Muscle exams are a very important part of our new patient examination process. There are several muscles that we look at, and it's in the Dawson Diagnostic Wizard ®. And they're very important to know if they're sore, and what is it telling us.
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We start off with the temporalis muscle.
Now, key point, when were doing the muscle exam, use three fingers to help when you're pressing, and press firmly. Don't press lightly. So temporalis, often, these muscles are sore when there's an occlusal muscle disorder. Many patients of ours have temporal headaches that can be corrected by occlusal equilibration. So for the temporalis, remember that it extends. The region is on the lateral third of the orbit of the eye. So pain behind the eye can indicate a temporal headache and extends to the top of our scalp.
We move to the masseters, superficial and deep.
Soreness there can indicate displacement of the same side condyle from Centric Relation to MI. Often, in our full-face photos, you'll see somebody with enlarged masseters which could possibly indicate a strong clencher or bruxer. Soreness here often can be corrected by occlusal equilibration. One key point to note, though, is that if somebody has a strong bruxing habit, we can reduce the soreness and protect the teeth, but they still may be bruxing.
Now we move into the hyoid muscles.
That is where I go from the masseters, the hyoid muscles and the digastrics, which are here around the neck. Often, these muscles engage when a patient has to displace from CR to MI in a protrusive manner. These muscles engage to provide relief and aid the lateral pterygoid muscles. One key point to note too is that these muscles can cause us to position our head forward. This often can cause soreness in our sternocleidomastoids, the occipital muscles, and the trapezius muscles. A key point, though, is to not have tunnel vision because soreness of these muscles may also indicate cervical misalignments, and you may have to refer to a physical therapist.
Now we go to lateral pterygoid muscles, which we all know very well.
Looking at both the superior and inferior muscles. One way to test if they're sore is to have them protrude their jaw forward, and resist them for about eight seconds. And then ask them, is there any tenderness in front of the ears or behind their eyes. Often, if there's soreness there, again, the lateral pterygoid muscle can become in spasm when the jaw has displaced forward or displaced left or right. So these muscles can become very sore. So this test will help to determine that.
Another way, too, is bimanual manipulation. If there's soreness there, or tension, or tenderness, it can indicate muscle bracing. So if you do an anterior deprogrammer and the tension or tenderness goes away, often, that can indicate then it's the lateral pterygoid muscle that is sore.
At this point, I take my gloves off, and I go into the internal part of the exam.
And really, the only muscle that we can palpate internally is the medial pterygoid muscle. I palpate it just apical to where I place my mandibular block when I'm doing anesthesia. So I palpate there. And just like the masseters and the temporalis, if there's soreness in these muscles, it can indicate displacement of the same side condyle. Hopefully, this will help you when you're doing your examination in terms of knowing what sore muscles can cause.