Eagle syndrome vs. thoracic outlet syndrome

Hello! Some brief background - I had intraoral surgery for eagle’s years ago, and my symptoms have resurfaced so I’ve gotten several opinions now on having a redo external surgery. My styloid is not terribly long (2.8cm) - one of the doctors I saw was not entirely convinced Eagles could come back like this years later, and wonders if anything else could be at play. We already ruled out any cervical/disc issues. My symptoms are neck/throat pain, shoulder pain, ear popping, and arm heaviness, all on the same side with the elongated styloid.
Other than the throat/ear symptoms, this also sounds somewhat like TOS, so I’m wondering if Eagles could ever cause TOS, or if they are truly separate issues.
Thanks for any advice!

First, I’m sorry you’re experiencing symptoms again. I don’t know if one causes the other, but I see a lot of folks on here that have both. I, for example have bilateral ES and TOS on my right side. I also know it is possible to have styloids regrow, especially if they weren’t completely removed the first time but even if they were. Wishing you luck on figuring this out!

I’ve been going through something similar to this the past 7 years. I have ES in addition to TOS. No surgery yet. I have had only what I can describe as pain on the right side of my neck, front of my neck(or throat), and down behind my clavicle, all on the right side. I asked my doctor to do a superficial cervical plexus block and amazingly everything that went numb exactly where it hurt, this was only about 2 weeks ago. After discussing the results with a neurologist he said the styloid process could be aggravating the region enough to cause the brain to send the pain along the entire plexus since its the largest concentration of sensory fibers in close proximity. Those fibers extend up into the auditory canal and can radiate into the ear. You might ask to do the cervical plexus block to see if that is the origin of the pain.

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Sorry to read that you’re having symptoms again :frowning_face: We have seen quite a few members with both, but haven’t a clue why, just squashed anatomy maybe?! 2.8 cms for a styloid is not especially elongated , but if you’re not tall, then that could affect you more than in a taller person. Plus the width & angle of the styloids can cause symptoms too, so it would be interesting if you could find that out too? We have had a few members who’ve come back with regrowth also though, it would be interesting too to know how much your SP was shortened to, so whether it has grown much since your surgery. Another possibility is that there could be scar tissue from surgery causing inflammation & symptoms…
Are you seeing anyone to look into whether you have TOS? Let us know if you get any answers, sorry if we can’t give you any here!


So there is a very small connection to with ES and TOS anatomically. If you follow the stylohyoid ligament down you eventually it connects to the hyoid, from the hyoid you have connections to the sternum, thyroid cartilage and also the scapula (shoulder blade). That last muscle is the omohyoid and with me it isn’t typical, its a variant in like 5% of the population. The omohyoid is a atypical cause of TOS, I think there is one case study. With this variation I have the muscle connects directly to the clavicle, until it bridges out from the clavicle to the scapula(that bridging portion is circled in the image I attached). It happens that that “bridge” spans the space over the brachial neurovascular bundle that is compressed in the thoracic outlet syndrome. When I have my arms at my side draw my shoulders down and back, I lose all blood flow to my arms. Perhaps the hyoid has more tension forces acting on it with this variation and the SHL calcifies to provide more stability to the hyoid? IDK, maybe see if you have the variant omohyoid.

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Your theory makes sense!

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Wow, thanks for all the suggestions! I’ll definitely look into the omahyoid theory and also see if the angles of my styloids are contributing. One surgeon thought 2.8cm was still elongated and thought a second surgery would be beneficial; the second surgeon I saw thought that wasn’t truly elongated and wondered if something else was causing the symptoms.
The first surgery I had (intraoral), they only detached the ligament and somewhat shortened/rounded the styloid but definitely didn’t remove it.

This blog may be helpful:


I have not heard of ES causing TOS or vise versa but I do know it can run as a concurrent issue. TOS is best evaluated by a vascular surgeon who treats TOS and it can often be resolved with conservative care ie: physical therapy. Only in extreme cases is surgery warranted. Your report of arm heaviness definitely fits into this category and TOS should be ruled out as a separate issue. Do you have temperature changes in that arm ie: cold or decreased circulation resulting in a blue tinge to your hand or numbness?

Hope this is helpful, best to you!

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Thank you, @JustBreathe! This is really helpful. It sure sounds like what I have so now I guess I need to find out if it’s caused by the ES or happening in parallel. That arm does get cold and occasionally numb so it sounds like this is what it is.

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I have had bilateral TO dx 2005. My last surgery was 10 yrs ago. I just got the ES dx. I have been blaming my neck pain, headaches, TMJ, ear pain, shortness of breath etc on the TOS but now I am so excited to have the ES surgery to see if I can live pain-free. Maybe I had both problems all this time. I had my tonsils removed 2004 wondering if this caused the trauma to start the calcifications of the stylohyoid ligament. I could have had the perfect storm brewing. I will let you know how it goes.


Wow I present TOS symptoms with my shoulders down and back, losing flow to hands. I also have ES presenting on CT but not overly long. My shoulder, scapula, scalene triangle are in constant pain on my more dominant side. I’m in Ontario Canada and no one wants to deal with me - ENT sends me to neurosurgeon, vascular sends me to ENT, neurosurgeon says TOS go back to vascular. Been going in circles for 10 years, I am in constant pain no one seems to wan t to help!

How did they find the omohyoid variations? Not many radiologists would look for this. My massage therapist has talked about a mystery muscle in that area. do you have any resources aabout this variation?

What spinal level is shown in the MRI pic that you posted?

Sorry, it took so long to reply, I’ve been logged out for a while, lol. This is the study, A Study of Anatomical Variability of the Omohyoid Muscle and its Clinical Relevance (nih.gov)

There are actually like 5 variants identified in this study of ~300 cadavers.

The level of that axial image was at T1.

Thank you for sharing the link with us, @sigmet25. Are you still experiencing pain relief from your superficial cervical plexus block? I hope so. If not, are you considering ES surgery?

I havent even been able to get into see Dr Samji yet, none of the CT disks I dropped off at their office would work, so they never got back to me. I just had my doctor send all my stuff over again. Ill do the surgery as soon as he gives me the diagnosis, no one at sutter will diagnose ES.

Last week was another trip to the ER for throat pain and I had my 3rd CTA, this one finally noticed my IJV was severely compressed between my SP and TP of C1. All three reports state “prominent styloid processes noted, correlate clinically for eagle’s syndrome”.

The blocks only work for a few hours. This Friday I’m having another one but she is going to try and inject the omohyoid muscle that I have pictured up above, it should be interesting, Ill let you know what happens. She’s awesome and will experiment with anything I ask.


Fantastic that you have a willing doctor who’s trying to help however she can. That’s rare these days, it seems.

I’m sorry about the mess w/ Dr. Samji’s office. I hope the new info that’s sent will be readable/decipherable & you can get on w/ getting a diagnosis & surgery. I understand IJV compression is miserable. I had other issues w/ ES but not that one.

Good that the CTA finally confirmed things; I hope that you can get somewhere with Dr Samji’s office soon!

Hi there… wondering how your surgery went and how you are feeling now? I have both V- TOS and Eagles. Was yours vascular? Hope you are doing better!
Thank you…

Hi @EHL,

It doesn’t sound like you’ve had surgery yet. Have you consulted with any of the doctors on our US Doctors List? I’m sorry you’re also dealing w/ TOS. I assume the “V” means vascular? ES can cause TOS type symptoms & some of our members who’ve had pretty extreme TOS symptoms w/ ES found the symptoms went away after ES surgery. I hope you’ve found good medical help, but if not, Dr. Milligan is in your state & is one of the most experienced ES surgeons on our list. Seeing him would be a good place to start.