Temporomandibular joint effusion and its relationship with perceived disability assessed using musculoskeletal ultrasound and a patient-reported disability index

Abstract

The relationship between effusion of the temporomandibular joint (TMJ) and patient-reported disability is poorly researched. This pilot study explored the link between TMJ inflammation as measured by ultrasound and patient disability assessed by the Steigerwald Maher TMD Disability Index (SMTDI). The study design used a prospective correlational approach involving a sample with TMJ dysfunction (TMD). Twenty-four patients were recruited from the European School of Osteopathy and a Kent dental practice. Participants completed the SMTDI to determine the level of TMD (symptomatic score >20). A SonoSite SLA ''Hockey Stick'' [13-6 MHz] musculo-skeletal transducer was placed over the TMJ in a transverse direction and effusion was calculated indirectly by measuring capsular width. An upper left quadrant protocol was used throughout. A regression analysis was run with participants' gender, age and capsular width as predictor variables modelled against reported SMTDI. Larger capsular widths were found to be significant predictors of SMTDI scores (r ¼ 0.803, p < 0.0001). The patient profile matched with the previous studies and the TMD sufferer population, indicating external validity. Results suggest that the SMTDI could be integrated into practice life as a quick, accessible and easy tool to monitor patients' progress and assess levels of inflammation, without the need for repetitive imaging. The study design proved reproducible and a larger scale study is indicated.

Shear Wave Elastography in the Evaluation of Temporomandibular Joint Disorders

“…An assessment of the joint space size, likewise in our study, has recently been proposed as an alternative to the direct method where the medial part of the joint is obscured by skeletal components (Klatkiewicz et al 2018). According to certain authors, the size of the TMJ space correlates to the volume of the exudate (Bas et al 2011;Johnston et al 2015). However, as reported in our present study, the joint space width does not correlate with articular disc stiffness.…”

The Role of Ultrasound in Temporomandibular Joint Disorders: An Update and Future Perspectives

“…A recent study by Johnston et al ( 116 ) explored the link between TMJ inflammation as measured by US and patient disability as assessed by the Steigerwald Maher TMD Disability Index (SMTDI). This is the first study in which capsular width was integrated into a functional disability questionnaire.…”

Can ultrasonography be used to assess capsular distention in the painful temporomandibular joint?

“…Johnston et al assessed the association between TMJ inflammation as measured by ultrasound and patient disability assessed by the Steigerwald Maher TMD Disability Index (SMTDI). The authors reported that greater capsular widths were found to be significant predictors of SMTDI scores [ 3 ]. Although the relationship between functional disability of mandible and capsular width has not been determined in this study, both maximum mouth opening and capsular width significantly correlated with pain scores.…”

“…The symptoms of TMD include muscle and joint pain, TMJ sounds, and limitations in the mandibular movements, often accompanied by tinnitus and headache. Facial pain localized in the TMJ is often attributed to inflammation of the synovium, which causes synovial effusion [ 2 , 3 ]. In general, panoramic radiography, computed tomography (CT), and magnetic resonance imaging (MRI) have been widely employed for diagnostic imaging examinations of the TMJ.…”