Temporomandibular disorders – validity of clinical diagnostics compared to magnetic resonance imaging

Background and Purpose. Orthopedic examination techniques of the musculoskeletal system contribute to the successful diagnostics of temporomandibular disorders (TMD). The purpose of this study is to determine the validity of TMD clinical diagnostics by comparing the findings of manual functional analysis (MFA) and the results of MRI of temporomandibular joint (TMJ). The diagnostic significance of limited mouth opening and pain upon passive mouth opening were taken into consideration. Patients and methods. 59 patients with clinical signs and symptoms of TMD were examined consecutively. There was a subgroup comprising 40 patients diagnosed with DD. Clinical diagnoses were made by means of MFA. MRI was the gold standard in the assessment of clinical diagnostics validity, in certain diagnoses of DD (disc displacement ; partial with reduction, complete with reduction, complete without reduction), as well as in the diagnostic significance of limited mouth opening (<40 mm) and pain upon passive mouth opening. Results Validity of MFA in diagnostics of TMD showed maximal sensitivity of 100% and specificity of 57%. Matching of TMD diagnoses between findings of MFA and MRI was 95%. Sensitivity of MFA for certain diagnoses of DD was from 67 to 78%. Lower values were determined for active mouth opening (<40 mm) for certain diagnoses of DD (from 25 to 35%), while the sensitivity for findings of pain in the TMJ on passive mouth opening was 86%. Conclusion. By using compression and joint play technique, the existing clinical diagnostics for specific diagnostics of subgroups as well as for various TMD diagnoses was enhanced.