Q. Could you please explain (1) TMJ disfunction in such cases of : capsular restriction,hyper mobility and capsulitis (2)mobilization direction in case of capsular restriction.

A.

Restricted mouth opening is judged at 35mm or less for men and 30mm or less for women and usually depends on the vertical overlap of anterior teeth. The origin of restricted mouth opening /passive stretch is ascertained by stretching the mouth wider and determining the location of the created discomfort [1].  

Capsular restrictions typically occur between 25-30mm of mouth opening and have a hard end feel (compare with restrictions of muscular origin which typically occur between 8-10mm of mouth opening and have a soft end feel) [1].

TMJ hypermobility is also known as condylar hypermobility and refers to the ability of the mouth to open beyond normal limits. Hypermobility may sometimes structural abnormality of the joint and may also contribute to joint noise or crepitus [1].

Capsulitis refers to inflammation of the joint capsule.TMJ inflammation is diagnosed when the TMJ is tender to palpation. Synovitis and capsulitis can cause TMJ tenderness or pain and they cannot be clinically differentiated. The collective term ‘TMJ inflammation’ is used to signify either or both and is diagnosed whenever there is TMJ tenderness [2].  

An inferior (caudal) glide is recommended to help relieve stiffness and capsular restriction. The clinician’s thumb is placed on the superior aspect of the posterior teeth and fingers along the lateral mandible. Distraction force is applied in a caudal direction primarily via the thumb. The force applied is low-velocity oscillations and/or sustained stretch [3].

 Here is a link to a helpful video on TMJ dysfunction;

Refs; 

[1] Akheel M. Hussian J. Temporomandibular joint disorders. A concise Textbook. Secrets to Taming TMJ Pain. 2014. Lulu.com. Pg 66.

 [2] Wright E F. Manual of Temporomandibular Disorders. 2010. 2nd Edition. Wiley-Blackwell Publishers. Part I. Initial Evaluation. Chapter 5. TMD Diagnostic Categories. Inflammatory Disorders. Pg 76.

[3] Manske R C et al. Orthopedic Joint Mobilization and Manipulation. An Evidence-Based Approach. 2018. Human Kinetics Publishers. Part II. Mobilization and Manipulation of the Craniomandibular Complex and Spine. Chapter 3. Temporomandibular Joint. Treatment Techniques. Pg 19.