Can Temporomandibular Joint (TMJ) dysfunction cause trigger tenderness and tenderness around the lower jaw and preauricular area?

TMJ Dysfunction and Tenderness Patterns

Yes, TMJ dysfunction characteristically causes tenderness over the affected TMJ joint itself and pain radiating to the periauricular area, temple, and neck, with patients demonstrating tenderness on examination of the TMJ. 1

Clinical Presentation of TMJ Dysfunction

The American Academy of Otolaryngology-Head and Neck Surgery explicitly identifies TMJ syndrome as perhaps the most common cause of referred otalgia (ear pain), with a characteristic pattern of symptoms that includes: 1

• Pain not only in the ear but also radiating to the periauricular area, temple, or neck 1
• Tenderness over the affected TMJ on examination 1
• Associated crepitus (clicking or grating sounds) may be present 1

Key Examination Findings

When examining a patient with suspected TMJ dysfunction, you should specifically assess for: 2

• Regional pain in the face and preauricular area 2
• Limitations in jaw movement 2
• Noise from the TMJs during jaw movements 2
• Tenderness on palpation of the TMJ and masticatory muscles 1
• Muscle hypertrophy and trigger points in muscles of mastication 1

Historical Features That Support TMJ Diagnosis

The American Academy of Otolaryngology-Head and Neck Surgery notes that patients often have: 1

• History of gum chewing 1
• Bruxism (teeth grinding) 1
• Recent dental procedure with subsequent malocclusion 1

Important Clinical Pitfall

A critical caveat: otalgia (ear pain) in the absence of swelling of the ear canal and without apparent middle ear disease should arouse suspicion of pathology outside the ear, with TMJ syndrome being the most common cause. 1 However, in older patients with tobacco and alcohol use history, or younger patients with human papillomavirus infection, upper aerodigestive tract cancer must be excluded with complete head and neck examination. 1

Prevalence and Impact

TMD affects up to 15% of adults and 7% of adolescents, with chronic pain being the overwhelming reason patients seek treatment. 2 As many as one-third of adults report having one or more TMD symptoms, which include jaw or neck pain, headache, and clicking or grating within the joint. 3

Examination Technique

The British Journal of Anaesthesia recommends specific examination components: 1

• Palpation of muscles of mastication for tenderness and trigger points 1
• Assessment of temporomandibular joint movement including crepitus 1
• Evaluation of muscle hypertrophy 1
• Cranial nerve examination 1