OSTEOARTHRITIS AND SYNOVITIS AS MAJOR PATHOSES OF THE TEMPOROMANDIBULAR-JOINT - COMPARISON OF CLINICAL-DIAGNOSIS WITH ARTHROSCOPIC MORPHOLOGY

Purpose: The purposes of this investigation were to determine how comm on osteoarthritis and synovitis are in patients with severe, recalcitr ant temporomandibular joint (TMJ) symptoms using clinical diagnostic c riteria as well as arthroscopic examination, and to compare the accura cy of the clinical and arthroscopic diagnoses with respect to specific ity and sensitivity. Patients and Methods: Clinical and arthroscopic d iagnoses were established in 126 joints of 84 patients with severe TMJ symptoms recalcitrant to conservative therapy. Ail joints were classi fied as having osteoarthritis (OA) or no osteoarthritis (non-OA) and s ynovitis (syn) or no synovitis (non-syn) using clinical and arthroscop ic criteria. Chi-squared analysis was used to determine whether there was a relationship between the clinical and arthroscopic diagnoses. Pr eoperative clinical diagnoses were compared with arthroscopic morpholo gic diagnoses to determine the specificity and sensitivity of the clin ical diagnostic criteria for synovitis and osteoarthritis. Results: A preoperative clinical diagnosis of OA was established in 59 of 126 joi nts (47%) compared with an arthroscopic diagnoses of OA in 82 of 126 j oints (65%), Chi-squared analysis showed a significant relationship be tween the clinical and arthroscopic diagnosis of OA. A clinical diagno sis of OA was associated with a high specificity (.977), however, ther e were 23 of 82 (.293) false-negative findings and a sensitivity of on ly .707. A preoperative clinical diagnosis of synovitis was establishe d in 114 of 126 joints (90%), compared with an arthroscopic diagnosis of synovitis in 112 of 126 (89%). Chi-squared analysis did not show a significant relationship between the clinical and arthroscopic diagnos is of synovitis. A clinical diagnosis of synovitis was associated with a high sensitivity (.920); however, there were 11 of 14 false-positiv e findings (.786) associated with a low specificity (.214). Conclusion s: Although there was high specificity for the clinical diagnosis of O A, the sensitivity was very low. Comparison of clinical and arthroscop ic diagnoses showed that osteoarthritis frequently escapes clinical de tection. The clinical diagnosis of synovitis showed that low specifici ty and symptoms may be caused by other pathoses.