In DC/TMD Axis I assessment, which diagnosis fits a patient with tender masseter muscles, pain with function, but no significant intra-articular joint sounds?

In DC/TMD Axis I assessment, which diagnosis fits a patient with tender masseter muscles, pain with function, but no significant intra-articular joint sounds?

• A. Disc displacement with reduction
• B. Neuralgic pain
• C. Arthralgia
• D. Myalgia (myofascial pain)

Answer: (D)

In DC/TMD Axis I, myalgia (myofascial pain) is diagnosed when the pain is primarily in the jaw muscles, with tenderness upon palpation of those muscles and pain provoked by jaw function, but without signs pointing to the joint itself. The key clues here are the tender masseter muscles and pain that worsens with use, preceded by no significant intra-articular joint sounds. Masseter tenderness indicates muscle involvement rather than joint pathology, and pain with function is common with myofascial pain because chewing activates or irritates the involved muscles. Disc displacement with reduction typically presents with audible joint sounds (clicks or pops) during opening or closing, reflecting disc movement within the joint, which is not evident here. Arthralgia would manifest as joint-specific pain and tenderness around the TMJ itself, not primarily within the muscles. Neuralgic pain would feel neuropathic, often with shooting or electric-like pain along distribution rather than focal muscle tenderness and palpation-confirmed muscle pain. So the presentation best aligns with myalgia (myofascial pain), reflecting a muscular source of pain without significant intra-articular joint involvement.

In DC/TMD Axis I, myalgia (myofascial pain) is diagnosed when the pain is primarily in the jaw muscles, with tenderness upon palpation of those muscles and pain provoked by jaw function, but without signs pointing to the joint itself. The key clues here are the tender masseter muscles and pain that worsens with use, preceded by no significant intra-articular joint sounds. Masseter tenderness indicates muscle involvement rather than joint pathology, and pain with function is common with myofascial pain because chewing activates or irritates the involved muscles.

Disc displacement with reduction typically presents with audible joint sounds (clicks or pops) during opening or closing, reflecting disc movement within the joint, which is not evident here. Arthralgia would manifest as joint-specific pain and tenderness around the TMJ itself, not primarily within the muscles. Neuralgic pain would feel neuropathic, often with shooting or electric-like pain along distribution rather than focal muscle tenderness and palpation-confirmed muscle pain.

So the presentation best aligns with myalgia (myofascial pain), reflecting a muscular source of pain without significant intra-articular joint involvement.