Assessment Framework of the Shoulder Girdle in Participants with Temporomandibular Disorders: Delphi Study

Background: Temporomandibular disorders (TMDs) are multifactorial conditions involving the joint, musculature, and associated systems. While physiotherapy commonly addresses the temporomandibular joint and cervical spine, emerging evidence suggests that dysfunction may extend to the shoulder girdle, influencing posture, muscle activity, and functional performance. Despite this, no structured framework exists to guide clinicians in assessing the shoulder girdle in individuals with TMD. Objective: To establish a clinically relevant assessment framework for the shoulder girdle in individuals with TMD using expert consensus via the Delphi method. Methods: A two-round Delphi study was conducted with an international panel of physiotherapy experts experienced in TMD management. Eleven statements relating to subjective and objective shoulder girdle assessment were evaluated using a 5-point Likert scale. Consensus thresholds were set at ≥70% for round one and ≥60% for round two. Data were analyzed using descriptive statistics. Results: Eleven experts participated in round one and nine in round two. Consensus was achieved for nine assessment components, including both subjective (pain, symptoms, injury history, and outcome measures) and objective (trigger points, muscle length, strength testing, and jaw-related influences on muscle performance) domains. Conclusion: This study presents the first known expert-derived framework for assessing the shoulder girdle in individuals with TMD. The findings support a broader, integrative clinical approach that considers regional interdependence.