The validity of clinical examination for diagnosing anterior disk displacement without reduction

Objective. The objective of this study was to evaluate the diagnostic accuracy of patient history and clinical signs as confirmed by magnetic resonance imaging examination for diagnosing anterior disk displacement without reduction. Study Design. A series of 273 consecutive patients with temporomandibular disorders were clinically examined according to well-defined criteria. Patients were first asked if they had a history of clicking. The following clinical characteristics of anterior disk displacement without reduction were then assessed: (1) maximal mouth opening less than 40 mm; (2) deflection of the mandible to the affected side at the maximal mouth opening position; (3) limitation of condylar translation on palpation during maximal mouth opening; (4) preauricular pain during mandibular movements; and (5) crepitation. Bilateral magnetic resonance images were obtained for all patients, and the magnetic resonance imaging interpretation was compared with the clinical examination findings to assess the diagnostic accuracy of the clinical findings. Results. The sensitivity was considerably low in contrast with the relatively high specificity for all six clinical parameters tested. The overall accuracies of the clinical parameters ranged from 71% to 81%. Conclusion. Our results suggest that the predictability of historical or clinical findings to differentiate anterior disk displacement without reduction from other diagnoses is not high.