Radiografska procjena valjanosti manualne funkcijske analize osteoartritisa temporomandibularnog zgloba

The finding of osteoarthritis of temporomandibular joint (TMJ ) obtained by clinical diagnosis, i.e. manual functional analysis (MF A) and the finding obtained by magnetic resonance imaging (MRI) as the gold standard were compared in 30 patients (mean age 52.6) diagnosed with osteoarthritis, selected out of 140 consecutive patients diagnosed with a TMJ disorder by MRI. The clinical parameters were symptoms of pain in the TMJ region, crepitations, and absence of clicking, which was confirmed by manual examinations as part of MF A. A positive MRI finding included flattening, subchondral degenerative changes with or without intact cortical bone, osteophytes and subchondral degenerative cysts of joint surfaces. The validity of MF A for osteoarthritis was as follows: sensitivity 0.38, specificity 0.91, positive predictive value (PPV) 0.77 and negative predictive value (NPV) 0.65. MRI examination revealed disk displacement (DD ) without reduction in 12 (40.00%) patients and DD with reduction in one (3.33%) patient. The finding of passive compressions for the osteoarthritis diagnosis depending on DD showed sensitivity of 0.29, specificity of 0.95, PPV 0.67 and NPV 0.78. Although MF A significantly improves validity of clinical diagnosis when differentiating a myogenic from TMJ disorder, clinical determination of osteoarthritis is not satisfactory. Nonspecific clinical signs and symptoms accompanied by predominant pain in the TMJ on dynamic but not on passive manual examinations cannot help differentiate DD from osteoarthritis.Uspoređen je nalaz osteoartritisa temporomandibularnog zgloba (TM Z) dobiven kliničkom dijagnostikom provedenom pomoću manualne funkcijske analize (MF A) i magnetskom rezonancijom (MR) kao zlatnim standardom. Od uzastopno prikupljenih 140 bolesnika kojima je pomoću MR utvrđen poremećaj TM Z izabrano je 30 bolesnika prosječne dobi od 52,6 godina s dijagnozom osteoartritisa. Klinički parametri su bili simptomi boli u području TM Z, krepitacije, odsutnost škljocanja, što se je potvrđivalo manualnim pretragama u okviru MF A. Pozitivan nalaz MR obuhvaćao je deplanaciju, subhondralne degenerativne promjene s intaktnom kortikalnom kosti ili bez nje, osteofite i subhondralne degenerativne ciste zglobnih ploha. Valjanost MF A bila je za osteoartritis: osjetljivost 0,38, specifičnost 0,91, pozitivna prediktivna vrijednost (PPV) 0,77 i negativna prediktivna vrijednost (NPV) 0,65. Pregled pomoću MR utvrdio je pomak diska bez redukcije u 12 (40,00%) i pomak diska s redukcijom u jednog (3,33%) bolesnika. Nalaz pasivnih kompresija za dijagnozu osteoartritisa ovisno o pomaku diska bio je: osjetljivost 0,29, specifičnost 0,95, PPV 0,67 i NPV 0,78. Iako MF A znatno poboljšava valjanost kliničke dijagnostike u diferenciranju miogenog od poremećaja TM Z, kliničko utvrđivanje osteoartritisa ipak nije zadovoljavajuće. Nespecifični klinički znaci i simptomi uz dominantnu bolnost TM Z pri dinamičkim, ali i ne i pasivnim manualnim pretragama ne mogu diferencirati pomak diska od osteoartritisa