Thursday, July 24, 2014

I have TMD

As of yesterday, I have a temporal mandibular disorder (TMD).  I've included a work up because it may be helpful for others to see how I work up a case.

"I've been working 6 days a week, 10+ hour days, and my responsibilities have increased (with no increase in pay, and more bills to pay).  I'm having a dull ache on opening on the right side, but is fine at rest.  There are no joint noises noted.  My right jaw muscle is sore to touch.  I can open, but it hurts to open all the way,  Chewing makes it worse."

My thinking sequence:

1. What is affected?
         The Temporal Mandibular joint is comprised of nerve, muscles, and a joint.  Each type of injury will manifest differently.

2. What caused it?
          Masking pain is bad.
Removing the cause of pain is ideal.
Diagnosis is key.

3. What do we do about it?
          The best situation is to create conditions for optimal healing.  Often times, the best treatment is nothing. 
         Merely managing pain is a second resort, and only for various severe circumstances.  Pain pills, muscle relaxants, and surgery all have side effects.

Okay.  Hete's my work up:
1. What is affected?   
+Muscle, specifically right masseter.   
     The area is tender to the touch.
     There is a soft end feel---max opening is possible, but with effort.  Think of forceful over stretching a cramped muscle.
+There are no joint noises, possible indications of osteoarthritis. 
+The pain is only during function, ruling out nerve damage (constant pain, no pain)

What caused it?
-no trauma noted.
-no fever noted, ruling out infection/inflammation
-no medications were noted, thus ruling out inflammation 
+ elevated stress was indicated.  
        Because of the muscle pain was likely from elevated stress, the cause of pain is likely psychosomatic.  This is fairly common in today's society with more stress.

What do I do about it?
+ The cause is psychosomatic.
+ In my case, I need to reduce my stress, exercise, and relax more. 

I hope that this is been helpful for you. Thank you for checking out my blog.