Structured clinical evaluation for rapid identification of temporomandibular joint closed lock

Temporomandibular joint (TMJ) closed lock, corresponding to Wilkes stage 3 internal derangement, is a common cause of restricted mouth opening and functional impairment. Early diagnosis is essential but challenging, particularly when imaging is unavailable. This study analyzed 40 consecutive patients diagnosed with TMJ closed lock. Patients were routinely evaluated using a standardized 11-test assessment format as part of regular practice, and these records were retrospectively analyzed. Statistical analysis compared findings between the affected and non-affected joints and the muscles of mastication. The most frequent clinical findings included tenderness in the affected joint on passive stretch (75%), on palpation (67.5%), on contralateral movement (57.5%), and on contralateral loading (47.5%). On average, the affected joint was tender in 4.1 of 11 tests, while the contralateral joint was positive in only 0.2 tests (P < 0.001). Passive stretch increased mouth opening from 27.1 mm to 31.7 mm, with a hard end feel observed in 85% of patients. Muscular tenderness was observed in 32.5% of patients, most commonly in the ipsilateral masseter (25%) and temporalis (12.5%). These findings support structured clinical evaluation for early recognition of TMJ closed lock, improving diagnostic accuracy and enabling timely intervention.