History

Symptoms of temporomandibular joint syndrome consist of the following:

Chronic pain in the muscles of mastication described as a dull ache, typically unilateral
Pain may radiate to the ear and jaw and is worsened with chewing
Locking of the jaw when attempting to open the mouth
Ear clicking or popping, usually when displacement of the articular disk is present
Headache and/or neck ache: In some cases, patients may complain of headache without localized pain in the temporomandibular joint
A bite that feels uncomfortable or different from usual
Neck, shoulder, and back pain
Bruxism, teeth clenching
Increasing pain over the course of the day
History of jaw and/or facial trauma

Physical

Characteristic findings on physical examination include the following:

Limitation of jaw opening (normal range is at least 40 mm as measured from lower to upper anterior teeth)
Palpable spasm of facial muscles (masseter and internal pterygoid muscles)
Unilateral facial swelling
Clicking or popping in the TMJ
Tenderness to palpation of the TMJ via the external auditory meatus (the tips of the fingers placed behind the tragi at each external acoustic meatus and pulled forward while the patient opens the jaw)
Crepitus over joint (in advanced disease)
Lateral deviation of mandible

Differential Diagnoses

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Author

Vivian Tsai, MD, MPH, FACEP Assistant Professor of Emergency Medicine, Mount Sinai School of Medicine, Queens Hospital Center

Vivian Tsai, MD, MPH, FACEP is a member of the following medical societies: Alpha Omega Alpha, American College of Emergency Physicians, Phi Beta Kappa

Disclosure: Nothing to disclose.

Coauthor(s)

Richard H Sinert, DO Professor of Emergency Medicine, Clinical Assistant Professor of Medicine, Research Director, State University of New York College of Medicine; Consulting Staff, Vice-Chair in Charge of Research, Department of Emergency Medicine, Kings County Hospital Center

Richard H Sinert, DO is a member of the following medical societies: American College of Physicians, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Steven M Heffer, MD Consulting Staff, Department of Emergency Medicine, Greenwich Hospital

Steven M Heffer, MD is a member of the following medical societies: American College of Emergency Physicians, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Gino A Farina, MD, FACEP, FAAEM Professor of Emergency Medicine, Hofstra North Shore-LIJ School of Medicine at Hofstra University; Program Director, Department of Emergency Medicine, Long Island Jewish Medical Center

Gino A Farina, MD, FACEP, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Herbert S Diamond, MD Visiting Professor of Medicine, Division of Rheumatology, State University of New York Downstate Medical Center; Chairman Emeritus, Department of Internal Medicine, Western Pennsylvania Hospital

Herbert S Diamond, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American College of Rheumatology, American Medical Association, Phi Beta Kappa

Disclosure: Nothing to disclose.

Acknowledgements

Jerome FX Naradzay, MD, FACEP Medical Director, Consulting Staff, Department of Emergency Medicine, Maria Parham Hospital; Medical Examiner, Vance County, North Carolina

Jerome FX Naradzay, MD, FACEP is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Joshua Parnes, MD Resident Physician, Department of Emergency Medicine, Kings County Hospital Center

Disclosure: Nothing to disclose.