Physical Therapy Intervention For A Patient With Temporomandibular Joint Dysfunction Caused By Two Traumatic Events: A Case Study

Background and Purpose: Temporomandibular disorders (TMD) are pathoanatomical dysfunctions of the temporomandibular joint (TMJ) associated with symptoms throughout the head and neck.Limited information exists regarding conservative physical therapy (PT) and post-surgical management of TMD. The dental profession is the main source of published literature specific to TMD. This paper describes a conservative and post-surgical PT plan of care (POC) for TMD. Case Description: A 32-year old female experienced two separate traumatic events at work resulting in TMD. She was referred to PT after the second assault because of symptoms of severe pain, limited range of motion, and jaw locking. She was unable to speak, eat, or return to work. The POC included manual therapy, therapeutic exercise, and patient education. She attended 16 total visits and she underwent two arthrocentesis procedures performed by an oral surgeon. Outcomes: The patient responded well to PT both pre- and post-arthrocentesis procedures in regards to ROM (Depression: 17 to 31 mm, L Lateral Excursion: 4 to 8 mm, R Lateral Excursion: 4 to 9.5 mm), numeric pain rating scale (7/10 to 1/10), and a reduction in locking symptoms. She met all her goals, which correlated with the decreasing Mandibular Functional Impairment Questionnaire results, and met most of the PT goals by discharge. She returned to a normal diet and full time work with minimal restrictions. Discussion: The patient had a positive outcome from her POC including conservative and surgical management of TMD. More research is needed to identify consistent indicators for individuals who would benefit from an interdisciplinary approach, and investigate the potential benefits of PT for TMD