mpds gaurav

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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


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Etiology

Muscular Hyperfunction.

Parafunctional Habits.

Mal Nutrional . Physcological Stress.

Sleep Disturbances.

Improper prosthesis.

Internal Derangements.

Degenerative joint disorders.


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Clinical Features

1> Pain :

Unilateral dull, aching pain, which increases withmuscular activity, and progressively worsens

towards the end of the day.


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Clinical Features

4> Tenderness on Palpation :

5> Headache:

Headache becomes worse while jaw movements .

6> Ear pain:

Patient notice ear pain but there are no signs of

infection.


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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

vertigo.


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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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2> Muscular Examination :

Pt. examined for Active trigger point,

Latent trigger point, Taut band, Jump sign

and Twitch response .


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3> Dental Evaluation :

Occlusal Discrepancies.

Attrition. Interferrence in occlusal due to

prosthesis.


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4> Cervical Examination :

Neck muscles are palpated and

range of neck movements areexamined.

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 ofmandible.


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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 ofAlkane vapocoolant.

Clinical or behavioral indications of

Hyperfunction or parafunctions.


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Diagnostic Criteria

3. Possible findings :

TMJ pain.

Joint Sounds. Inflammation.


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Management

The aim of management should be:

1. Control of factors that worsen MPDS.2. Reduction of harmful loading on the joints.

3. Restoration of jaw function.

4. Resumption of regular daily activities.

5. Pain reduction.


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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 .

Soft diet.


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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 stretchmassage .


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Management

Phase II :

To be initiated if Phase onetreatment 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, includingUltrasonic therapy, Electro galvanic stimulation,Transcutaneous Electrical Nerve Stimulation

(TENS).


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Management

Phase IV :

Psychological counseling . Biofeedback.

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