title: Temporomandibular joint pain: relationship to internal derangement type, osteoarthrosis, and synovial fluid mediator level of tumor necrosis factor-alpha.
abstract: OBJECTIVE
  The purpose of this study was to investigate whether patients with temporomandibular joint (TMJ)-related pain classified as capsulitis/synovitis may be linked to magnetic resonance imaging (MRI) findings of internal derangement, osteoarthrosis, or the synovial fluid aspirate findings of tumor necrosis factor-alpha (TNF-alpha) level.
  
  
  METHODS
  The study comprised 23 patients with temporomandibular disorders (TMD), who had nonchronic pain (pain onset < or =6 months) and a unilateral TMJ-related diagnosis of capsulitis/synovitis. Bilateral sagittal and coronal magnetic resonance images were obtained to establish the presence or absence of internal derangement, osteoarthrosis, or both. TMJ synovial fluid aspirates were obtained from the pain and contralateral nonpain sides to determine the TNF-alpha level.
  
  
  RESULTS
  Comparison of the TMJ side-related data showed a significant relationship between the clinical TMD diagnosis of capsulitis/synovitis and the MRI diagnoses of TMJ internal derangement (P =.002) and of TMJ internal derangement type (P =.04). The mean TNF-alpha level in synovial fluid aspirates from TMJs assigned a clinical TMD diagnosis of capsulitis/synovitis was significantly higher than in those obtained from contralateral nonpain sides (P =.001). There was no correlation between the clinical diagnosis of capsulitis/synovitis and the MRI diagnosis of TMJ osteoarthrosis (P =.13) or between the MRI diagnosis of TMJ osteoarthrosis and that of TMJ internal derangement (P =.70) or TMJ internal derangement type (P =.33).
  
  
  CONCLUSIONS
  The results suggest that the TMJ pain condition of capsulitis/synovitis is related to TMJ-side specific MRI diagnoses of internal derangement and internal derangement type, and synovial fluid aspirate findings of TNF-alpha level. The data confirm the concept of elevated mediator level as a diagnostic approach for patients presenting with TMJ-related pain. MRI and synovial fluid aspirates may be used as diagnostic methods for evaluating TMJ-related pain conditions.
authors.affiliation: University of Innsbruck, Department of Oral and Maxillofacial Surgery, Austria. Maxillofaziale-Chirurgie@uibk.ac.at
authors.forename: R
authors.initials: R
authors.lastname: Emshoff
authors.forename: P
authors.initials: P
authors.lastname: Puffer
authors.forename: A
authors.initials: A
authors.lastname: Rudisch
authors.forename: R
authors.initials: R
authors.lastname: Gassner
mesh_terms: D000293:Adolescent; D000328:Adult; D016009:Chi-Square Distribution; D005157:Facial Pain / Q000209:etiology*; D005260:Female; D006801:Humans; D017746:Joint Capsule / Q000276:immunology; D004204:Joint Dislocations / Q000150:complications / Q000175:diagnosis*; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D010003:Osteoarthritis / Q000150:complications / Q000175:diagnosis; D019152:Paracentesis; D018709:Statistics, Nonparametric; D013582:Synovial Fluid / Q000737:chemistry / Q000276:immunology; D013585:Synovitis / Q000150:complications / Q000175:diagnosis* / Q000276:immunology; D019224:Temporomandibular Joint Disc / Q000473:pathology; D013705:Temporomandibular Joint Disorders / Q000150:complications / Q000175:diagnosis*; D014409:Tumor Necrosis Factor-alpha / Q000032:analysis
chemical_list: D014409:Tumor Necrosis Factor-alpha