Had an arthrocentesis done at 9.30 a.m. due to a closed lock. Before the procedure, my opening (straight up and down, I forget what this is called) was 11 mm. The procedure itself was not bad at all--three shots of Novacaine, a muscle relaxant into the muscle, and then two 22 gauge needles to do the lavange. I didn't even get knocked out, just went with the local anesthetic. After the procedure, the opening doubled. Yay!
It is now 8.00 p.m. and I've got a horrible squishy feeling in the joint, more pain than I had before, and my ability to open my jaw is exactly where it was twelve hours ago.
I am beginning to think that my "expert" doctor is a dope. The first time I experienced a closed lock that I was unable to "unlock" myself was just a month ago. I've only had a splint for two weeks (and it just made the clenching worse). I feel like this guy is playing it "by the books" without regard to what is ACTUALLY going on in my joint.
Enough complaining. To all of you who have had this procedure--how did it go for you? What happened after (the night after, the week after, a few months after)? What should I expect from here out? What can I do to speed my recovery?
Many thanks <smile>
Nicole (22 years old)
Last edited by planner; 02-28-2005 at 04:57 PM.
Reason: oops! I should proofread before I hit send!
I'm sorry I don't have any info for you, but I read your post and felt so bad for you. I've never had this procedure done before. Maybe you'll be better in the morning. Let us all know, and I'll be thinking of you and praying for you.
It's now been 24 hours since the procedure and I'm feeling better this morning. I woke up around 5 a.m. and my jaw was so stiff that the pain was extending down my neck. I sat up, did some gentle stretches, took an anti-inflamatory, and got my heating pad with a wet washcloth in the cover to relax the muscles. Now the joint is actually sort of comfortable. I guess your kind thoughts are working!
I am still concerned that my range of motion is about the same or less as when I have a closed lock. I am so paranoid that I actually have a closed lock, but the joint is too tired and inflamed for me to realize it! If I wait until the soreness and inflammation subside, which could be a while, then too long will have passed to open up the closed lock without <eeep!> another arthrocentesis.
I'm going to keep updating this thread in case in the future there's another clueless person like me wanting to know "what should I expect?" Thanks again for your kind words!!
Opening varies between 18 and 24 mm. Still lots of stiffness and soreness. Doing P.T. and gentle stretches. When I close my jaw, it feels like the disc slips out. When I push my jaw forward and open it, it feels like it slips back in.
My oral surgeon is trying to convince me that it's a GOOD THING that this is happening. He says, "Well, it's slipping back in now, whereas before it would slip out and remain out as a closed lock." In my opinion... and I apparently don't know poo-poo about this... but if the disc is slipping in and out then that's NOT GOOD. It seems like it would be doing EVEN MORE damage to my already destroyed disc.
I don't like this doctor.
Now I'm wearing an NTI splint... I guess it's ok, it's actually helping with the overbite, but it has increased the grinding and clenching. Go figure. The dentist who fitted me with it can't seem to believe that.
I've learned that doctors will treat you how they THINK you should be treated, and not actually HOW you SHOULD be treated. I'm discouraged.
Yes, I have had a full set of MRIs done (with jaw closed and opened, although it was opened during a closed lock). I have had several sets of Xrays done. I have not, however, had any diagnostic testing since the procedure (one week and one day ago). I have decided to begin looking for a new doctor, although I'll stick with my current one for the time being.
The disc in my jaw fell out this morning in the shower as I tilted my head back to rinse my hair. After a course of muscle relaxants and moist heating pad, I've regained some opening. I can't even tell if it's "in" or "out."
I can't believe how bad it has gotten so quickly. Three or four months ago, I would wake up occasionally with a closed lock and I would pop it back in after a try or two. Now... well, whatever. Can't work, can't sleep, can't eat. And I can't believe how quickly it happened.
My message to folks just cruising the board: preventitive treatment is the best treatment. Don't put it off. And do you research before you let anyone touch your face:-)
I will stop updating this thread. I don't know if the arthrocentesis helped or hurt, although I suspect that it has made things worse, at least in the short term. I'd welcome anyone else to post their experiences, as I'd love to read them.
i have read your posts and it sounds like my story in terms of the progression of your condition and the treatment options you chose. my jaw was dislocated 3 years ago but the disc on the right slipped entirely off the condyle 1 year ago which left me with a closed lock. i, too was able to "pop" the joint back in place with some ease 3 years ago but when i had the closed lock the it took me tgreat effort to pop it back into place. i really wasn't doing anything when the disc fell for good 1 year ago. 4 months ago i opted for bilateral arthroscopic surgery against the advice of my dentist. he fitted me with a splint which i was wearing but rushed the treatment because i was in pain and also filled with fear. i had the surgery and my surgeon repoitioned and sutured my right disc and performed a partial discectomy on the left. as i have said before, i would give anything to go back to the condition i was in the day before the surgery - i wouldn't even ask for the day before i was originally injured - i'd gladly take my condition the day before my surgery. as goodwillstacey said "my pain is at an all time high and my function is at an all time low." i resumed my splint therapy immediately after surgery and hope it will provide reflief to my jaw joints. like you, i cannot believe how quickly my condition has deteriorated from one level to the next and do firmly believe the arthroscopy left me severly worse than i was. i wholeheartedly agree with you that anyone should do their research before anyone touches their face and conservative treatment should be exhausted before any surgical intervention is considered. thank you for posting your experience and for also providing links regarding the arthrocentesis. i hope you will gain back some function with the use of splint therapy.
Would you please answer my (one hundred million) questions? I'm interested in the background of your condition.
How long did you pursue splint therapy before the arthroscopy?
Did you have an arthrocentesis before the arthroscopy?
Why did your dentist recommend against arthroscopy?
Who else was on your treatment team (I assume dentist and OMF surgeon)?
Why do you believe that splint therapy is the right therapy for you?
What type of splints have you tried, and who fitted you for them?
I have found that splint therapy is ineffective for me. I have tried the "bite plate" style that fits onto the top jaw. That just triggered me to "bite down," and I had several disc displacements while wearing it. I'm currently trying the NTI and I haven't seen an improvement.
It seems to me that the problem is my JOINT itself, as in intra-articular disease, and not just that I'm stressed out or anxious or depressed or my occlusion is messed up (it is, but that's another story) or anything else that would go along with "pain."
Actually, today I have very little pain. It's been one week and two days since the arthrocentesis. I think I was a little impatient and expected there to be immediate positive results from my "little" procedure:-) The pain was manageable with medications after the procedure (NSAIDS and once or twice percocet), but currently I'm not taking anything. I still can't bite down without the disc slipping out. If I look in the mirror the wrong way, the disc slips out:-) Again, the problem is not the pain (there is some, but it is manageable), but the lack of function; this leads me to believe that I'm a good candidate for arthroscopy.
I'm seeing a "well-renowned" surgeon on Saturday. I'll post with all the gorey details
Looking back now, I'd like to qualify my first post... It was twelve hours after the arthrocentesis and I was in pain at that point... now that the pain from the procedure has cleared up, I see why the surgeon took the course he did. It seems that sometimes the most conservative, realistic treatment is to act quickly, even if it involves disturbing the joint.
I am excited to get (yet another) opinion on Saturday!
i did not have arthrocentesis. i pursued splint therapy for 4 months b/4 the arthroscopy. i also had trigger point injections and cortisone injections into the jaw joint. i was on stabilzation splint(s) and repositioning splint(s) (sorry, i don't remember all the names). my treatment team consisted of my general dentist, my omf, and my tmj/myofascial specialist. my tmj/myofacial specialist fitted me with the splints and preached to me to be conservative in treatments and more importantly, be patient, in giving these treatments time to see some noticeable results but i was very impatient and wanted relief asap and rushed the therapy. like you, b/4 i had the surgery, all i had to do was twist my head a little too fast and my jaw would "pop" in and out (i now know that was the disc slipping off the condyle) and i would have to "pop" the disc back into place. this would happen all day long. my dentist, omf, and myofascial dentist all recommended agaist the arthroscopy because when i was able to get the disc back on the condyle i had excellent range of motion - i just wasn't able to keep the disc there. they were confident with the proper splint therapy, i would be able to capture the disc which would reduce all the pain i was in from popping my jaw joint all day long. they also warned of the complications inherent in this type of surgery - and lo and behold - i had major complications from the surgery! now that the disc is back on the condyle i have less range of motion then before the surgery and, am in more pain. i know some people, like yourself, tend to bite into the appliance but, there are so many splints out there i hope you will stay on the conservative path and see which one is right for your case. i too, was adamant about having surgery because i had a lack of function. i had manageable pain (i know NOW) but was so full of fear i could not differentiate between the pain and the fear. i thought i was a good candidate for this "minimally invasive" surgery. all the surgeon had to do was go into the jaw joint and reposition the disc on the condyle. well, unfortunately, there is no outline or impression of exactly where my disc was. when i went back to my surgeon for follow-ups he said well, i thought i repositioned it more posteriorly. it doesn't matter where he repositioned it - my jaw joint is worse with the disc riding the condyle. i hope your second opinion provides you with more answers in your case. considering how complex the jaw joint is, i would avoid pursuing another invasive surgery. i hope, you may be able to recapture and stabilize the disc with splint therapy. i have been using my current splint (farrar) since surgery and it has allowed my jaw to move forward to a more optimum position for the joints. it is also allowing the joints to heal from the surgery. had i stayed on this conservative path, i believe i could have avoided the surgery. i just did not give it enough time. please let us know how you progress - i'm interested too. i hope you see your pain level decrease to the point where you could have a variety of options for your treatment.
It has been very interesting to read all that everyone has written on this subject. I have had jaw problems for years, it has gotten worse. I went to the Oral surgeon, he took x-rays and sent me to have an MRI. I had my boss read the MRI, He is a General Dentist. First let me say that most of my pain and locking is in the right side but after my boss read the report from the MRI, he said that I have a problem on the left side also. I was worried. I went back to the Oral Surgeon today, the disc on both the right and the left are out of place. He gave me 3 options, leave it alone, (which I have done for years), try splint therepy, (which I have done years ago), or he could do Arthrocentesis. He explained the procedure to me, I didn't think it sounded to bad so I scheduled an appointment to have this done but after reading what I have read I am not to sure that I want to do this. He told me that it wont fix the problem but I shouldn't have pain and locking for a while. So do I do this? If this doesn't work then he could do surgery. Is there anyone out there who has had any success? I am at the point where I will do anything to have this problem corrected but I also want other opinions.
I really know how you feel. Do I do it, or do I do something else? Sometimes I wish there was a "definite opinion." You know, you break a leg, you put it in a cast, and usually that's the end of the story.
Unfortunately, there's no one that can tell you what to do other than YOU. Do all of the research that you can. Remember that persons who have had a negative experience with something are more likely to talk about their experience than a person for whom "everything went smoothly." Therefore take everything with a grain of salt (or the whole shaker).
For me, the arthrocentesis did exactly what it was intended to do. I had a closed lock, and it inflated the joint enough to allow the disc to slip back into place. I am fortunate in that I do not experience a whole lot of pain from my TMJ normally--but a closed lock can be excruciating. So for me, looking back, doing an arthro was probably the right thing to do.
Unfortunately, every reaction causes repercussions. For me, I have lost a significant amount of my opening. When I open my jaw fully, it is as if I have a closed lock. Yet I am able to chew soft foods (not possible with a lock) and feel "normal" if my jaw is supported (i.e. opened and pushed anteriorally a bit).
If you can afford it, see a second doctor for another opinion. If your left side feels fine, I would suggest leaving it alone--no sense in causing more problems, right? I would be interested in what your boss (dentist) saw in the X-rays. Has your oral surgeon seen the X-rays as well as the MRIs?
Just like everything else dealing with this disorder, there are positive and negative aspects to an arthrocentesis. That's why it is SO important to make an informed decision. Don't let other people's stories scare you. If you, AND your doctor(s), feel it is the right decision, go for it.
I am having this procedure done May 16th.. But, my doctors stress PT starting the next day.. Did you all have PT? I was told there is no point to get the surgery done unless you have PT to go along w/it.
I did do PT on my own. My doctor told me to begin immediately after the procedure (the next day). I did: stretches to the front, back, and each side. In the beginning I moved my jaw (GENTLY!!!) using my fingers, so that I was not using my muscles at all (so as to avoid the risk of a muscle spasm). The stretches in the beginning kept the scar tissue from reforming. After two weeks or so (don't remember exactly), I was eating somewhat solid food again and did the exercises using my maxilofacial/mastication muscles. After the intrusion from the procedure healed, I found that the stretches were hurting more than helping. At that point, I stopped PT and allowed the joint to finish strengthening on its own.
At this point, I am back to 75% of where I was before the procedure. Don't expect results fast... remember it took a while to get to the state you're in! Take care of yourself, and update us if you get the chance.