Arthralgia

GGC - MSK Index
NHS GGC

Description

Pain of joint origin that is affected by:

  • jaw movement
  • function
  • parafunction

Reproduced with TMJ provocation tests

History

Pain in:

  • jaw
  • temple
  • ear or front of ear

AND pain modified by:

  • jaw movement
  • function
  • parafunction

Examination

Confirm location of pain in area of TMJ

AND report of familiar pain in the TMJ with at least one of:

  • palpation of lateral pole/around lateral pole of mandibular condyle
  • maximum unassisted or assisted opening, right or left lateral movements, or protrusion movement of the mandible

Patients can be specific with point of pain

Diagnostic Criteria

  • Sensitivity: 0.89
  • Specificity: 0.98

Disc displacement with reduction (DD+R)

Description

An intracapsular biomechanical disorder involving the condyle-disc complex.

In the closed mouth position, the disc is in an anterior position relative to the condylar head and the disc reduced upon opening of the mouth.

Medial and lateral displacement of the disc may also be present

History

Patient reports history of TMJ noises on jaw movement or function

OR the patient reports noise present during the examination

Examination

Click with opening and closing, OR Click with opening or closing

AND Click with lateral or protrusive movements

Detected by palpation during at least one of three repetitions

Diagnostic Criteria (without imaging)

  • Sensitivity: 0.33
  • Specificity: 0.94

Disc displacement with reduction (DD+R) with intermittent locking

Description

An intracapsular biomechanical disorder involving the condyle-disc complex. In the closed mouth position, the disc is in an anterior position relative to the condylar head, and the disc intermittently reduces with opening of the mouth.

When the disc does not reduce with opening of the mouth, intermittent limited mandibular opening occurs

History

Patient reports TMJ noises with jaw movement or function and jaw locks with limited mouth opening and then unlocks

Examination

Clicks with opening and closing OR both click with opening or closing

AND click with lateral or protrusive movements palpated during at least one of three repetitions

When present in clinic a manoeuvre is required to open mouth

Diagnostic Criteria (without imaging)

  • Sensitivity: 0.38
  • Specificity: 0.98

Disc displacement without reduction (DD-R) with limited opening

Description

An intracapsular biomechanical disorder involving the condyle disc complex. In the closed mouth position, the disc is in an anterior position relative to the condylar head, and the disc does not reduce with opening of the mouth.

Medial and lateral displacement of the disc may also be present.

This is associated with persistent limited mandibular opening that does not reduce with the clinician or patient performing a manipulative manoeuvre.

History

Current TMJ lock with limited opening

Limitation severe enough to interfere with ability to eat

Examination

Passive stretch with maximum opening <25mm

Diagnostic Criteria (without imaging)

  • Sensitivity: 0.80
  • Specificity: 0.97

Disc displacement without reduction (DD-R) without limited opening

Description

An intracapsular biomechanical disorder involving the condyle-disc complex. In the closed mouth position, the disc is in an anterior position relative to the condylar head and the disc does not reduce with opening of the mouth.

Medial and lateral displacement of the disc may also be present.

Over time the joint capsule can be stretched to allow nearly full ROM and the disorder is no longer associated with limited opening.

History

Prior history of TMJ locking with limited opening

Limitation was severe enough to interfere with ability to eat

Examination

Passive stretch maximum opening >40mm

Diagnostic Criteria (without imaging)

  • Sensitivity: 0.54
  • Specificity: 0.79

Degenerative

Description

Degenerative disorder involving the joint, characterised by deterioration of articular tissue with concomitant osseous changes in the condyle and/or articular eminence

History

In the last 30 days, any TMJ noises present with jaw movement

OR

Patient reports any noise present during the examination

Examination

Crepitus detected with palpation during at least one of:

  • opening or closing
  • right or left lateral or protrusion movements
  • limited mouth opening

Imaging

CT scan is gold standard and positive with one of:

  • subchondral cysts
  • erosion
  • generalised sclerosis
  • osteophytes

Diagnostic Criteria (without imaging)

  • Sensitivity: 0.55
  • Specificity: 0.61

Subluxation

Description

Hypermobility disorder (mouth opening >50mm) involving the disc-condyle complex and the articular eminence

In the open-mouth position, the disc-condyle complex is positioned anterior to the articular eminence and is unable to return to a normal closed mouth position without a manipulative manoeuvre.

History

In the last 30 days, jaw locking or catching in a wide open mouth position, even for a moment, and could not close from the wide-open position.

AND

Inability to close the mouth without a self- manoeuvre.

Examination

Positive if the above occurs during the examination.

Imaging

Positive for the condyle positioned beyond the height of the articular eminence with the patient unable to close his/her mouth.

Diagnostic Criteria (based on history only)

  • Sensitivity: 0.98
  • Specificity: 1.00

Editorial Information

Last reviewed: 30/04/2024

Next review date: 30/04/2025

Reviewer name(s): Louise Ross , Alison Baird , Karen Glass .