Mpds (Myofacial pain dysfunction syndrome)
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MYOFACIAL PAIN DYSFUNCTION SYNDROME
SHAHBAZ ALAMSATYABAMA DENTAL COLLEGE
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MPDS is a pain disorder, in which unilateral pain is referred from the trigger points in myofacial structures, to the muscles of head and neck.
DEFINITION
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These are localized tender areas within taut bands of skeletal muscles when stimulated by macro- micro traumatic episodes
TRIGGER POINTS
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30 % of population suffers
Female- male ratio is 3:1
Age group – 15-40 years
EPIDEMIOLOGY
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ETIOLOGY
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All Etiological factors leads to micro or macro trauma to musculoskeletal system leading to muscle spasm
This hyper tonicity may lead to muscle fatigue and accumulation of metabolic byproducts such as Lactic acid, prostaglandins, bradykinins, histamine
The accumulation of these chemical pain mediators, lowers pain threshold to mechanical and chemical stimuli leading to MPDS.
PATHOPHYSIOLOGY
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Spasm of lateral pterygoid muscle
Spasm of elevator muscles
Spasm of lateral pterygoid and elevator muscles
CLASSIFICATION
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Cardinal symptoms of MPDS
CLINICAL FEATURES
Pain or discomfort
Limited motion of the jaw
Joint noises- Clicking, snapping
Tenderness to palpation of the muscles of mastication
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Associated symptoms of MPDS
NeurologicTingling
NumbnessBlurred vision
TwitchesLacrimation
OtologicTinnitusEar painDizzinessVertigo
Diminished hearing
Gastrointestinal tractNausea
VomitingDiarrhea
ConstipationDry mouth
MusculoskeletalFatigueTension
TirednessWeaknessJoint pain
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Various masticatory muscles and their clinical effects
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Laskins Diagnostic criteria
Four cardinal signs
• Unilateral pain• Muscles tenderness• Clicking- clicking or popping noise in the TMJ• Limitation of jaw movement
Negative characteristics
• No radiographic evidence• No tenderness in TMJ area on palpation via the external
auditory meatus
Diagnosis
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1.Articular or TMJ function
2.Palpation for tenderness
3.Grading of click or crepitation
Physical Examination
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Range of motion
a)Vertical opening – check for hypo mobility( Normal range for an adult is 40-50
mm)
b) Deviation while opening and closing
c) Protrusive deviation and movement – normal range is 10mm
d) Lateral excursion – Normal range is 10mm
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Palpation for tenderness
The area responsive to palpation are called
“Trigger points”.
The muscles are palpated bilaterally and
simultaneously with firm but gentle pressure
lasting for 1-2 mins
Middle finger is used for palpation
For larger area adjacent fingers can be used.
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Grading of click
• Early , immediate or wide open zones of
condylar excursion are noted
• It should be noted whether the sound is on
opening , closing or both.
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Resistance test
Opening Protrusion Left excursion Right excursion
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MANAGEMENT
Goal of treatment :• 1.TrP inactivation• 2.Prevention of recurrence• 3.Correction of perpetuating factors
Prognosis depends on :• Correct diagnosis• Early and proper treatment• Acute MPS good prognosis
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• To educate and empower patients to understand and manage the symptoms of MPDS and to regain and maintain normal function with as much independence as possible
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Follow – 7 R’s for occlusal rehabilitation
1.Remove - extract2.Reshape - grind3.Reposition - orthodontia4.Restore – conservative dentistry5.Replace - prosthesis6.Reconstruct – TMJ surgery7.Regulate – control habit and symptoms
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Pharmacotherapy
Pain control – mainly used analgesics Salicylates (aspirin 2 tabs 0.3-
0.6 gm/4 hourly)
Tranquilizers – provides calming effect in anxiety state and relieves
tension, fear and produces a sense of well being (Diazepam 2-5 mg at
bedtime)
Antidepressants – these are mood elevators like lithium carbonate
and caffeine
Sedatives & Hypnotics – reduces excitement and produces sleep
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PHYSICAL MEDICATION
Tongue exercise Mouth opening exerciseHot packs
Ultrasound
Massage
Electrical stimulation (TENS)
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ANESTHESIA•Muscle and fascia (trigger point)
•TMJ (Intracapsular and extracapsular) – 0.5 ml of 0.5% Xylocaine in conjugation with injection of hydrocortisone
•Refrigerated spray – vapocoolant spray, such as ethyl chloride or fluoromethane is used to reduce muscle spasm
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Other therapies
Hypnotherapy – here patient cooperation is must and should follow hypnotist suggestions. It provides muscle relaxation
Acupuncture – it is a simple, effective and conservative pain control modality. But this therapy is used only to give relief from pain and will not remove basic cause.
Surgery – various surgical procedures like eminectomy, zygomectomy, menisectomy, high condylectomy are advocated.
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