This Article Abstract Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Saved Citations Download to citation manager Request Permissions Request Reprints Add to My Marked Citations Citing Articles Citing Articles via Google Scholar Citing Articles via Scopus Google Scholar Articles by Shaefer, J.R. Articles by Anderson, Q.N. Search for Related Content PubMed PubMed Citation Articles by Shaefer, J.R. Articles by Anderson, Q.N. Social Bookmarking                         What's this?

Pressure-Pain Thresholds and MRI Effusions in TMJ Arthralgia

Departments of Diagnostic and Surgical Sciences

D.L. Jackson

Restorative Sciences, University of Minnesota, School of Dentistry, Minneapolis, MN

E.L. Schiffman

Departments of Diagnostic and Surgical Sciences

Q.N. Anderson

Department of Radiology, Hennepin County Medical Center, Minneapolis, MN

It has been suggested that MRI-depicted effusions identify patients with TMJ arthralgia. The Research Diagnostic Criteria (RDC) propose a pressure-pain threshold (PPT) of 1 pound for the identification of TMJ arthralgia. The hypotheses in this study were that: (1) there is no association between MRI-depicted effusions and TMJ arthralgia, and (2) a PPT of 1 pound does not discriminate between subjects with and those without arthralgia. Thirty females with TMJ disc displacement with reduction were divided into two groups based on the presence or absence of the self-report of TMJ pain. Bilateral TMJ PPTs and MRIs were obtained. Increasing palpation pressure from 1 to 3 pounds increased the sensitivity for identifying arthralgia from 22% to 100%, with a corresponding decrease in the specificity from 100% to 81%. The sensitivity and specificity of effusions for identifying arthralgia were 85% and 28%, respectively. These results suggest that the use of palpation pressures greater than 1 pound is a valid test for TMJ arthralgia. However, TMJ effusions lack adequate specificity for identifying TMJ arthralgia and were not associated with pain.

Key Words: temporomandibular joint (TMJ) arthralgia • effusions • magnetic resonance imaging (MRI) • pressure-pain threshold (PPT) • and Research Diagnostic Criteria for Temporomandibular Joints (RDC).

REFERENCES

• Adame C., Monje F., Munoz M., Martin-Granizo R. (1998). Effusion in magnetic resonance imaging of the temporomandibular joint: a study of 123 joints. J Oral Maxillofac Surg 56:314-318.[CrossRef][Medline] [Order article via Infotrieve]
• Anderson G., Schiffman E., Schellhas K., Fricton J. (1989). Clinical vs. arthrographic diagnosis of TMJ internal derangement. J Dent Res 68:826-829.
• Cholitgul W., Nishiyama H., Sasai T., Uchiyama Y., Fuchihata H., Rohlin M. (1997). Clinical and magnetic resonance imaging findings in temporomandibular joint disc displacement. Dentomaxillofac Radiol 26:183-188.[Abstract]
• Cohen M. (1996). Arthralgia and myalgia. In: Pain 1996-an updated review. Campbell JN, editor. Seattle: IASP Press, pp. 327-337.
• Drace J., Enzmann D. (1990). Defining the temporomandibular joint: closed, partially open, and open mouth MR imaging of asymptomatic subjects. Radiology 177(1):67-71.[Abstract/Free Full Text]
• Dworkin S., LeResche L. (1992). Research diagnostic criteria for temporomandibular disorders: review, criteria, examinations, and specifications, critique. J Cranio Mandib Dis Fac Oral Pain 6:301-355.
• Fricton J. (1991). Chronic orofacial pain. In: Advances in pain research and therapy. Portenoy R, Laska E, editors. Vol. 18. New York: Raven Press, pp. 375-389.
• Fricton J., Nelson A., Monsein M. (1987). IMPATH: microcomputer assessment of behavioral and psychosocial factors in craniomandibular arthropathy. Cranio 5:372-381.[Medline] [Order article via Infotrieve]
• Kircos L., Ortendahl D., Mark A., Arakawa M. (1987). Magnetic resonance imaging of the TMJ disc in asymptomatic volunteers. J Oral Maxillofac Surg 45:852-854.[Medline] [Order article via Infotrieve]
• Liedberg J., Panmekiate S., Petersson A., Rohlin M. (1996). Evidence-based evaluation of three imaging methods for the temporomandibular disc. Dentomaxillofac Radiol 25:234-241.[Abstract]
• Murakami K., Nishida M., Bessho K., Iizuka T., Tsuda Y., Konishi J. (1996). MRI evidence of high signal intensity and temporomandibular arthralgia and relating pain. Does high signal correlate to the pain? Br J Oral Maxillofac Surg 34:220-224.[Medline] [Order article via Infotrieve]
• Raustia A., Pyhtinen J., Pemu H. ( 1994). Clinical, magnetic-resonance imaging and surgical findings in patients with temporomandibular joint disorder-a survey of 47 patients. Rofo Fortschr Geb Rontgenster Neuen Bildgeb Verfahr 160:406-411.
• Ribeiro R., Tallents R., Katzberg R., Murphy W., Moss M., Magalhaes A., et al. (1997). The prevalence of disc displacement in symptomatic and asymptomatic volunteers aged 6 to 25 years. J Orofac Pain 11:37-47.[Medline] [Order article via Infotrieve]
• Schellhas K., Wilkes C. (1989). TMJ inflammation: comparison of MR fast scanning with T1 and T2 weighted imaging techniques. Am J Roentgenol 153:93-98.[Abstract/Free Full Text]
• Schiffman E., Fricton J., Haley D., Tylka D. (1988). A pressure algometer for myofascial pain syndrome: reliability and validity testing. In: Dubner R, Gebhart GF, Bond MR, editors. Proceedings of the Fifth World Congress on Pain. New York: Elsevier.
• Schiffman E., Anderson G., Fricton J., Burton K., Schellhas K. (1989). Diagnostic criteria for intraarticular TM disorders. Community Dent Oral Epidemiol 17:252-257.[Medline] [Order article via Infotrieve]
• Schiffman E., Fricton J., Haley D., Shapiro B. (1990). The prevalence and treatment needs of subjects with temporomandibular disorders. JAm Dent Assoc 120:295-303.
• Ware JE Jr (1987). Standards for validating health measures: definition and content. J Chron Dis 40:473-480.[CrossRef][Medline] [Order article via Infotrieve]
• Westesson P., Brooks S. (1992). Temporomandibular joint: relationship between MR evidence of effusion and the presence of pain and disk displacement. Am J Radiol 159:559-563.[Abstract/Free Full Text]

Journal of Dental Research, Vol. 80, No. 10, 1935-1939 (2001)
DOI: 10.1177/00220345010800101401


CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter    What's this?

This Article Abstract Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Saved Citations Download to citation manager Request Permissions Request Reprints Add to My Marked Citations Citing Articles Citing Articles via Google Scholar Citing Articles via Scopus Google Scholar Articles by Shaefer, J.R. Articles by Anderson, Q.N. Search for Related Content PubMed PubMed Citation Articles by Shaefer, J.R. Articles by Anderson, Q.N. Social Bookmarking                         What's this?