examination of the temporomandibular joint

Clinical examination of the temporomandibular joint


The most characteristic symptoms of disorders of the temporomandibular joint (TMJ) are orofacial pain, noises in the joint, limitation of movement – mouth opening – or a combination of these. Limitation may present suddenly as locking or may be slowly progressive.


Pain in the TMJ area usually has a local cause and is seldom referred to any distance.

The patient should also be asked about the influence of chewing, yawning, swallowing or talking. If pain is present on one of these, a disorder of the TMJ is most likely. Some disorders of the cervical spine (see Section 2) and the parotid gland may exceptionally also provoke pain on swallowing.

A clear description of the type of pain should always be sought. A sharp severe pain tends to suggest an arthrogenic problem, a diffuse ache of less intensity points more to a muscular disorder.

A painful click may be the consequence of subluxation of the intra-articular meniscus. Pain coming on spontaneously and progressively increasing over some weeks is often the result of arthritis. Continuous dull pain felt in the area of the masticatory muscles and usually worse at the end of the day may indicate myalgia.

Pain referred to the temporomandibular joint area

Occasionally pain is referred from the neck. When there is doubt, a preliminary examination of the neck must be performed.

Other structures may give rise to painful conditions in the TMJ area and can be divided into neurological and non-neurological disorders.

Neurological disorders

Trigeminal nerve neuritis

This may be encountered in patients of 45–60 years of age. It affects females more often than males and the right side more frequently than the left. The patients complain of unilateral shooting pain, from the ear towards the temporal area and the maxilla, sometimes even in the forehead and towards the pharynx. The cause of the pain may be so obscure that unnecessary dental extraction takes place. Pain is seldom accompanied by diminished sensitivity but characteristic trigger points are often found. Stimulation of these, even sometimes by light touch, results in pain felt elsewhere, which is followed by a refractory period of up to 30 seconds during which stimulation does not lead to new pain. The pain attacks seldom last longer than a few seconds. They may recur at irregular intervals, sometimes on a daily, weekly or even a monthly basis. They are isolated or come on in clusters.2

Non-neurological disorders

Temporal arteritis

This is one of the manifestations of a giant-cell arteritis, an autoimmune process.7 It is usually seen unilaterally in males over 50 years of age and is frequently associated with polymyalgia rheumatica. It is characterized by a knocking pain around the temporal vessels. The skin overlying the artery is red, swollen and warm. The erythrocyte sedimentation rate is raised.

Jun 5, 2016 | Posted by in ORTHOPEDIC | Comments Off on examination of the temporomandibular joint

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