MRI necessary to diagnose TMJ?

[Mstiles]

Hello everyone,

I’ve got PMR/GCA, currently on 17.25 mg pred down from 40 in January.

I Recently developed jaw problems chewing on the right side. My bite is off. GP said it was TMJ not related to the GCA. she ordered a facial CT scan. The radiologist messaged back that wouldn’t show the jaw, so she ordered an MRI as requested.

Long story short, I have tinnitus, much worse since the illness, and the noise was unbearable, couldn’t handle it. I’ve had lots of good suggestions from the forum about how to get through it, but it is just an extra stress.

Can just an X-ray show what’s going on? Do I need really need an MRI?

[PMRpro Ambassador]

What's wrong with having an MRI? x-rays show bone stuff - MRIs will show the other stuff.

"Temporomandibular joint (TMJ) dysfunction is a common condition that is best evaluated with magnetic resonance (MR) imaging. The first step in MR imaging of the TMJ is to evaluate the articular disk, or meniscus, in terms of its morphologic features and its location relative to the condyle in both closed- and open-mouth positions. Disk location is of prime importance because the presence of a displaced disk is a critical sign of TMJ dysfunction. However, disk displacement is also frequently seen in asymptomatic volunteers, so that other findings may be required to help make the diagnosis. These findings include thickening of an attachment of the lateral pterygoid muscle, rupture of retrodiskal layers, and joint effusion and can serve as indirect early signs of TMJ dysfunction. It is important for the radiologist to detect early MR imaging signs of dysfunction, thereby avoiding the evolution of this condition to its final stage, an advanced and irreversible phase that is characterized by osteoarthritic changes such as condylar flattening or osteophytes. Further studies conducted with the latest MR imaging techniques will allow a better understanding of the sources of TMJ pain and of any discrepancy between imaging findings and patient symptoms."

[Mstiles in reply to PMRpro]

Thank you for the detailed info. Explains everything. I don’t have much confidence in my GP, she didn’t know what to order?

[PMRpro Ambassador in reply to Mstiles]

TBH I doubt many GPs would know which was best - and it wouldn't occur to most to look it up even if it isn't particularly difficult to find the info. Or you pick up the phone and call the local radiology department. But as that extract says - better sooner than later to avoid the potential long term problems.

[Maisie1958]

Hello Mstiles - hope you get through your MRI this time. I had MRI/MRA of head several weeks ago and was extremely worried about coping- best advice I had was to close my eyes before going in and keeping them closed. Also remembering it was open both ends. My heart was certainly pounding initially but honestly towards the end I was relaxed and risked opening my eyes! The operator also told me what was going on and how long each particular scan/view would take and rattled through very efficiently-I had been informed it would take an hour but was probably out in 35minutes. She wasn’t particularly chatty but just got on with it which suited me. I’m sure she would have given more time between views if I had wanted -so worthwhile having a bit of a discussion before starting? I was being investigated for Pulsatile Tinnitus and although the scan was very noisy it didn’t make the tinnitus worse after, though other people have said it did theirs. Fortunately nothing found but now waiting for appointment for MRA of neck. Apparently my scanner was one of the newer wider ones and bright white inside. I know some places have open ones (you are in the USA aren’t you) -I’m not sure if they give such good detail though.

Anyway just wanted to wish you all the best and hope you get sorted soon,

Irene x

[Mstiles in reply to Maisie1958]

Thank you for the tips and sharing your experience Maisie. I know the pred has made me a lot more anxious and sensitive to noise. I just wasn’t expecting the noise to be so loud!

This time I will be prepared with some valium and better ear plugs.

[Maisie1958 in reply to Mstiles]

Yes better ear plugs would help! I had hoped for earphones playing soothing music not the squishy foam plugs that didn’t seem to do anything.

All good wishes x

[nickm001]

In simple terms, MRI will show soft tissue structure and bones, while CT is used for bone structures primarily. For TMJ problems MRI is much better. Gradient noise, the tapping that happens during MRI scan can be pretty loud, especially on 3Tesla scanners. They offer ear plugs or similar to lessen the noise, but you will still hear it.

[Mstiles]

Thank you for the clear explanation. Never had to have one before PMR/GCA.