Palpation and Pressure Pain Threshold: Reliability and Validity in Patients with Temporomandibular Disorders

Abstract

This study assessed the interexaminer reliability and validity of palpation (PA) and pressure pain threshold (PPT) of the temporomandibular joint (TMJ) and the masseter and temporalis muscles in patients with temporomandibular disorders (TMD) and asymptomatic controls. Eighty (80) subjects were distributed into two groups: Group 1 consisted of 40 TMD patients with muscular and joint pain selected by RDC/TMD Axis I; and Group 2 (control) with 40 asymptomatic individuals. Training and calibration of examiners was undertaken prior to testing. Mean reliability values were 0.64 and 0.78 (PPT), and 0.59 and 0.75 (PA), for patients and controls, respectively. Results showed statistically significant differences (p<0.001), for PA and PPT among TMD patients compared with the control. The results also showed acceptable specificity values (above 0.90), although sensitivity had low values. The tests had low diagnostic validity to discriminate between patients and controls, with low positive predictive values (PPV).

The role of the clinical examination in management of temporo-mandibular and cervical disorders

“…Examiners can reproduce such muscular pain by digital pressure that can be objectified in a calibration that is quite important because it will, to a great extent, determine the result of the test 11 .…”

“…But reproducibility between operators is no better than average except for the trapezius muscle. • Posterior muscles The principle posterior muscles to be palpated are: -semispinal: in in its superior, medial, and inferior cervical portions -scapular elevator muscle: at its insertion on the supero-medial angle of the scapula 11 and at the center of the scapula 29 ; -splenius of the neck: at its insertion on the lateral surface vertebra T4;…”

“…It is difficult to compare the results of studies on muscular and joint palpation because the methods, the sites, and the pressures exerted vary between the teams that carried out exams [8][9][10][11] .…”

Efeito de exercícios motores orofaciais e laserterapia nos sintomas de desordem temporomandibular e funções orofaciais

“…A dificuldade para padronizar a pressão aplicada com os dedos, bem como fazer um julgamento adequado da resposta do paciente que geralmente é classificada de 0 a 3, pode resultar no diagnóstico de falso-positivos e falso-negativos (Gomes et al, 2008).…”

Funções orofaciais em portadores de síndrome de Sjögren

“…Apesar de ser descrito variabilidade neste exame decorrente das diferentes técnicas dos examinadores, localização dos pontos a serem palpados e taxa de pressão, tem se mostrado útil para avaliar a sensibilidade muscular à dor (Gomes et al, 2008;Chaves et al, 2010) (Ohrbach et al, 2013;Schiffman et al, 2014). Também podem os músculos submentais e o tendão do músculo temporal (Chaves et al, 2010).…”