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.