Examination Tests
Cervical Axial Rotation
Patient lies in supine with knees flexed to flatten the lumbar spine. Place both hands around each side of the patient’s neck, with little fingers placed on distal transverse processes of C2, middle fingers placed on transverse processes of C7 and index fingers placed on spinous process of T1. Place thumbs directly under and parallel to SCM’s. Passively rotate the cervical spine as a unit to the left by rotating the neck with right thumb, 3rd, 4th, and 5th fingers while right index finger stabilizes T1. Compare soft tissue limitations or rotational limits or differences secondary to thoracic spine position by rotating neck from neutral to the left and from neutral to the right, through C7 and T1 and surrounding soft tissue.
A positive test is indicated by limitation in one direction when compared to the other, or when inequality of range of motion exists.
Horizontal Upper Extremity Abduction
Patient lies in supine with knees flexed to flatten the lumbar spine. Passively take the patient’s arm into horizontal abduction while securing the shoulder joint with one hand and maintaining forearm supination with the other hand.
A positive test is indicated by limited horizontal abduction of one extremity when compared to the other. Less than 30° is considered limited.
Mandibular Opening
Patient lies in supine with knees flexed to flatten the lumbar spine.
Place a small bolster of appropriate size under the patient’s neck to prevent extension of the mid-cervical spine and flexion of the OA joint. The head should still be in contact with the mat or plinth not a pillow.
Ask the patient to open their jaw as they keep their neck on the bolster and their head stable. Measurement of the maximum voluntary mandibular vertical opening can be obtained by measuring between the maxillary and mandibular incisal edges with a ruler scaled in millimeters.
Normal mandibular opening is 35-40 mm or greater.
Mandibular Lateral Trusion with Protrusion
Patient lies in supine with knees flexed to flatten the lumbar spine.
Place a small bolster of appropriate size under the patient’s neck to prevent extension of mid cervical spine and flexion of the OA joint.
Ask the patient to place their tongue on the roof of their mouth and protrude their jaw gently forward. Then have them move laterally and measure the distance between midlines of the maxillary and mandibular incisors.
Normal mandibular opening with lateral trusion and protrusion is 5-10 mm.
Mandibular Opening with Non-Reducing or Reducing Disc
Patient lies in supine with knees flexed to flatten the lumbar spine.
Place a small bolster of appropriate size under the patient’s neck to prevent extension of mid cervical spine and flexion of the OA joint.
Ask the patient to place their tongue on the roof of their mouth and protrude their jaw gently forward and to the right. Then have them attempt to open. If they can not open, they more than likely have a non-reducing disc on the left. Measure the distance between maxillary and mandibular incisal edges in millimeters. If they click on the left as they open to the right, measure or judge the distance between mandibular and maxillary incisal edges at the point where the click took place, in millimeters.
Repeat same process on the other side. This TMJ test is important for comparison purposes before and after treatment.
Infrazygoma Height Comparison
Patient lies in supine with knees flexed to flatten the lumbar spine.
Place a small bolster of appropriate size under the patient’s neck to prevent extension of mid cervical spine and flexion of the OA joint.
By placing your respective index fingers under each of the patient’s zygoma arches, visually and proprioceptively determine if they are uneven.
This subjective, integrative test helps the examiner assess treatment outcome of the sphenoid temporal position.
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