Evaluation and management of temporomandibular disorders. Part 1: an orthopedic physical therapy update on examination and clinical reasoning.

Temporomandibular (TM) disorders afflict many people globally and, despite the presence of existing peer-reviewed material that assists conservative orthopedic providers, recent advances in knowledge indicate that updated resources are required for students, clinicians, and educators. This two-part series builds off previously published material to present newer supplementary information that can be useful during the evaluation and management processes. Content in Part 1 of this series includes a discussion about the factors that have been shown to contribute to TM disorders, an updated perspective of relevant pain science, a discussion of self-report outcome measures, and various different topics related to the examination of patients with TM disorders. Part 2 addresses information related to the temporomandibular joint disc, joint hypermobility, oral splints, and clinical reasoning. In combination with other available publications, this two-part series provides clinicians an opportunity to improve their delivery of effective and efficient clinical services for people diagnosed with TM disorders.

Evaluation and management of temporomandibular disorders. Part 2: an orthopaedic physical therapy update on examination and clinical reasoning.

Temporomandibular (TM) disorders afflict many people globally and, despite the presence of existing peer-reviewed material that assists conservative orthopedic providers, recent advances in knowledge indicate that updated resources are required for students, clinicians, and educators. This two-part series builds off previously published material to present newer supplementary information that can be useful during the evaluation and management processes. Content in Part 1 of this series includes a discussion about the factors that have been shown to contribute to TM disorders, an updated perspective of relevant pain science, a discussion of self-report outcome measures, and various different topics related to the examination of patients with TM disorders. Part 2 addresses information related to the temporomandibular joint disc, joint hypermobility, oral splints, and clinical reasoning. In combination with other available publications, this two-part series provides clinicians an opportunity to improve their delivery of effective and efficient clinical services for people diagnosed with TM disorders.

The role of sleep dysfunction in temporomandibular onset and progression: A systematic review and meta-analyses.

BACKGROUND: Painful temporomandibular (TM) disorders result in 4.3 billion dollars spent annually in the United States. The complex interplay of physiological processes in persistent pain and dysfunctional sleep has been established. Recently, dysfunctional sleep has been identified as a potential pathway to the onset of painful TM disorder. OBJECTIVES: The aims were to (1) identify self-report outcome measures (SROMs) of sleep quality that are clinimetrically sound in patients with painful TM disorders and (2) determine whether sleep dysfunction has any diagnostic or prognostic value for this population. METHODS: A systematic search following PRISMA guidelines was run in six databases: CINAHL, Dental, PsychALL, PubMed, Scopus and Web of Science. Any study involving minors was excluded. Risks of biases were examined in all studies. Diagnostic pooled findings were reported. RESULTS: Of the identified articles (n = 681), 18 were included in this systematic review (n = 1 clinimetric studies, n = 11 diagnostic studies, n = 6 prognostic studies). Nine different assessment tools were used; only the Pittsburg Sleep Quality Index (PSQI) has been validated in patients with painful TM disorders. Overall, sleep dysfunction was diagnostic for painful TM disorders. The pooled relative risk of sleep dysfunction was 1.71 (95% CI 1.30. 2.26). When PSQI scores were greater than 5/21, the unadjusted hazard ratio for development of painful TM disorders was reported to be 2.1. CONCLUSION: At present, the only SROM that has diagnostic and prognostic value in evaluating and managing patients with painful TM disorders is the PSQI.

Radiological variables associated with progression of femoroacetabular impingement of the hip: a systematic review.

OBJECTIVES: Femoroacetabular impingement is gaining increased recognition as a cause of hip dysfunction. Of great concern is its potential association with labral tears and osteoarthritis. This systematic review examines the evidence regarding radiographic variables associated with the progression of femoroacetabular impingement. DESIGN: Systematic review. METHODS: Articles were selected following a comprehensive search of PubMed, CINAHL, SportDiscus, Embase, and Medline databases from database inception through October 2012. Inclusion criteria involved (1) estimates of the association between prognostic variables and progression of femoroacetabular impingement, (2) prospective or retrospective design, (3) patients diagnosed with femoroacetabular impingement based on established criteria, (4) the outcome of interest was radiologic and/or clinical progression of femoroacetabular impingement, and (5) access to the full text. Two independent reviewers assessed the methodological quality of each study and the association between prognostic variables and femoroacetabular impingement progression. RESULTS: Thirteen articles met the inclusion criteria; nine were considered to be of high quality. Moderate evidence of progression of femoroacetabular impingement to labral pathology was associated with increased alpha angle. Moderate evidence for their lack of association with progression of FAI was associated with alpha angle with respect to development of osteoarthritis, acetabular index, center edge angle, coxa profunda, coxa vara, and pistol grip deformity. CONCLUSIONS: There is moderate evidence that increased alpha angle at baseline is associated with progression of femoroacetabular impingement to labral tear. Moderate evidence suggests a lack of association between other radiographic variables and progression of femoroacetabular impingement.