TMJ Disorders · Jaw Ligament Sprain · Nerve Entrapment · Glastonbury, CT
Jaw pain, clicking or locking, and face, ear and head pain can come from the joint itself, from sprained ligaments and muscle attachments of the jaw and face, or from nerves entrapped around the jaw, neck and skull base. Dr. Paul Tortland, DO, FAOASM, CAQSM, RMSK treats TMJ problems without surgery, most often with prolotherapy and, when entrapped nerves are involved, ultrasound-guided nerve hydrodissection.
Quick answer
The temporomandibular joint (TMJ) connects the jaw to the skull and is held in place by ligaments and the muscles of the jaw and face. When those ligaments or muscle attachments are sprained, or when nerves around the jaw, neck and skull base become entrapped, the result can be jaw pain, clicking or locking, difficulty chewing, and pain that spreads to the face, ear, head or neck. The jaw and upper neck work as one unit, so Dr. Tortland evaluates both, particularly in patients with hypermobility or Ehlers-Danlos syndrome.
Associated conditions
Cervical instability, Ehlers-Danlos syndrome and hypermobility, cervicogenic headache, whiplash, nerve entrapment
Diagnosis method
History and exam of the jaw, neck and skull base, with ultrasound as appropriate
Interventional options
Prolotherapy, nerve hydrodissection
First visit
At least an hour, $500, ultrasound included
Physician
Paul Tortland, DO, FAOASM, CAQSM, RMSK
Who treats you
Dr. Tortland personally, every visit
Main treatments
Usually prolotherapy for sprained ligaments and muscle attachments of the jaw and face; hydrodissection for entrapped nerves
Insurance
Regenerative procedures not covered; HSA / FSA eligible
When to see a doctor
Consider an evaluation if you have jaw pain, clicking, popping or locking, difficulty chewing or opening wide, pain in the face, ear or temple, headaches, or pain at the base of the skull and upper neck, especially if the problem began after whiplash or a blow to the jaw, or if you have hypermobility or Ehlers-Danlos syndrome.
Seek emergency care right away, not an office visit, for a jaw that is locked open or cannot close after an injury, jaw pain with chest pressure, shortness of breath or pain spreading to the arm, facial swelling with fever, sudden severe headache unlike any before, new facial weakness or drooping, or difficulty swallowing or speaking.
TMJ pain is often approached as a dental or bite problem alone, but pain around the jaw can also come from sprained ligaments, strained muscle attachments, nerves entrapped at the jaw, neck or skull base, and the upper neck itself. When the true source is missed, treatment aimed at the wrong structure may not give lasting relief.
Related conditions
Jaw pain is frequently connected to, or mistaken for, the conditions below.
Diagnose · Confirm · Treat
01
An unrushed first visit maps your jaw pain, clicking or locking, headaches, and facial or ear pain, any prior whiplash or jaw injury, and any history of hypermobility or EDS, and examines the jaw, face, neck and skull base.
02
Because the jaw and upper neck work together, the neck is assessed as well. When neck ligament laxity is suspected, it is evaluated as described on our cervical instability page.
03
Dr. Tortland, who is registered in musculoskeletal ultrasound (RMSK), may use live ultrasound to look at the tissues around the jaw and to locate nerves before a procedure.
04
When nerves around the jaw, neck or skull base are entrapped, ultrasound-guided hydrodissection frees the nerve from surrounding tissue.
05
A dextrose solution is injected to stimulate a localized healing and tightening response in sprained ligaments and muscle attachments of the jaw and face. Prolotherapy is usually the main treatment for TMJ problems in this practice.
06
If hypermobility or Ehlers-Danlos syndrome is contributing, other lax joints are evaluated too, as described on our Ehlers-Danlos and hypermobility page.
07
Follow-up at six to ten weeks compares your symptoms against baseline; prolotherapy is typically given as a short series of injections spaced several weeks apart.
Candidacy
Comparison
Frequently asked
Sources
01
Mulvaney SW, Tortland PD, Shiple B, Curtis K. Regenerative medicine options for chronic musculoskeletal conditions: a review of the literature. Endurance and Sports Medicine. 2018.
02
Henderson FC Sr, Austin C, Benzel E, et al. Neurological and spinal manifestations of the Ehlers-Danlos syndromes. Am J Med Genet C Semin Med Genet. 2017;175(1):195-211.
03
Saramantos A, Kyrgidis A, Venetis G, et al. Clinical efficacy of prolotherapy for temporomandibular joint disorders: a systematic review and meta-analysis. Clin Pract. 2025;15(3):51.
05
Hauser RA, Lackner JB, Steilen-Matias D, Harris DK. A systematic review of dextrose prolotherapy for chronic musculoskeletal pain. Clin Med Insights Arthritis Musculoskelet Disord. 2016;9:139-159.
Candidacy is determined by exam, not over the phone. Bring your imaging, dental findings and any history of hypermobility or trauma, and start with a clear evaluation in one visit.