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A Pilot Investigation of the Types of Somatic Dysfunctions and Tender Points Associated with Temporomandibular Joint Disorders

Journal: The Journal of the American Osteopathic Association Date: 2009/01, 109(1):Pages: 40. doi: Subito , type of study: observational study

Full text    (https://www.degruyter.com/document/doi/10.7556/jaoa.2009.109.1.40/html)

Keywords:

diagnosis [290]
observational study [152]
pilot study [134]
temporomandibular dysfunction [34]
tender points [13]

Abstract:

Background: Temporomandibular joint disorders (TMD) are common conditions with symptoms of temporomandibular joint (TMJ) pain, crepitis, and restricted range-of-motion. The most common causes of TMD result from disorders of the muscles of mastication, the articular joint or a combination of the two that lead to malocclusion, bruxism, jaw clenching and articular inflammation. Many dentists, osteopathic physicians and other health care professionals believe that there is a causal relationship between TMD and somatic dysfunctions (SD's) found in the cranial and cervical regions. Hypothesis: Temporomandibular joint disorders are associated with a predictable constellation of SD's and tender points (TP's) of the cranium and upper spine. Methods: Male and female subjects (n=10) with a history of TMD underwent a palpatory exam by a single NMM-OMM resident after 6 weeks of conservative exercise therapy with the Facejogger® (ZTS Trainings & Sportgeräte GmbH), a device used to standardize exercise for TMJ muscles. A Palpation Exam Checklist (PEC) divided into 3 sections: Structural/SD (11 somatic dysfunction types), TP (8 bilateral points) and TMJ specific patterns (R/L deviation; R/L clicking), was completed for each subject. The degree of SD or TP severity was graded according to the AOA standard scale of 0-3; zero=none and three=severe. The score was collapsed to a binominal variable with 0 equivalent to the absence, and 1-3 equivalent to the presence of SD or TP. The proportion of total pain attributable to each SD or TP was calculated. Results: Eighty percent of the subjects experienced TP's in the lateral pterygoid and AC7; 90% in the medial pterygoid; and 100% in the masseter muscles. Eighty percent of the subjects exhibited SD at C4; 90% at C2; and 100% at the CT junction, OA, and C3. TP's that exhibited ≥80% prevalence accounted for 50.0% of the diagnosed points and 65.4% of total pain experienced by subjects. SD's that exhibited ≥80% prevalence accounted for 45.5% of total SD and 64.4% of total severity perceived by the practitioner. Conclusions: This was a pilot study, limited by small sample size. However it provides statistical support that TMD exhibits a specific pattern of somatic dysfunction, where 64%-66% of SD's and TP's are localized to a minority of diagnosed points. These results seem to indicate that TMD has a distinct SD and TP pattern that is diagnostically relevant for the associated disorder.


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