Surface electromyography of jaw muscles and kinesiographic recordings: diagnostic accuracy for myofascial pain
Summary The present investigations attempted to assess the diagnostic accuracy of commercially available surface electromyography (sEMG) and kinesiography (KG) devices for myofascial pain of jaw muscles. Thirty‐six (n = 36) consecutive patients with a research diagnostic criteria for temporomandibu...
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Published in | Journal of oral rehabilitation Vol. 38; no. 11; pp. 791 - 799 |
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Main Authors | , , , , , |
Format | Journal Article |
Language | English |
Published |
Oxford, UK
Blackwell Publishing Ltd
01.11.2011
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Subjects | |
Online Access | Get full text |
ISSN | 0305-182X 1365-2842 1365-2842 |
DOI | 10.1111/j.1365-2842.2011.02218.x |
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Abstract | Summary The present investigations attempted to assess the diagnostic accuracy of commercially available surface electromyography (sEMG) and kinesiography (KG) devices for myofascial pain of jaw muscles. Thirty‐six (n = 36) consecutive patients with a research diagnostic criteria for temporomandibular disorders (RDC/TMD) axis I diagnosis of myofascial pain and an age‐ and sex‐matched group of 36 TMD‐free asymptomatic subjects underwent sEMG and KG assessments to compare EMG parameters of the masseter and temporalis muscles as well as the jaw range of motion and the interarch freeway space. EMG data at rest were not significantly different between myofascial pain patients and asymptomatic subjects, while the latter achieved significantly higher levels of EMG activity during clenching tasks. Symmetry of muscle activity at rest and during clenching tasks, KG parameters of jaw range of motion and the measurement of the interarch vertical freeway did not differ between groups. Receiver operating characteristics curve analysis showed that, except EMG parameters during clenching tasks, all the other outcome sEMG and KG measures did not reach acceptable levels of sensitivity and specificity, with a 30·6–88·9% percentage of false‐positive results. Therefore, clinicians should not use sEMG and KG devices as diagnostic tools for individual patients who might have myofascial pain in the jaw muscles. Whether intended as a stand‐alone measurement or as an adjunct to making clinical decisions, such instruments do not meet the standard of reliability and validity required for such usage. |
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AbstractList | The present investigations attempted to assess the diagnostic accuracy of commercially available surface electromyography (sEMG) and kinesiography (KG) devices for myofascial pain of jaw muscles. Thirty-six (n = 36) consecutive patients with a research diagnostic criteria for temporomandibular disorders (RDC/TMD) axis I diagnosis of myofascial pain and an age- and sex-matched group of 36 TMD-free asymptomatic subjects underwent sEMG and KG assessments to compare EMG parameters of the masseter and temporalis muscles as well as the jaw range of motion and the interarch freeway space. EMG data at rest were not significantly different between myofascial pain patients and asymptomatic subjects, while the latter achieved significantly higher levels of EMG activity during clenching tasks. Symmetry of muscle activity at rest and during clenching tasks, KG parameters of jaw range of motion and the measurement of the interarch vertical freeway did not differ between groups. Receiver operating characteristics curve analysis showed that, except EMG parameters during clenching tasks, all the other outcome sEMG and KG measures did not reach acceptable levels of sensitivity and specificity, with a 30·6-88·9% percentage of false-positive results. Therefore, clinicians should not use sEMG and KG devices as diagnostic tools for individual patients who might have myofascial pain in the jaw muscles. Whether intended as a stand-alone measurement or as an adjunct to making clinical decisions, such instruments do not meet the standard of reliability and validity required for such usage. Summary The present investigations attempted to assess the diagnostic accuracy of commercially available surface electromyography (sEMG) and kinesiography (KG) devices for myofascial pain of jaw muscles. Thirty‐six (n = 36) consecutive patients with a research diagnostic criteria for temporomandibular disorders (RDC/TMD) axis I diagnosis of myofascial pain and an age‐ and sex‐matched group of 36 TMD‐free asymptomatic subjects underwent sEMG and KG assessments to compare EMG parameters of the masseter and temporalis muscles as well as the jaw range of motion and the interarch freeway space. EMG data at rest were not significantly different between myofascial pain patients and asymptomatic subjects, while the latter achieved significantly higher levels of EMG activity during clenching tasks. Symmetry of muscle activity at rest and during clenching tasks, KG parameters of jaw range of motion and the measurement of the interarch vertical freeway did not differ between groups. Receiver operating characteristics curve analysis showed that, except EMG parameters during clenching tasks, all the other outcome sEMG and KG measures did not reach acceptable levels of sensitivity and specificity, with a 30·6–88·9% percentage of false‐positive results. Therefore, clinicians should not use sEMG and KG devices as diagnostic tools for individual patients who might have myofascial pain in the jaw muscles. Whether intended as a stand‐alone measurement or as an adjunct to making clinical decisions, such instruments do not meet the standard of reliability and validity required for such usage. The present investigations attempted to assess the diagnostic accuracy of commercially available surface electromyography (sEMG) and kinesiography (KG) devices for myofascial pain of jaw muscles. Thirty-six (n = 36) consecutive patients with a research diagnostic criteria for temporomandibular disorders (RDC/TMD) axis I diagnosis of myofascial pain and an age- and sex-matched group of 36 TMD-free asymptomatic subjects underwent sEMG and KG assessments to compare EMG parameters of the masseter and temporalis muscles as well as the jaw range of motion and the interarch freeway space. EMG data at rest were not significantly different between myofascial pain patients and asymptomatic subjects, while the latter achieved significantly higher levels of EMG activity during clenching tasks. Symmetry of muscle activity at rest and during clenching tasks, KG parameters of jaw range of motion and the measurement of the interarch vertical freeway did not differ between groups. Receiver operating characteristics curve analysis showed that, except EMG parameters during clenching tasks, all the other outcome sEMG and KG measures did not reach acceptable levels of sensitivity and specificity, with a 30·6-88·9% percentage of false-positive results. Therefore, clinicians should not use sEMG and KG devices as diagnostic tools for individual patients who might have myofascial pain in the jaw muscles. Whether intended as a stand-alone measurement or as an adjunct to making clinical decisions, such instruments do not meet the standard of reliability and validity required for such usage.The present investigations attempted to assess the diagnostic accuracy of commercially available surface electromyography (sEMG) and kinesiography (KG) devices for myofascial pain of jaw muscles. Thirty-six (n = 36) consecutive patients with a research diagnostic criteria for temporomandibular disorders (RDC/TMD) axis I diagnosis of myofascial pain and an age- and sex-matched group of 36 TMD-free asymptomatic subjects underwent sEMG and KG assessments to compare EMG parameters of the masseter and temporalis muscles as well as the jaw range of motion and the interarch freeway space. EMG data at rest were not significantly different between myofascial pain patients and asymptomatic subjects, while the latter achieved significantly higher levels of EMG activity during clenching tasks. Symmetry of muscle activity at rest and during clenching tasks, KG parameters of jaw range of motion and the measurement of the interarch vertical freeway did not differ between groups. Receiver operating characteristics curve analysis showed that, except EMG parameters during clenching tasks, all the other outcome sEMG and KG measures did not reach acceptable levels of sensitivity and specificity, with a 30·6-88·9% percentage of false-positive results. Therefore, clinicians should not use sEMG and KG devices as diagnostic tools for individual patients who might have myofascial pain in the jaw muscles. Whether intended as a stand-alone measurement or as an adjunct to making clinical decisions, such instruments do not meet the standard of reliability and validity required for such usage. |
Author | MANFREDINI, D. FERRONATO, G. COCILOVO, F. TONELLO, S. GUARDA-NARDINI, L. FAVERO, L. |
Author_xml | – sequence: 1 givenname: D. surname: MANFREDINI fullname: MANFREDINI, D. organization: TMD Clinic, Department of Maxillofacial Surgery – sequence: 2 givenname: F. surname: COCILOVO fullname: COCILOVO, F. organization: School of Dentistry, University of Padova, Padua Italy – sequence: 3 givenname: L. surname: FAVERO fullname: FAVERO, L. organization: School of Dentistry, University of Padova, Padua Italy – sequence: 4 givenname: G. surname: FERRONATO fullname: FERRONATO, G. organization: TMD Clinic, Department of Maxillofacial Surgery – sequence: 5 givenname: S. surname: TONELLO fullname: TONELLO, S. organization: TMD Clinic, Department of Maxillofacial Surgery – sequence: 6 givenname: L. surname: GUARDA-NARDINI fullname: GUARDA-NARDINI, L. organization: TMD Clinic, Department of Maxillofacial Surgery |
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References | Lund JP, Widmer CG, Feine JS. Validity of diagnostic and monitoring tests used for temporomandibular disorders. J Dent Res. 1995;74:1133-1143. Cooper BC. Parameters of an optimal physiological state of the masticatory system: the results of a survey of practitioners using computerized measurement devices. Cranio. 2004;22:220-233. Dworkin SF, Leresche L, DeRouen T, von Korff MR. Assessing clinical signs of temporomandibular disorders: reliability of clinical examiners. J Prosthet Dent. 1990;63:574-579. Okeson JP. Management of temporomandibular disorders and occlusion, 6th edn. St Louis: Elsevier-Mosby, 2008. Suvinen TI, Kemppainen P. Review of clinical EMG studies related to muscle and occlusal factors in healthy and TMD subjects. J Oral Rehabil. 2007;34:631-644. Dworkin SF, Leresche L. Research diagnostic criteria for temporomandibular disorders: review, criteria examinations and specifications, critique. J Craniomandib Disord Fac Oral Pain. 1992;6:301-355. Manfredini D, Tognini F, Zampa V, Bosco M. Predictive value of clinical findings for temporomandibular joint effusion. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2003;96:521-526. Koh KJ, List T, Petersson A, Rohlin M. Relationship between clinical and magnetic resonance imaging diagnoses and findings in degenerative and inflammatory temporomandibular joint diseases: a systematic literature review. J Orofac Pain. 2009;23:123-139. Manfredini D, Guarda-Nardini L. Ultrasonography of the temporomandibular joint: a literature review. Int J Oral Maxillofac Surg. 2009;38:1229-1236. Metz CE. Basic principles of ROC analysis. Sem Nuc Med. 1978;8:283-298. Jankelson B, Radke J. The myomonitor: its use and abuse. Quintessence Int Dent Digest. 1978;9:35-39, 47-52. Leeflang MM, Deeks JJ, Gatsonis C, Bossuyt PM; Cochrane Diagnostic Test Accuracy Working Group. Systematic reviews of diagnostic test accuracy. Ann Intern Med. 2008;149:889-897. Suvinen TI, Malmberg J, Forster C, Kemppainen P. Postural and dynamic masseter and anterior temporalis muscle EMG repeatability in serial assessments. J Oral Rehabil. 2009;36:814-820. Palla S, Farella M. External validity: a forgotten issue? Int J Prosthodont. 2010;23:293-294. Cooper BC, Kleinberg I. Establishment of temporomandibular physiological state with neuromuscular orthosis treatment affects reduction of TMD symptoms in 313 patients. Cranio. 2008;26:104-117. Steenks MH, de Wijer A. Validity of the research diagnostic criteria for temporomandibular disorders axis I in clinical and research settings. J Orofac Pain. 2009;23:9-16. Bodéré C, Téa SH, Giroux-Metges MA, Woda A. Activity of masticatory muscles in subjects with different orofacial pain conditions. Pain. 2005;116:33-41. De Leeuw R. The American Academy of Orofacial Pain. Orofacial pain: guidelines for assessment, diagnosis, and management. Chicago: Quintessence Publishing, 2008. Klasser GD, Okeson J. The clinical usefulness of surface electromyography in the diagnosis and treatment of temporomandibular disorders. J Am Dent Assoc. 2006;137:763-771. Manfredini D, Guarda-Nardini L. Agreement between research diagnostic criteria for temporomandibular disorders and magnetic resonance diagnoses of temporomandibular disc displacement in a patient population. Int J Oral Maxillofac Surg. 2008;37:612-616. Dao TTT, Feine JS, Lund JP. Can electrical stimulation be used to establish a physiologic occlusal position? J Prosthet Dent. 1988;60:509-514. Manfredini D, Piccotti F, Ferronato G, Guarda-Nardini L. Age peaks of different RDC/TMD diagnoses in a patient population. J Dent. 2010;38:392-399. Tartaglia GM, Moreira Rodrigues da Silva MA, Bottini S, Sforza C, Ferrario VF. Masticatory muscle activity during maximum voluntary clench in different research diagnostic criteria for temporomandibular disorders (RDC/TMD) groups. Man Ther. 2008;13:434-440. McNeill C. Management of temporomandibular disorders: concepts and controversies. J Prosthet Dent. 1997;77:510-522. Ahmad M, Hollender L, Anderson Q, Kartha K, Ohrbach R, Truelove EL et al. Research diagnostic criteria for temporomandibular disorders (RDC/TMD): development of image analysis criteria and examiner reliability for image analysis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009;107:844-860. Lund JP, Donga R, Widmer CG, Stohler CS. The pain-adaptation model: a discussion of the relationship between chronic musculoskeletal pain and motor activity. Can J Physiol Pharmacol. 1991;69:683-694. Jankelson B. Neuromuscular aspects of occlusion: effects of occlusal position on the physiology and dysfunction of the mandibular musculature. Dent Clin North Am. 1979;23:157-168. Mohl ND. Reliability and validity of diagnostic modalities for temporomandibular disorders. Adv Dent Res. 1993;7:113-119. Petersson A. What you can and cannot see in TMJ imaging - an overview related to the RDC/TMD diagnostic system. J Oral Rehabil. 2010;37:771-778. Ohrbach R. Disability assessment in temporomandibular disorders and masticatory system rehabilitation. J Oral Rehabil. 2010;37:452-480. Murray GM, Peck CC. Orofacial pain and jaw muscle activity: a new model. J Orofac Pain. 2007;21:263-278. Svensson P, Wang K, Sessle BJ, Arendt-Nielsen L. Associations between pain and neuromuscular activity in the human jaw and neck muscles. Pain. 2004;109:225-232. Castroflorio T, Bracco P, Farina D. Surface electromyography in the assessment of jaw elevator muscles. J Oral Rehabil. 2008;35:638-645. 2009; 23 1993; 7 1995; 74 2004; 22 2010; 38 2010; 37 2010 2005; 116 2008; 37 2008 2006 2008; 13 2008; 35 2008; 149 2004; 109 2006; 137 2007; 34 2003; 96 1978; 8 1978; 9 1992; 6 2010; 23 1990; 63 2009; 36 1979; 23 1991; 69 1997; 77 2008; 26 2009; 107 2007; 21 1988; 60 2009; 38 |
References_xml | – reference: Klasser GD, Okeson J. The clinical usefulness of surface electromyography in the diagnosis and treatment of temporomandibular disorders. J Am Dent Assoc. 2006;137:763-771. – reference: Bodéré C, Téa SH, Giroux-Metges MA, Woda A. Activity of masticatory muscles in subjects with different orofacial pain conditions. Pain. 2005;116:33-41. – reference: Suvinen TI, Malmberg J, Forster C, Kemppainen P. Postural and dynamic masseter and anterior temporalis muscle EMG repeatability in serial assessments. J Oral Rehabil. 2009;36:814-820. – reference: Palla S, Farella M. External validity: a forgotten issue? Int J Prosthodont. 2010;23:293-294. – reference: Manfredini D, Tognini F, Zampa V, Bosco M. Predictive value of clinical findings for temporomandibular joint effusion. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2003;96:521-526. – reference: Leeflang MM, Deeks JJ, Gatsonis C, Bossuyt PM; Cochrane Diagnostic Test Accuracy Working Group. Systematic reviews of diagnostic test accuracy. Ann Intern Med. 2008;149:889-897. – reference: Manfredini D, Guarda-Nardini L. Agreement between research diagnostic criteria for temporomandibular disorders and magnetic resonance diagnoses of temporomandibular disc displacement in a patient population. Int J Oral Maxillofac Surg. 2008;37:612-616. – reference: Lund JP, Widmer CG, Feine JS. Validity of diagnostic and monitoring tests used for temporomandibular disorders. J Dent Res. 1995;74:1133-1143. – reference: Jankelson B, Radke J. The myomonitor: its use and abuse. Quintessence Int Dent Digest. 1978;9:35-39, 47-52. – reference: Manfredini D, Guarda-Nardini L. Ultrasonography of the temporomandibular joint: a literature review. Int J Oral Maxillofac Surg. 2009;38:1229-1236. – reference: Petersson A. What you can and cannot see in TMJ imaging - an overview related to the RDC/TMD diagnostic system. J Oral Rehabil. 2010;37:771-778. – reference: Ahmad M, Hollender L, Anderson Q, Kartha K, Ohrbach R, Truelove EL et al. Research diagnostic criteria for temporomandibular disorders (RDC/TMD): development of image analysis criteria and examiner reliability for image analysis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009;107:844-860. – reference: Dworkin SF, Leresche L, DeRouen T, von Korff MR. Assessing clinical signs of temporomandibular disorders: reliability of clinical examiners. J Prosthet Dent. 1990;63:574-579. – reference: De Leeuw R. The American Academy of Orofacial Pain. Orofacial pain: guidelines for assessment, diagnosis, and management. Chicago: Quintessence Publishing, 2008. – reference: Suvinen TI, Kemppainen P. Review of clinical EMG studies related to muscle and occlusal factors in healthy and TMD subjects. J Oral Rehabil. 2007;34:631-644. – reference: Cooper BC. Parameters of an optimal physiological state of the masticatory system: the results of a survey of practitioners using computerized measurement devices. Cranio. 2004;22:220-233. – reference: Metz CE. Basic principles of ROC analysis. Sem Nuc Med. 1978;8:283-298. – reference: Cooper BC, Kleinberg I. Establishment of temporomandibular physiological state with neuromuscular orthosis treatment affects reduction of TMD symptoms in 313 patients. Cranio. 2008;26:104-117. – reference: Svensson P, Wang K, Sessle BJ, Arendt-Nielsen L. Associations between pain and neuromuscular activity in the human jaw and neck muscles. Pain. 2004;109:225-232. – reference: Dao TTT, Feine JS, Lund JP. Can electrical stimulation be used to establish a physiologic occlusal position? J Prosthet Dent. 1988;60:509-514. – reference: Jankelson B. Neuromuscular aspects of occlusion: effects of occlusal position on the physiology and dysfunction of the mandibular musculature. Dent Clin North Am. 1979;23:157-168. – reference: Dworkin SF, Leresche L. Research diagnostic criteria for temporomandibular disorders: review, criteria examinations and specifications, critique. J Craniomandib Disord Fac Oral Pain. 1992;6:301-355. – reference: Mohl ND. Reliability and validity of diagnostic modalities for temporomandibular disorders. Adv Dent Res. 1993;7:113-119. – reference: Castroflorio T, Bracco P, Farina D. Surface electromyography in the assessment of jaw elevator muscles. J Oral Rehabil. 2008;35:638-645. – reference: Murray GM, Peck CC. Orofacial pain and jaw muscle activity: a new model. J Orofac Pain. 2007;21:263-278. – reference: Tartaglia GM, Moreira Rodrigues da Silva MA, Bottini S, Sforza C, Ferrario VF. Masticatory muscle activity during maximum voluntary clench in different research diagnostic criteria for temporomandibular disorders (RDC/TMD) groups. Man Ther. 2008;13:434-440. – reference: Steenks MH, de Wijer A. Validity of the research diagnostic criteria for temporomandibular disorders axis I in clinical and research settings. J Orofac Pain. 2009;23:9-16. – reference: Koh KJ, List T, Petersson A, Rohlin M. Relationship between clinical and magnetic resonance imaging diagnoses and findings in degenerative and inflammatory temporomandibular joint diseases: a systematic literature review. J Orofac Pain. 2009;23:123-139. – reference: Okeson JP. Management of temporomandibular disorders and occlusion, 6th edn. St Louis: Elsevier-Mosby, 2008. – reference: Manfredini D, Piccotti F, Ferronato G, Guarda-Nardini L. Age peaks of different RDC/TMD diagnoses in a patient population. J Dent. 2010;38:392-399. – reference: Ohrbach R. Disability assessment in temporomandibular disorders and masticatory system rehabilitation. J Oral Rehabil. 2010;37:452-480. – reference: McNeill C. Management of temporomandibular disorders: concepts and controversies. J Prosthet Dent. 1997;77:510-522. – reference: Lund JP, Donga R, Widmer CG, Stohler CS. The pain-adaptation model: a discussion of the relationship between chronic musculoskeletal pain and motor activity. Can J Physiol Pharmacol. 1991;69:683-694. – volume: 9 start-page: 35 year: 1978 end-page: 39 article-title: The myomonitor: its use and abuse publication-title: Quintessence Int Dent Digest – volume: 26 start-page: 104 year: 2008 end-page: 117 article-title: Establishment of temporomandibular physiological state with neuromuscular orthosis treatment affects reduction of TMD symptoms in 313 patients publication-title: Cranio – volume: 77 start-page: 510 year: 1997 end-page: 522 article-title: Management of temporomandibular disorders: concepts and controversies publication-title: J Prosthet Dent – volume: 37 start-page: 612 year: 2008 end-page: 616 article-title: Agreement between research diagnostic criteria for temporomandibular disorders and magnetic resonance diagnoses of temporomandibular disc displacement in a patient population publication-title: Int J Oral Maxillofac Surg – volume: 107 start-page: 844 year: 2009 end-page: 860 article-title: Research diagnostic criteria for 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Snippet | Summary The present investigations attempted to assess the diagnostic accuracy of commercially available surface electromyography (sEMG) and kinesiography... The present investigations attempted to assess the diagnostic accuracy of commercially available surface electromyography (sEMG) and kinesiography (KG) devices... |
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SubjectTerms | Adult Case-Control Studies electromyography Electromyography - methods Facial Pain - diagnosis Facial Pain - physiopathology Female Humans kinesiography Male Masseter Muscle - physiopathology Musculoskeletal Pain - diagnosis Musculoskeletal Pain - physiopathology myofascial pain Range of Motion, Articular Reproducibility of Results research diagnostic criteria for temporomandibular disorders surface electromyography Temporal Muscle - physiopathology temporomandibular disorders Temporomandibular Joint Disorders - diagnosis Temporomandibular Joint Disorders - physiopathology |
Title | Surface electromyography of jaw muscles and kinesiographic recordings: diagnostic accuracy for myofascial pain |
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