Association between arthralgia and imaging findings of effusion in the temporomandibular joints
Mahmoud, Ruba Faisal Ghazi
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The temporomandibular joint (TMJ) complex consists of the condyle, articular eminence, and articular disc. This disc divides the intracapsular components of the joint into upper and lower joint spaces. Magnetic resonance imaging (MRI) is considered the reference standard for soft tissue diagnosis of the TMJ. One aim of the study was to identify if an association exists between arthralgia of the TMJ and MRI identified joint effusion. The clinical significance of identifying the presence of TMJ effusion on MRI lies in its potential association with inflammation, clinically assessed as pain at the lateral TMJ pole or around the pole area. Unfortunately the literature has been divided in asserting whether pain in the joint area is associated with the presence of MRI assessed effusion. A systematic review of the literature was unable to provide conclusive evidence for or against an association between TMJ pain and effusion. Materials and methods: Clinical and imaging findings from 336 joints were obtained from a historical cohort involving individuals with temporomandibular disorders. Two by two tables of association were used to determine if clinical signs associated with arthralgia were associated with the presence of ipsilateral effusion in the TMJ. These clinical signs included pain on range of motion (maximum unassisted and assisted opening as well as excursive movements), TMJ manipulation (compression and translation), and palpation of the lateral pole of the TMJ and around the TMJ pole. In addition, a total pain score (range 0-7) was created which represented the sum of positive responses to pain on any of the clinical range of motion tests. Statistical testing included the T-test to test for possible association of joint effusion with any pain to these clinical measures. Results: Statistical tests of association between joint effusion and range of motion, excursions, protrusion, joint manipulation and palpation all had p values > .05. Conclusion: The results suggest that there is no statistically significant association between an MRI diagnosis of joint effusion and TMJ arthralgia.