Correlation of clinical parameters to the arthrographic depiction of temporomandibular joint internal derangements

This prospective clinical investigation of 188 patients with signs and symptoms of temporomandibular joint (TMJ) pain and dysfunction examines the correlation between clinical signs and symptoms versus the arthrographic characteristics of intracapsular disease related to displacement of the meniscus. An attempt has been made to establish which specific clinical signs and symptoms, as determined by arthrography, best predict the condition of the joint. Our findings suggest that most of the clinical signs and symptoms are not sufficiently reliable in themselves to permit prediction of the condition of the meniscus. Those clinical parameters that did show a strong correlation were tested in combinations using stepwise discriminant analysis to evaluate clinical tendencies. Thus, patients with normal meniscal position and function were often noted to have normal mandibular ranges of movement, no joint noises on opening and closing of the jaw, and no tomographic evidence of degenerative joint disease. Subjects with meniscal displacement with reduction were often found to have joint clicking, deviation of the jaw upon opening, and an absence of degenerative joint disease by multidirectional tomography. Patients who had meniscal displacement without reduction were often found to have limitation in jaw movement, crepitation on opening and closing of the jaw, and associated degenerative changes on multidirectional tomograms. If specific treatment plans are to be tailored for different stages of TMJ internal derangements, clinical findings alone or clinical findings in conjunction with plain radiographs of the TMJ are not consistently accurate.