International Journal of Recent Advances in Multidisciplinary Topics 16
Volume 5, Issue 6, June 2024
https://www.ijramt.com | ISSN (Online): 2582-7839
Recent Advances in Diagnosis of MPDS – A
Literature Review
Sthitaprajna Lenka1, Susmita Nayak2*, Karan Baruah3, Someswar Chakraborty4,
Anandamay Goswami5, Vijayant Patel6, Avijit Garai7, Jyotiranjan Mohanty8, Pradeep Barik9
1
Professor, Department of Oral & Maxillofacial Surgery, Institute of Dental Sciences, Siksha ‘O’ Anusandhan (Deemed to be University),
Bhubaneswar, Odisha, India
2,3,4,5,6,7,8,9
Post Graduate Student, Department of Oral & Maxillofacial Surgery, Institute of Dental Sciences, Siksha ‘O’ Anusandhan (Deemed
to be University), Bhubaneswar, Odisha, India
Abstract: Myofascial pain is one of the most common disorders clinical symptoms like limitation of mouth opening, clicking
of pain confined to head and neck region which affects the most sound while opening mouth, pain anywhere in head and neck
unique joint in our body i.e., the Temporomandibular joint.
region or pain on palpation of muscles of mastication. Patients
Myofascial pain is a type of pain that gets allude from certain
trigger areas in masticatory musculature to the of head and neck may also have secondary symptoms like nausea, vomiting,
musculature. It is a TMJ disorder with diversified etiological fatigue, weakness, tinnitus, ear pain, blurred vision, etc.
factors like stress, anxiety, mental illness, parafunctional habits,
muscle hyperfunction, sleep disturbances, occlusal prematurities, 2. History
faulty prosthesis or any injuries to the tissues of TMJ. MPDS is
one of the most misdiagnosed and mistreated condition in 1. In 1934, Costen first gave one etiological factor related to
dentistry. A proper history of patient and clinical examinations are occlusion in TMJ. He reported that there is an association of
utmost important for a beneficial treatment of patient suffering sinus pain, ear ache, hearing loss, ringing in ears, altered
from MPDS. The article will provide step by step clinical sense of balance and place, sudden spinning sensation while
examinations and diagnostic criteria’s and treatment planning of moving head and pain in back of the head with MPDS [4].
MPDS.
2. In 1956, Scwartz given the term “TMJ pain dysfunction
Keywords: Myofascial pain, TMJ disorder, Myofascial pain syndrome”. He further state that the symptoms of MPDS are
dysfunction syndrome, Trigger points. due to the masticatory and peri masticatory muscles [5].
3. In 1969, Laskin given the term “myofascial pain
1. Introduction dysfunction syndrome”. He gave a theory called
As the name suggests, it’s a syndrome that means it has got “psychophysiologic theory” which states that the muscles
more than one manifestations, which might include pain and spasm is due to psychological stress and advised few drugs
disturbances in head and neck musculature. It is a type of TMD like tranquilizers and muscle relaxants [6].
which may caused by the muscles surrounding the joint itself. A. History of the Patient
It can be defined as a facial pain disorder in which pain of History of the patient is very necessary to diagnose the cause.
one side of face is allude from the trigger areas in muscles of When a patient comes with a chief complaint of pain in the face
mastication to the head and neck musculature [1]. It should not then questions related to onset, time during which pain
be confused with neuralgic pain, the pain from MPDS is continues, frequency and nature of pain, site and reference area
constant or dull aching when compared to neuralgic pain which of pain, time of the day at which the pain is more severe, factors
is very sharp, spontaneous, shooting and intermittent in nature that relieve and aggravates the pain and symptoms associated
[2]. to it along with it any history of previous trauma or any
There are a wide variety of etiological factors which may prolonged dental work are also asked.
lead to pain in masticatory and peri masticatory musculature Patient’s psychological assessment should be taken which
which may include certain psychological factors like stress, include sleeping habits, para-functional habits, family or
mental illness, anxiety that results in altered chewing pattern or emotional problems.
there may be any parafunctional habits or stress relieving habits
like tongue thrusting, bruxism, lip smacking. Sleep 3. Physical Examinations
disturbances can also contribute to the cause of myofascial pain.
Other etiological factors may include occlusal prematurities or A. General Examination Like Vital Signs
any faulty prosthesis [3]. In order to rule out any other pathological condition vital
Patients suffering from MPDS may face various primary signs are important. Hypertension may also be a cause of
Lenka et al. International Journal of Recent Advances in Multidisciplinary Topics, VOL. 5, NO. 6, JUNE 2024 17
headache in some patients. Elevated body temperature may also while doing these functions then medial pterygoid
results in certain systemic infections. If the condition of pain muscle may be involved.
cannot be discovered and unexplained vital signs like blood v) SCM – Although it is not directly taking part in
pressure, pulse rate, body temperature and respiration rate mandibular movements but trigger points or source of
should be examined pain found in this muscle and refer pain to temporal
and ear area. The full length of this muscle should be
B. Clinical Examination of TMJ
palpated from its attachment to the mastoid process
i) Range of motion – The inter-incisal distance of normal down to clavicle.
individual is around 40mm to 50mm. Pain along with Posterior cervical muscle or the back of the neck like
limited active range of motion indicates structural muscular attachment in the occipital region, slenius capitis,
disturbance but range of motion is limited passively trapezius may also be involved.
then it leads to restricted movements which suggest
muscle problems. D. Dental/Occlusal Evaluation
ii) Direction of opening – A deviation is due to disk If there is any open bite in anterior region, any cross bite,
derangement in one or both joints and a deflection decreased vertical dimension, Attrited tooth, tooth mobility,
occurs when the movement is restricted in one joint wear facets, any missing teeth should be checked. Kind of
which may suggest muscle problems. malocclusion, dentofacial or any skeletal deformities should be
iii) Palpation of TMJ – It is done to determine pain or checked.
tenderness of TMJ. Palpation of both the joints
E. Examination of Cervical Region
simultaneously while opening and closing the jaw is
done. The posterior portion of the joint is also palpated To check whether the source of pain is muscular or vertebral
while mouth is fully open, it is done to determine any in origin, careful investigation of pain and limitation of
inflammation of ear. movement is necessary. When limited range of movement is
present and the patient can stretch it to a greater range passively,
C. Muscular Examination the source is muscular in origin (known as soft end feel). If the
It is helpful for locating muscle pathology, evaluating muscle patient is having any vertebral problem, then the patient cannot
tone, locating trigger points, evaluating temperature change, stretch to a greater range normally (known as hard end feel).
locating any swelling and identifying anatomical landmarks.
i) Temporalis muscle – Anterior region, middle region 4. Diagnosis
and posterior region of temporalis muscle over the A provisional diagnosis of MPDS is made when no other
temporal fossa at the side of the head is palpated for clinically detectable organic lesion can be found to account for
involvement of pain. Intraoral palpation of the tendon the patient’s symptoms and signs.
of temporalis is done by moving the finger over
anterior border of the ramus till the coronoid process A. Other Diagnostic Criteria’s
and the tendon of temporalis attachment are felt. There 1. Trigger points injection – The source of pain is also be
are some TMDs which can develop a tendonitis of determined by muscular injection. A therapeutic effect
temporalis that can cause muscle pain and the pain can can also be produced, example, local anaesthetic
referred to the retro-orbital region. injection into the trigger areas, can lead to relief of
ii) Muscle of Masseter – The deep part of masseter pain, even if the anaesthetic solution is metabolized. If
muscle is palpated over the zygomatic arch at its trigger point is suspected, it is injected with L.A and
superior attachment and the superficial part of will lead to relief of pattern of pain referral. 0.5cc of
masseter muscle is palpated over the mandibular lower L.A (without epinephrine) is injected. Lignocaine or
border. If pain is felt by doing this palpation, then bupivacaine can also be given for long term
masseter muscle is involved. therapeutic effect.
iii) Functional manipulation of lateral pterygoid – In case 2. Nerve block injection – It can also be given for the
of inferior part of lateral pterygoid muscle, force is diagnosis of myofascial pain. To determine whether a
applied by the examiner and the patient is asked to structure which is painful is actually a source of pain
protrude against this force and in case of superior part or a site, diagnostic nerve blocks are very useful. If
of lateral pterygoid muscle, two tongue blades are giving the injection is mainly for diagnostic purpose,
placed bilaterally and the patient is asked to bite on a short acting L.A agent should be given without a
these tongue blades. If the patient witness any kind of vasoconstrictor.
pain while doing these functional manipulation then 3. Auriculotemporal nerve block – By taking routine
the lateral pterygoid is involved. aseptic measures, preparation of preauricular area is
iv) Medial pterygoid – In this case the patient is asked to done. Insertion of 26-27g needle is done little anterior
clench the teeth together, widely open the mouth, to the junction of earlobe and the tragus over the skin.
protrude the mandible against resistance and bite on Advancement of needle behind the posterior portion of
the separators. If the patient witness any kind of pain the condyle is done in an antero-medial way to total
Lenka et al. International Journal of Recent Advances in Multidisciplinary Topics, VOL. 5, NO. 6, JUNE 2024 18
depth of 1cm and 1.5cc of L.A solution is deposited history should be taken, proper clinical examination of the
after checking aspiration. The pain will get eliminated patient should be done which may include palpation of TMJ,
within 5minutes if the true source of pain is joint itself. palpation of masticatory and peri-masticatory musculature. If
Infraorbital nerve block can also be used. required further examination should be done like; giving trigger
point injection and nerve block injection to arrive at a precise
B. Examination of Radiographs
diagnosis of MPDS and further conservative treatment should
To diagnose the pathologies of intra-articular disk, pathology be started accordingly.
of bone and pathology of soft tissue, radiographic examinations
are very useful. References
1. OPG – It is done for evaluating the TMJ on both sides,
[1] Goran Jecmenica, “Save Yourself from Trigger Points & Myofascial Pain
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