Myofascial Pain Dysfunction Syndrome ( MPDS )

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Introduction

Most common type of TMD. Characterised by : Regional Dull Aching pain. Localised Tenderness in one / more masticatory muscle

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History

Costen 1934. Schwartz 1956. Laskin 1969.

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Definition of Important Terms

Active trigger point Latent trigger point Referred pain Taut band Jump sign Twitch response Click to edit Master subtitle style

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Etiology

Muscular Hyperfunction. Parafunctional Habits. Mal Nutrional . Physcological Stress. Sleep Disturbances. Improper prosthesis. Internal Derangements. Degenerative joint disorders. 4/21/12

Clinical Features
1> Pain :
Unilateral dull, aching pain, which increases with muscular activity, and progressively worsens towards the end of the day.

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Clinical Features
2>Increased stress levels :
Results in habits, like :

Bruxism. Clenching of teeth.

Leading to :

Muscular overuse Fatigue Spasm.

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Clinical Features
4> Tenderness on Palpation : 5> Headache:

Headache becomes worse while jaw movements .

6> Ear pain:

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Patient notice ear pain but there are no signs of infection.

Clinical Features
7> Sounds:

Clicking or popping sounds, termed as crepitus, are common in patients with a TMJ disorder.

8> Dizziness:

Majority of patients report a vague dizziness or 4/21/12 vertigo.

Clinical Features
9> Fullness of the ear:
Patients describes muffled, clogged, or full ears.

10> Tinnitus :

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Clinical Examination
1> TMJ :

Extent of mouth opening and lateral excursions. Palpation for Tenderness. Evaluation of TMJ Sounds.

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Clinical Examination
2> Muscular Examination :

Pt. examined for Active trigger point, Latent trigger point, Taut band, Jump sign and Twitch response .

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Clinical Examination
3> Dental Evaluation :

Occlusal Discrepancies. Attrition. Interferrence in occlusal due to prosthesis.

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Clinical Examination
4> Cervical Examination :

Neck muscles are palpated and range of neck movements are examined. Movement of Cervical Spine.

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Diagnostic Criteria
1.
.

Primary Findings :
Pt. complains of pain in one or more masticatory muscle. Tenderness on palpation over the muscle. Presence of Trigger points. Pain aggrevated due to movement of mandible.
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. . .

Diagnostic Criteria
2. Secondary Findings :

Restricted range of movement of mandible. Maximum assisted opening > Maximum unassisted opening > Pain free opening. Range of movement increased by use of Alkane vapocoolant. Clinical or behavioral indications of Hyperfunction or parafunctions. 4/21/12

Diagnostic Criteria
3. Possible findings :

TMJ pain. Joint Sounds. Inflammation.

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Management

The aim of management should be: Control of factors that worsen MPDS. Reduction of harmful loading on the joints. Restoration of jaw function. Resumption of regular daily activities. Pain reduction.

1. 2. 3. 4. 5.

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Management

Management is divided into four phases: Phase I :

Initiated upon diagnosis, and consists of :

Patient education. Avoidance of clenching and grinding .

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diet.

Management

NSAIDs , with or without a muscle relaxant.

The most commonly used agents are : Diazepam (2-5 mg twice a day) Ibuprofen (400 mg thrice a day). Naproxen (500 mg twice daily) .

Moist Heat therapy +Vapocoolant Spray and stretch 4/21/12 massage .

Management
Phase II :
To be initiated if Phase one treatment fails.
Medications are continued. Custom made oral orthopaedic acrylic appliance (splint) is added. These include occlusal splints, bite guards and night guards.
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Management
Phase III :
Physiotherapy of the muscle groups, including Ultrasonic therapy, Electro galvanic stimulation,

Transcutaneous Electrical Nerve Stimulation (TENS).

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Management
Phase IV :

Psychological counseling . Biofeedback.

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