Temporomandibular Joint Dysfunction

Referral from her pediatrician

Case Description: The patient is an 18 y/o female.  The R side of her jaw had popped and clicked for years, but ~3 weeks prior to starting PT, she noted that her jaw had “locked” on waking one morning and had not unstiffened.  She notes that it had become quite painful with any attempted opening and was limiting her ability to eat, brush her teeth, or yawn.  She could no longer get her jaw to pop as she had in the past.  Over the counter anti-inflammatories has provided no relief.  Her pediatrician ended up referring her to physical therapy. 

Intervention: The patient was seen for 5 physical therapy visits over 7 weeks

	Opening	Treatment
Initial Evaluation (IE) – Her hx/signs/symptoms matched presentation for disc displacement without reduction	28 mm (5/10 pain) and very apprehensive. Limited and painful L excursion	Soft tissue mobilization to masseter/temporalis and home heating routine.  Diet modification to decrease strain a TMJ.
4 weeks after IE	35 mm (mild pain) and very apprehensive	Self-stretching home routine reviewed and advanced as it had become less painful. Visits tapered to 2-week follow-ups.
Discharge (7 wks after IE)	41 mm (0-1/10 pain). Excursion consistent R vs L	Light maintenance routine reviewed to insure sustainability of results.  Consultation follow-up offered as needed.

Summary: Her history and presentation of intermittent clicking/popping followed locking with minimal opening and absence of clicking/popping is consistent with TMJ disc displacement without reduction, making her an excellent candidate for PT services. With conservative care she was able to return to nearly normal function and was independent with an advanced home program to fully meet her goals.  Her Temporomandibular Dysfunction Disability index improved from 18% to 8% impairment with good prognosis for full recovery. 

Comments at Discharge: “I have wider range of motion with little to no pain.” She had cancelled a follow-up visit with an oral surgeon as she felt she was managing well on her own and would not need further intervention.” 

Luke Vander Zouwen, DPT
Full Potential Physical Therapy