examination

Last reviewed 01/2018

Physical examination may reveal the following:

  • myofascial pain
    • dull, diffuse, cyclic pain seen in several sites of the head and neck (1,2)
    • pain is worse in the morning in cases where the patient have been clenching or grinding (bruxism) their teeth while asleep (2)
    • diffuse muscle tenderness around the joint with limited jaw function (2)
    • wear facets on the dentition in bruxism (2)
  • internal derangement
    • pain is continuous, localized to the temporomandibular joint and is exacerbated by jaw movement (1)
    • mandible movement is restricted with deviation of the joint during opening and closing (1)
  • osteoarthritis
    • crepitus or grating sounds
    • pain or swelling localized to the TMJ can indicate intra-articular inflammation (2)

Examination of the TMJ and masticatory muscles (3)

  • this should include careful palpation of all structures
  • determining myospasm and myofascial trigger points
    • this may be done by palpation of the masseter or sternocleidomastoid muscles
    • it can be performed by placing a finger over the TMJ or into the ear canal while the patient opens and closes the mouth
    • a clicking or popping sensation that occurs when mouth opening may indicate displacement of the intra-articular disk during mandibular movement
      • clicking is a common symptom
      • it is part of the diagnostic criteria for TMJ disorders
      • it does not correlate well with pain severity or functional limitation
      • the absence of clicking sounds is not a reliable symptom
  • pain or swelling localized to the TMJ can indicate intra-articular inflammation

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