Clinical Features of TMJ Osteoarthritis

Clinical Features of Joint Pain

• Pain during palpation and movements in temporomandibular joint (TMJ).
• Maximum unassisted opening and assisted opening elicit pain.
• Pain during lateral excursion.
• Coarse crepitus absent in simple arthralgia cases.

Osteoarthritis of the Temporomandibular Joint

• Aetiology includes trauma, infection, metabolic disturbances, and previous surgeries.
• Characterized by joint pain with movement and limitations in motion.
• Deviation towards the affected side and grating joint sounds without clicking.
• May involve TMJ hypermobility, dislocation, or subluxation.

TMJ Hypermobility/Dislocation/Subluxation

• Defined as the mandibular condyles moving past the articular eminence into the infratemporal fossa.
• Usually associated with internal derangement of the TMJ.
• Aetiology includes trauma, developmental disorders, connective tissue disorders, and idiopathic causes.

Headache Attributed to TMD

• Occurs in the temple region related to TMD pain.
• Affected by jaw movement or function and reproducible upon masticatory system provocation.

Shoulder Joint Characteristics

• Most mobile joint in the body, dependent on soft tissue integrity and bony structures.
• Static stability influenced by labrum, glenohumeral ligaments, and capsular ligaments.

Tietze Syndrome

• Characterized by painful, benign swelling of costal cartilages.
• Diagnosis based on exclusion; physical exam reveals chest pain during movement and palpation.
• Typically occurs after minor trauma or physical strain, sometimes related to viral infections.

Hyperkyphosis

• Defined as an increase in thoracic kyphosis exceeding 40 degrees.
• Aetiology includes vertebral fractures, degenerative disc disease, muscle weakness, and neurological conditions.

Heuter-Volkmann Principle in Scoliosis

• Bone growth is inhibited in high-pressure areas and accelerated in low-pressure areas.
• Uneven pressure leads to deformities like scoliosis due to misaligned joint surfaces.

T4 Syndrome

• Presents vague symptoms in the upper thoracic spine and shoulder girdle.
• Rare condition focusing on dynamic stability influenced by shoulder girdle musculature.

Stability Structures of the Glenohumeral Joint

• Static stability involves the shallow glenoid socket, labrum, and joint capsule.
• Ligamentous support provided by anterior glenohumeral ligaments and coracohumeral ligaments.
• Dynamic stability arises from the rotator cuff, deltoid, and biceps/triceps muscles.

Shoulder Joint Movements

• Sternoclavicular joint resting position: arm at side; closed-packed position: full clavicle rotation with maximum abduction.
• Acromioclavicular joint resting position: arm at side; closed-packed position: at 90 degrees abduction.

Sources of Shoulder Pain

• Differentiated into intrinsic (local) and extrinsic (referred) sources.
• Visceral sources of pain can include heart, liver, and lung conditions, often presenting as deep, poorly localized pains.

Pancoast Tumour

• Uncommon lung cancer presenting with cough, dyspnea, and shoulder-related symptoms.
• Associated with radiculopathy and can lead to Horner’s syndrome if untreated.

Myofascial Pain and Trigger Points

• Myofascial trigger points in neck muscles, particularly scalene and rotator cuff muscles, can refer pain to the shoulder.

Transient Brachial Plexopathy

• Non-specific, unlocalized ache post-overhead activities; may or may not be aggravated by passive tests.

Long Head of Biceps Tendinopathy

• Caused by repetitive overload, anatomical factors, and direct trauma.
• Symptoms include diffuse anterior shoulder pain, especially during stretching or resisted contraction.

Shoulder Instability

• Distinction between laxity (measured translation) and instability (symptomatic).
• Instability occurs when ability to maintain humeral head positioning is compromised.