Sault Josiah D, Emerson Kavchak Alicia J, Tow Nancy, Courtney Carol A
a Department of Outpatient Physical Therapy , University of Illinois Hospital and Health Sciences System , Chicago , IL , USA .
c Fellowship in Orthopedic Manual Physical Therapy , University of Illinois at Chicago , Chicago , IL , USA.
Cranio. 2016 Mar;34(2):124-32. doi: 10.1179/2151090314Y.0000000039.
Temporomandibular disorders (TMD) encompass a variety of dysfunction of the maxillofacial region. A strong relationship between TMD and cervical spine pain exists, and widespread hyperalgesia is common in TMD. This case describes the management and reduction in regional hyperalgesia in a patient with chronic TMD.
A 23-year-old female with a 10-year history of tinnitus and bilateral (B) jaw pain, and 5-year history of intermittent neck pain, presented with pain, which could reach 10/10 on the numeric pain rating scale, locking, tightness and restricted eating habits. Cervical motion testing did not reproduce her jaw pain. Her mouth opening (MO) and B temporomandibular joint (TMJ) accessory glides were limited and painful. Accessory glides at the upper cervical facet joints reproduced her jaw pain. Pressure pain thresholds (PPT) at her B masseters and thenar eminences at the hand were diminished, indicating hyperalgesia.
Treatment included passive mobilizations at her TMJs and cervical spine. Home exercises included self-mobilization of her TMJs and neck. In six sessions, her MO improved from 30 to 45 mm and average pain improved from 4/10 to 0/10. The jaw pain and function questionnaire improved from 16/52 to 5/52. PPTs at her right/left masseter and thenar eminence improved from 140/106 and 221/230 kPa to 381/389 and 562/519 kPa, respectively.
This case described the treatment and reduction of upper extremity hyperalgesia of a patient with chronic jaw and neck pain. Manual therapy may be a valuable intervention in the treatment of chronic TMD with distal hyperalgesia.
颞下颌关节紊乱病（TMD）包括多种颌面区域功能障碍。TMD与颈椎疼痛之间存在密切关系，广泛的痛觉过敏在TMD中很常见。本病例描述了一名慢性TMD患者局部痛觉过敏的管理及减轻情况。
一名23岁女性，有10年耳鸣和双侧颌部疼痛病史，5年间歇性颈部疼痛病史，现出现疼痛，数字疼痛评分量表上可达10分，伴有锁颌、紧绷感及饮食习惯受限。颈椎活动度检查未诱发其颌部疼痛。她的张口度（MO）及双侧颞下颌关节（TMJ）附属滑动受限且疼痛。上颈椎小关节的附属滑动诱发了她的颌部疼痛。双侧咬肌和手部鱼际肌的压痛阈值（PPT）降低，提示痛觉过敏。
治疗包括对其颞下颌关节和颈椎进行被动松动术。家庭锻炼包括自我松动颞下颌关节和颈部。经过6次治疗，她的张口度从30毫米提高到45毫米，平均疼痛从4分降至0分。颌部疼痛与功能问卷评分从16/52提高到5/52。右侧/左侧咬肌和鱼际肌的PPT分别从140/106千帕和221/230千帕提高到381/389千帕和562/519千帕。
本病例描述了一名慢性颌部和颈部疼痛患者上肢痛觉过敏的治疗及减轻情况。手法治疗可能是治疗伴有远端痛觉过敏的慢性TMD的一种有价值的干预措施。
