Yonsei Med J.  2016 Nov;57(6):1500-1507. 10.3349/ymj.2016.57.6.1500.

Clinical Signs and Subjective Symptoms of Temporomandibular Disorders in Instrumentalists

• Jang JY
• Kwon JS
• Lee DH
• Bae JH
• Kim ST

• KMID: 2427171
• DOI: http://doi.org/10.3349/ymj.2016.57.6.1500

Abstract

PURPOSE
Most of the reports on instrumentalists' experiences of temporomandibular disorders (TMD) have been reported not by clinical examinations but by subjective questionnaires. The aim of this study was to investigate the clinical signs and subjective symptoms of TMD in a large number of instrumentalists objectively.
MATERIALS AND METHODS
A total of 739 musicians from a diverse range of instrument groups completed a TMD questionnaire. Among those who reported at least one symptom of TMD, 71 volunteers underwent clinical examinations and radiography for diag-nosis.
RESULTS
Overall, 453 participants (61.3%) reported having one or more symptoms of TMD. The most frequently reported symptom was a clicking or popping sound, followed by temporomandibular joint (TMJ) pain, muscle pain, crepitus, and mouth opening limitations. Compared with lower-string instrumentalists, a clicking or popping sound was about 1.8 and 2 times more frequent in woodwind and brass instrumentalists, respectively. TMJ pain was about 3.2, 2.8, and 3.2 times more frequent in upper-string, woodwind, and brass instrumentalists, respectively. Muscle pain was about 1.5 times more frequent in instrumentalists with an elevated arm position than in those with a neutral arm position. The most frequent diagnosis was myalgia or myofascial pain (MFP), followed by disc displacement with reduction. Myalgia or MFP was 4.6 times more frequent in those practicing for no less than 3.5 hours daily than in those practicing for less than 3.5 hours.
CONCLUSION
The results indicate that playing instruments can play a contributory role in the development of TMD.

Keyword

Temporomandibular disorders (TMD); clinical sign; subjective symptom; instrumentalist; arm position

MeSH Terms

Adult
Facial Pain/etiology
Female
Humans
Magnetic Resonance Imaging/methods
Male
*Music
Occupational Diseases/*etiology/physiopathology
Physical Examination
Range of Motion, Articular/*physiology
Sound/*adverse effects
Temporomandibular Joint/*physiopathology
Temporomandibular Joint Disorders/*diagnosis/etiology/physiopathology

Figure

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  Fig. 1 Flow chart of study. TMD, temporomandibular disorders.

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  Fig. 2 Arm position was divided into two groups: neutral arm position (<40° elevation of the arm while playing: clarinet, French horn, bassoon, oboe, cello, double bass) and elevated arm position (≥40° elevation of the arm while playing: flute, trumpet, trombone, violin, viola). Adapted from Nyman, et al. Am J Ind Med 2007;50:370-6.25

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  Fig. 3 Frequency of subjective symptoms in 739 subjects (patients could report more than one subjective symptom). MO, mouth opening; TMJ, temporomandibular joint.

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  Fig. 4 Frequency of clinical diagnoses in 71 subjects (multiple diagnoses per patient were possible). DD w/ R, disc displacement with reduction; DD w/o R, disc displacement without reduction; TMJ, temporomandibular joint; MFP, myofascial pain; TMJ OA, TMJ osteoarthritis; TMJ O, TMJ osteoarthrosis.

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