterior fi bers of the temporalis muscle and the anterior portion of the digastric muscles


Lateral excursion


Unilateral contraction of the temporalis muscle produces lateral excursion to the same side


The medial and lateral pterygoid muscles produce lateral excursion to the opposite sides


CHAPTER SUMMARY


Throughout every person’s life—every day, all through- out the day—the TM joint is involved with the life- sustaining activities of eating and swallowing and vital verbal and nonverbal communication. The TM joint is designed to withstand powerful forces and repeti- tive motion. The articular surfaces and the design of the upper and lower joints combine to produce a joint


Although joint disorders can occur in very young chil- dren and elderly adults, they are most common in women between the ages of 20 and 40 years. It is speculated that hormonal infl uences may affect the articular carti- lage and joint structures. The dysfunction is often the result of trauma to the cervical spine or mouth and jaw, poor posture, infl ammatory conditions, or faulty move- ment patterns. Teeth grinding, open-mouth breathing, forward head posture, and malocclusion can contribute to TM joint dysfunction. Disc derangement, a condition in which the disc is displaced from its normal functional relationship with the mandibular condyle and the tem- poral bone, can also contribute to TM joint dysfunction. Although TM joint subjective symptoms and clinical signs are present in older adults, the risk appears to be relatively low, and symptoms are not necessarily associ- ated with degenerative changes seen on radiography or magnetic resonance imaging.


Soft tissue and joint mobilization techniques, muscle strengthening and stretching, and orthotic devices are effective interventions to address TM joint dysfunction. Table 7.2 summarizes pathologies that may damage the TM joint, resulting in one or all of the cardinal signs of TM joint dysfunction.


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