What is TMJ Dysfunction?

TMJ is characterized by pain in the jaw, joint and surrounding tissues and limitations in the jaw movements, locking of the jaw, painful chewing, inability to open or close the mouth completely, and severe limitation in use of the jaw.

The pain itself can radiate into the mandible, ear, neck, and tonsillar pillars. You have two TMJ’s: one in front of each ear, and one that connects the lower jaw bone (the mandible) to the skull.

What causes TMJ Dysfunction? 

Not all causes for TMJ Dysfunction are known, some possible causes or contributing factors are: injuries to the jaw/head/neck, various forms of arthritis, dental procedures, genetics, hormones, low-level infections, autoimmune diseases, stretching of the jaw and clenching or grinding of the teeth. Because motor vehicle accidents injure many structures of the body, they are frequently a cause of TMJ syndrome.

Signs and Symptoms: 

• Dull, sharp, aching or severe pain in the jaw joint
• Being unable to open the mouth comfortably
• Clicking, popping or grating sounds in the jaw joint
• Locking of the jaw when attempting to open the mouth
• Headaches
• A bite that feels uncomfortable or “off”
• Neck, shoulder and back pain
• Swelling on the side of the face

Testing: 

Tests that are recommended are often intended to rule out other possible medical conditions.

• Plain X-rays
• MRI
• Labwork
• Physical examination
• Diagnostic Injection

Diagnosis: 

At present, there is no widely accepted, standard test to correctly identify all TMJ conditions. In most cases, however, a targeted history and physical examination of the head, neck, face and jaw provide information useful for making a diagnosis.

Treatments: 

• Drug Therapy
• Physical Therapy
• Intra-articular Injection
• Trigger point injections
• Manipulation of skull, jaw and related tissues
• Orthotic Devices-not generally useful without above treatments at the same time

Cervicocranial Syndrome is due to vertebral instability and or dysfunction related to trauma of any source including surgery, which affects the function of the nerve cell aggregations and reflexes located in the neck just in front of the vertebrae as well as spinal cord.

Vertebral instability or misalignment as well as dysfunction occurs because the ligaments that support the neck become weakened or injured. This condition may develop in people who spend a good portion of their day hunched over while working, sustained traumatic injury to head and neck or surgery of either head or neck.

Any activity that precipitates the head forward posibtion and puts the cervical vertebral ligaments in a stretched position will cause the ligaments to weaken over time.

Signs and Symptoms:

• Vertigo
• Cephalea/Headache
• Tinnitus
• Facial pain/facial numbness/swelling on one side of the face
• Otalgia/ear pain
• Dysphagia(difficulty swallowing)
• Dysfunction of equiloibrium
• Loss of voice/hoarseness
• Neck pain
• Severe fatigue/Muscle weakness
• Sinus congestion
• A sense of the eyeball being pulled out
• A sense of pins-and-needles sensation of the hands and forearms
• Dental pain
• Lacrimation (tearing of the eyes)
• Blurred vision
• Shoulder pain
• Nausea/Vomiting
• Localized cyanosis of the face (bluish color)

Testing: 

• History and Physical examination
• Cervical X-rays
• CT or CAT scan
• MRI
• Diagnostic Block

Diagnosis: 

A comprehensive medical history and thorough physical exam by clinician, along with appropriate testing to determine there are no pathogenesis lesions of the joints of the skull, which may be responsible for pain and dysfunction in the segmental areas.

Treatments: 

• Drug therapy
• Physical therapy
• Anesthetic/Corticosteroid Injections of involved joints and ligaments
• Osteopathic manipulation
• Massage therapy
• Diagnostic Nerve Blocks
• Radiofrequency Thermocoagulation/rhizotomy of pathologic reflexes and neural tissue
• Nero Stimulation

MPS is a fancy way to describe muscle pain. It refers to pain and inflammation in the body’s soft tissues. Myofascial pain is a chronic condition that affects the fascia (connective tissue that covers the muscles) and or the muscle fibers/spindles themselves. Myofascial pain syndrome may involve either a single muscle or a muscle group.

In some cases, the area where a person experiences the pain may not be where the myofascial pain generator is located.  There are associated trigger points in one or multiple muscles which maintain this pathology much like a reflex operating continuously.

Factors which can increase risk of myfascial pain (MPS):

• Muscle injury
• Inactivity
• Stress and anxiety
• Neck, Head or Shoulder Injury
• Age
• Sex – women are more likely than men to experience myofascial pain syndrome

Signs and Symptoms: 

• Deep, aching pain in a muscle
• Pain that persists or worsens
• Muscle stiffness
• Joint stiffness near the affected muscle
• Area of tension in your muscle that may feel like a knot or tight spot and may be particularly sensitive to touch
• Difficulty sleeping due to pain.

Testing: 

• History and Physical exam
• CT or CAT scan
• MRI
• Discography
• Myelograms
• EMG/NCV
• Bone scans
• Ultrasound imaging

Diagnosis: 

A comprehensive physical exam and medical history by clinician, along with appropriate testing to determine treatment is required.

Treatments: 

• Physical therapy
• Trigger point injections
• Anesthetic/Corticosteroid injections
• Facet Joint Nerve Rhizotomy
• Massage therapy
• Manipulation