Temporomandibular Joint Dysfunction

Referral from her dentist

Case Description: The patient is a 36 y/o female.  ~2 months before seeking care she had a very painful “pop” at her L jaw on opening and had since been painful and limited with all attempted opening. Historically her jaw would pop intermittently without pain and if her opening was ever limited, she would wiggle her jaw around and it would then regain full mobility, but these strategies were no longer working. She had been limiting her diet to food requiring minimal opening and chewing.  She was very fearful that she had damaged her jaw, permanently limiting her ability to eat, yawning, or have a regular dental cleaning.

Intervention: The patient was seen for 8 physical therapy visits over 2 months

	Opening	Treatment
Initial Evaluation (IE) – Her hx/signs/symptoms matched presentation for disc displacement without reduction	29 mm (5/10 pain) and very apprehensive	Soft tissue mobilization to masseter/temporalis and home heating routine. Instruction in gentle passive stretching.  Diet modification to decrease strain a TMJ.
4 weeks after IE	41 mm (mild pain) and very apprehensive	Self-stretching home routine reviewed and consolidated, reducing her frequency and intensity of stretching.
Discharge (8 wks after IE)	41 mm (no pain) and no apprehension	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 by sharp pain 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 38% to 18% impairment with good prognosis for full recovery. 

Comments at Discharge: “My range of motion has improved drastically and my fear of movement is completely gone!  I now look forward to continued improvement instead of being scared…The whole staff is very welcoming and my experience was always met with reassurance – I felt calm and in good hands!”

Luke Vander Zouwen, DPT
Full Potential Physical Therapy