Does Eagle's make TOS worse?

Well, I posted the question and now I am posting the answer… In my case, yes. Used to, to be precise. I hope, that is how it will remain in the future. Used to.

Elongated styloid processes in my case, seemingly, would constantly irritate various nerves and other structures in the neck, causing bunch of muscles to spasm trying to immobilise the whole neck. Some of those muscles are… scalenes. And scalenes are attached to the first and second ribs (not going to go into the details which scalene is attached where, that’s not the point). So when they contract, one of the effects is… the 1st/2nd ribs elevate. That helps to inhale deeply as it expands the volume of the chest. But if the scalene muscles remain spasmed and don’t relax, those ribs (or one of them, usually the first) remain elevated. And potentially pressed against the clavicle… …compressing everything in between. That’s exactly what TOS formally is. Blood vessels and/or nerves compressed between the first rib (or cervical rib if one exists) and the clavicle.

UPD: “used to” before the bilateral styloidectomy two months ago.

UPD2: saying that, I still have various TOS-like symptoms, but they are less intense and I don’t have that many TOS flare-ups whenever I would feel Eagle’s-flare-ups. So my conclusion is that yes, the Eagle’s in my case would make TOS worse. Was that the only cause of TOS-like symptoms – I am still to find out.


Hey VDM how are you doing/feeling?

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Glad that the surgery has helped, great info, thanks!


@Ddmarie As usually, with ups and downs. But TOS symptoms is something I look positively at, if the elongated styloids were the only reason causing TOS or TOS-like symptoms.


Bingo VDM…I agree with the scalenes theory. No doubt the nerve irritation from elongated styloids can aggravate TOS. The question is, does TOS predispose (tight scalenes) you to Eagles pain from the elongated styloids? There is a significant % of population with elongated styloids that are not symptomatic. IJV from ES is a different animal.

I was referred for TOS evaluation in 2017 after I started having shooting neck nerve pain to ears that eventually led me to the Eagles diagnosis and the ES surgery in 2020. Things have been somewhat calm since ES surgery but the underlying TOS progressively has worsened. 2 years after ES surgery that neck nerve pain has resurfaced and now worsened by diagnostic botox in the scalene. I have been using botox as a tool for jaw, face and neck spasm pretty successfully until now. I was in so much neck pain in 2019 and went down eagles road, that I forgot my original path many years ago started with TOS referral. This is why it is good to get all your records.

I have no doubt that elongated styloids aggravated my scalenes. Tightened scalenes clamping down on the elongated styloids create havoc and pain. Targeting tight scalenes prior to ES surgery might be beneficial although botox should not be used 6 weeks or less prior to surgery. I know my ES surgeon said my neck was very tight when he opened me up. I think the ES surgery (a long with botox) in my case disrupted the scalene tightness for a period of time.

Based on post-op CT scan, I highly suspect not all calcifications in ES surgery were removed and one or more are still aggravating a nerve in my neck which is separate but connected issue from TOS. That constant nerve irritation is impacting the scalenes. I encourage all potential ES surgery candidates to quiz your surgeon on his/her approach to removing calcifications and all pieces of elongated styloids. Some just open you up and take out what they see or can easily remove leaving pieces of calcifications.

I have been to 3 TOS surgeons and still going through a variety of testing and in the middle of deep dive into TOS and it is a complex beast. There is no doubt I have TOS but what to do about it and where, is the question. After 1 year of intense inquiry…we may have narrowed it down. In my case, I am certain Eagles aggravated the TOS and scalenes but did not cause the underlying TOS like symptoms. It’s a journey for sure VDM. I wish you the best on your continued journey.


I agree there may be a link between TOS & VES. A medic report in 2016 noted I had bilateral TOS. After bilateral surgery right side now has no swelling in TOS base of neck area. At week 6-7 post op left side does still get swelling in TOS area when upright but I think/hope it is reducing now. Hope you find a solution soon. D


That’s good & an interesting improvement @PatientD; hope it continues!

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Following on from the latest Myofunctional orthodontics post…

For fascial continuity, the tongue is connected to the strap muscles and the sternocleidomastoid muscle and to the musculature acting on the thoracic outlet [12-13]. :exploding_head:

The Anatomical Relationships of the Tongue with the Body System - PMC (


@vdm @Snapple2020

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AWESOME VIDEO! Thx for posting it!


Awesome video @vdm thank you for sharing! You are always so helpful and informative. I appreciate you!!


If you pay attention, there are multiple layers of muscles in the neck.
Some of them are superficial or mid-level muscles.
Others are deep muscles, very close to the spine, interconnecting vertebrae/skull at different levels, varying from short short levels to whole-spine-level (e.g. multifidus).

In my thinking, weak, spasmed deep muscles are the cause why mid-layer and superficial muscles have to take over their job, causing stiff neck and shoulders. Also, they cause spasms very close to the spine and prevent spine (neck) from moving freely.

Before my bilateral styloidectomy in November, it was very painful for me to use my deep neck muscles, as any movement of the skull, especially the lateral flexion would make the styloid processes stab into the muscles, nerves, and other structure around. The body learned to rely on superficial muscles for holding the head in place, as much immobile as possible to avoid pain.

Eventually that became “the norm”, and my neck became stiff and rigid. I believe, that was a long process, at least it took a few years.

Now, that the styloids are gone, I notice how much better I can feel and use the layer of deep muscles.

But the neuromuscular retraining is a hell of itself. My chest hurts like it was on fire, because now my spine can rotate and flex sideways. That’s something new, nerve roots definitely do not like that so don’t the muscles around the ribs.


Very in-depth observations, @vdm. I love how you think & analyze your own body & then share what you learn us. Your observations are very logical & make sense.

Retraining muscles that have been dysfunctional for awhile sounds like when one starts weight training. The muscles get sore & miserable for awhile until they become accustomed to the new demands being placed on them. Thankfully as new muscle fibers & muscle memory develop the pain subsides & a new level of strength & flexibility can be observed.