Prediction of TMJ arthralgia according to clinical diagnosis and MRI findings.
OBJECTIVE
The aim of this study was to investigate the ability of clinical and magnetic resonance imaging (MRI) diagnoses to predict pain in the temporomandibular joint (TMJ).


METHODS
One hundred forty-nine patients were examined by 2 calibrated examiners in strict accordance with the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). All patients who presented with a defined clinical RDC/TMD diagnosis were included and underwent bilateral coronal and sagittal MRI of the TMJ. Two raters blinded to the clinical diagnosis interpreted the MRI scans for TMJ pathology. The results were tested against the clinical diagnosis according to the RDC/TMD, including pain-related disability and psychosocial status, for associations to TMJ arthralgia using logistic regression analysis (GENMOD procedure, P < .05).


RESULTS
MRI-depicted anatomic changes, such as joint effusions, disc displacement, and osteoarthrosis, were not significantly correlated with the presence of pain in the TMJ. However, a significant relationship between pain on palpation of the masseter muscle origin (P = .0050) and psychosocial factors (P = .0452) and pain in the TMJ was demonstrated.


CONCLUSIONS
Pain in the TMJ caused by the anatomic proximity of the muscle masseter origin and the lateral TMJ pole and the possible existence of trigger points in the musculature may lead to a false-positive or a false-negative diagnosis of arthralgia. Additionally, clinicians must consider the psychosocial aspects of pain in ideal treatment planning.
Ohlmann
Brigitte
B
Department of Prosthodontics, University of Heidelberg, Heidelberg, Germany. Brigitte_Ohlman@med.uni-heidelberg.de
Rammelsberg
Peter
P
Henschel
Volkmar
V
Kress
Bodo
B
Gabbert
Olaf
O
Schmitter
Mark
M
D000293:Adolescent; D000328:Adult; D000368:Aged; D018771:Arthralgia / Q000175:diagnosis* / Q000523:psychology; D003863:Depression / Q000523:psychology; D005157:Facial Pain / Q000175:diagnosis; D005188:False Negative Reactions; D005189:False Positive Reactions; D005260:Female; D005544:Forecasting; D006801:Humans; D004204:Joint Dislocations / Q000175:diagnosis; D008279:Magnetic Resonance Imaging; D008297:Male; D008406:Masseter Muscle / Q000503:physiopathology; D008875:Middle Aged; D015588:Observer Variation; D010003:Osteoarthritis / Q000175:diagnosis; D010173:Palpation; D016059:Range of Motion, Articular / Q000502:physiology; D016037:Single-Blind Method; D013001:Somatoform Disorders / Q000523:psychology; D019224:Temporomandibular Joint Disc / Q000503:physiopathology; D013705:Temporomandibular Joint Disorders / Q000175:diagnosis* / Q000523:psychology