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TMJ & Cerv-Thor

Anatomy of the Temporomandibular Joint (TMJ)

Lateral View

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Physiologic (Osteokinematic) Motions of TMJ

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Motion Normal End Feel(s) Capsular Pattern
Opening (depression)/ closing (elevation)

Open = tissue stretch/elastic

Closed = bone-to-bone

Opening – deviates toward restriction & contralateral deviation limited
Protrusion/retrusion Tissue stretch/elastic
Lateral deviation Tissue stretch/elastic

Accessory (Arthrokinematic) Motions of the TMJ

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Arthrology

Concave surface: Mandibular fossa

Convex surface: Mandibular condyle & interposed disk
Arthrokinematics

To facilitate opening:

Condyle rotates anterior for 1st 25 mm, followed by anterior & inferior gliding of condyle & disk for remaining 15 mm, resulting in contact between convex condyle & convex articular eminence

To facilitate closing:

Condyle & disk glide posterior & superior followed by posterior ROT of condyle as it returns to mandibular fossa

To facilitate protrusion:

Condyle & disk glide anterior & inferior without ROT

To facilitate retrusion:

Condyle & disk glide posterior & superior without ROT

To facilitate right deviation:

Left condyle & disk glide anterior & inferior; right condyle spins around vertical axis

To facilitate left deviation:

Right condyle & disk glide anterior & inferior; left condyle spins around vertical axis

TMJ Mobilization Techniques

TMJ Distraction

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Indications:

  • To improve all physiologic motions

Patient:

  • Sitting with head & neck in neutral

Clinician:

  • Standing to side of pt

  • Stabilizing contact: Clinician's arm cradles pt's head, keeping it close to clinician's chest

  • Mobilizing contact: Thumb contacts mandibular molars as flexed 2nd digit contacts submandibular region

Accessory Motion Technique:

  • Downward distraction force elicited through thumb contact

Accessory With Physiologic Motion Technique:

  • Pt & clinician in same position as described above

  • Pt actively opens mouth while downward force is applied through thumb contact

TMJ Anterior Glide

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Indications:

  • To improve depression, protrusion, & lateral deviation to the contralateral side

Patient:

  • Sitting with head & neck in neutral

Clinician:

  • Standing to side of pt

  • Stabilizing contact: Clinician's arm cradles pt's head, keeping it close to clinician's chest

  • Mobilizing contact: Thumb contacts mandibular molars as flexed 2nd digit contacts submandibular region

Accessory Motion Technique:

  • Slight distraction force followed by anterior glide elicited through thumb contact

Accessory With Physiologic Motion Technique:

  • Pt & clinician in same position as described above

  • Pt actively protrudes, depresses, or laterally deviates the mandible to the contralateral side while anterior glide applied ...

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