Q&A: Arthrocentesis May Provide Temporary Relief for Sufferers of TMJ Pain
Q: Does arthrocentesis provide relief from TMJ symptoms?
A:Let's start with definitions of the terms in your question.
Arthrocentesis is a minor medical procedure in which a needle is inserted into a joint. This procedure is usually performed to remove fluid from a joint in order to relieve pressure or to run tests on the fluid to determine why it's there. In addition, a needle inserted into a joint can be used to inject medications into the joint to relieve symptoms. The knee is the most common site for arthrocentesis. Other terms for this are joint aspiration or joint tap, both of which refer to removing fluid from a joint.
TMJ is an abbreviation for temporomandibular joint, the joint that allows jaw motion. Pain in this joint or nearby structures is common. It's often called TMJ syndrome, but goes by other names such as the TMJ dysfunction syndrome, or the TMJ myofascial pain syndrome.
Causes of TMJ syndrome include nighttime jaw clenching or teeth grinding, degenerative joint disease, cartilage damage in the joint, and jaw alignment problems. Stress is also thought to play a role in many cases.
Specialists treating TMJ pain, such as dentists and oral surgeons, will usually recommend a thorough dental evaluation and medications to relieve pain. Jaw exercises and wearing a mouth guard can help in many cases. For those who continue to have significant symptoms (especially if associated with limited jaw movement), arthrocentesis may provide at least temporary relief.
TMJ arthrocentesis is considered minor surgery and may be performed under general anesthesia. More extensive surgery may be offered as a last resort, and only when there is a surgically correctible cause.
During arthrocentesis, a number of options may be considered:
Removing joint fluid if any is present
Injecting a novocaine-type anesthetic
Injecting fluid to “wash out” the joint or to attempt to restore normal placement of a “slipped disc” in the joint
A combination of these may be performed. For instance, fluid may be removed, followed by the injection of a steroid/anesthetic mix. In addition, other medications, including hyaluronic acid, morphine and botulinum toxin have occasionally been injected into the TMJ with reports of success. Research studies to date are not conclusive about how effective they are or whether one is routinely better than another. There is also no reliable way to predict who will benefit most from TMJ arthrocentesis.
Whenever possible, the treatment of TMJ syndrome should be directed by its cause. For example, people with rheumatoid arthritis should have therapy directed at the disease while people who grind their teeth at night may find relief with a mouth guard worn at night. Until the role of TMJ arthrocentesis is better defined, people with TMJ syndrome should review all of their options with their health care providers. It may take time and some “trial and error” to identify an effective treatment.
Robert Shmerling, M.D., is associate physician and clinical chief of rheumatology at Beth Israel Deaconess Medical Center and an associate professor in medicine at Harvard Medical School. He is an active teacher in the Internal Medicine Residency Program, serving as the Robinson Firm Chief. He is also a teacher in the Rheumatology Fellowship Program and has been a practicing rheumatologist for more than 25 years.
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