Temporomandibular Joint Injection

Acute or chronic capsulitis

Causes and findings:
• Trauma - often after a car accident or meniscal tear
• Osteoarthritis, poor jaw alignment, nocturnal teeth grinding
• Pain over joint
• Pain on eating, especially hard or large foods
• Headaches
• Painful:
• opening, deviation or protrusion of jaw with asymmetry of movement
• clicking or locking

Equipment:
Syringe - 1ml
Needle - 25G 0.5 inches (16mm) orange
Kenalog 40 - 10 mg
Lidocaine - 0.75 ml 2%
Total volume - 1 ml

Anatomy:
The temporomandibular joint space can be palpated just in front of the ear as the patient opens and closes the mouth. A meniscus lies within the joint and the needle must be placed below this to enter the joint space. The joint can be infiltrated most easily when the jaw is held wide open.

Technique:
• Patient lies on unaffected side with head supported and mouth held open
• Identify and mark joint space
• Insert needle vertically into inferior compartment of joint space below meniscus
• Inject solution as a bolus

Aftercare:
The patient should avoid excessive movement of the jaw such as biting on a large apple or hard food. Gentle active movements and isometric exercises are carried out. A guard to prevent grinding the teeth at night and/or the advice of an orthodontist might be helpful.

Comments:
It might be necessary to manoeuvre the needle about to avoid the meniscus. If the meniscus is displaced, reduction by manipulation should be attempted about 1 week after giving the injection when the inflammation has subsided.