This protocol applies to temporomandibular joint syndrome in the context of arthrogenous temporomandibular disorder (TMD) — where the pathology is primarily joint-based rather than muscular. Management of this subtype differs from myogenous TMD and carries specific contraindications.
The preceding treatment line added conservative adjunctive interventions, including manual therapy, therapeutic exercise and movement re-education, and cognitive behavioural therapy, alongside analgesics for acute exacerbation.
This protocol is indicated when those measures have not achieved decreased pain and increased range of jaw movement and function — the defined goals for that line. Failure to reach these targets triggers escalation to the current step.
When the conservative measures above have not achieved the required targets, the protocol moves to a procedure-based adjunct: intra-articular injection of the TMJ within the context of surgical TMJ procedures. The specific injectable options available and the evidence supporting each differ — the complete, structured regimen is available via the full protocol.
Neuromodulatory agents have not been shown to be beneficial for arthrogenous TMD sub diagnoses and their use in such situations is not advocated.
There is evidence building for the use of hyaluronic acid as an intra-articular injection in surgical TMJ procedures (e.g., arthrocentesis).
Evidence for the beneficial effects of intra-articular corticosteroid injection is weak.
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