Hi new here...can you help me with my x ray please

Hi Im jo. 47 from wiltshire. Im normally super fun, active and happy sports lover…im now a shadow of myself with misetable symptoms. Started last June with facial psin/numbness. Electric ear pain. Neck pain and numbness. Jaw pain. Inside of mouth like pallete and tongue tingles. Down to my throat that feels like something is stuck in it. My swallow feels awful. Vertigo. Dizzy. Vision problems. Pain at base of skull. Basically miserale. I recently found this site by pure coincidence lookingbat symptoms on other sites. The only scan i have is from dentist. I was hoping maybe someone might see something or understand my scan or symptoms. Im feeling super sad and super alone. Any help would be so grategully received and if you are feeling symptoms like mine…im so sorry…its just plain miserable!

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@JoJomoo - Your pano x-ray shows your styloids clearly & they are elongated. The left one is a very strange sort of wavy shape & both are very pointed at the tips. Your symptoms of dizziness, vertigo & vision problems could be caused by either compression of your internal carotid artery or your internal jugular vein. Carotid compression produces more stroke-like symptoms whereas Jugular compression causes intracranial hypertension which in turn can cause massive brain fog, visual changes, pulsatile tinnitus & sometimes CSF leaks. Your other symptoms are typical of nerve pains that ES can cause by the styloids contacting various cranial nerves that pass through the same area of your neck as your styloids.

Mr. Hughes in London would be one doctor you could consult with to get a diagnosis.

I’ve circled your styloids in fuchsia.

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I am so grateful for your reply.

Are any of your teeth clashing or do they fit together ok? This can also be a cause of facial pain.

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Not surprised that you’re getting symptoms looking at the styloids as @Isaiah_40_31 has labelled!
It does sound like you’re having nerve pain, so it would be worth trying one of the nerve pain meds like Amitriptyline, Gabapentin, Lyrica or Carbamazepine, your GP should be able to prescribe that for you- there’s info about the meds in the Newbies Guide Section I sent you a link to.

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Thanks @Jules im not technical and struggling replying…so embarrassing! Do you think ive put my x ray up on the correct section of the forum to get seen? Are yiu guys thinking i could have eagles? I have never felt so ill in all my life. I am electric everywhere and last week was told i possibly have TOS and when i was asked to raise my arm in the air and look certain directions i lost pulse. I cant help but think this is all connected or just rubbish bad luck. So so grategul for your help.

@JoJomoo: Just to add to @Isaiah_40_31 's reply, as you may have aptly noted, the ruler on the right side of your image would indicate that your left styloid process (which on the image is on the right side; it’s why that big “R” is on the bottom-left side) is easily over the commonly used 30mm benchmark used to gauge elongation. Measurement using dental panoramic x-ray is not as precise as using head/neck computed tomography, but was found to be accurate by this small study from July 2022:

Hence, PAN, which are routinely taken, cost-effective and involving relatively low radiation dose, may be used as substitute for CT for the purpose of diagnosis of elongated styloid process. However, for precise measurement of the length of styloid process, CT is still the imaging modality of choice.

So the question that remains is whether your obviously elongated styloid process is the cause for your symptoms. If so, this would then mean that you indeed have Eagle’s Syndrome. For that diagnosis, you would have to be referred to a specialist with experience in that condition. This is not easy to do due to the condition’s rarity, and @Isaiah_40_31 's suggestion for Dr. Hughes would seem to be a very quick path to diagnosis, and thus treatment. (Notably, a neurologist sleep doctor recently told me at an appointment for my father that her otolaryngologist friends “cry whenever it’s Eagle’s Syndrome”.)

I do not know or have clinical experience enough with thoracic outlet syndrome to make mention beyond that compression of the largest venous outlet of the head occurs when the Eagle’s Syndrome is of the novel Jugular variant. I don’t imagine it a far stretch for Thoracic Outlet Syndrome—which I understand is when the venous outlet is disturbed near the base of the neck rather than the base of the head—to have similar presentations. I once told my brother based purely on a naive self-diagnosis that I had thoracic outlet syndrome many years back. I don’t see why the two conditions can’t be co-morbid in any case.

Do you have what’s colloquially referred to as ‘scapular winging’ or more formally “scapular dyskinesia”? I do. I was able to check fairly trivially by just putting the back of either hand up my back as far as I could and see that my scapula was sticking out where it shouldn’t (there are a few different directions for the scapula to ‘wing out’). I suspect this is because the nerve that powers the largest shoulder muscle—the trapezius—(and the largest neck muscle—the sternocleidomastoid) is being compressed near and by the styloid process. The instability of the corresponding joints, namely the sternoclavicular junction, would seem to be able to affect the thoracic outlet just based on proximity.

(Not sure what you mean by ‘losing pulse’)

(I for one thank you for posting the x-ray, btw, and sorry to hear that you’re so ill.)

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@Chan i am so grateful for your opinion and time. Its truly been misetable and frightening with no answers. When i saw the TOS specialist they get you to raise your arm in various positions, bent, up high etc and hold on to your pulse on wrist and get you to look in different directions…when i looked left my pulse went which is a big indicator of TOS. I went on a tos site similar to this and mentioned my symptoms and it was someone on their who said are you sure its not eagles …i looked up eagles and cried when i read stories and symptoms so similar to mine. Im beyond grateful for the support so far on here.

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@chan it was my chiropractor who suggested TOS after my scalene muscles being touched sent me to my knees in pain! Also the electric sensation i have inbetween my clavicle and shoulder. I cant raise my arm. My forearm is preety numb now. My leftcarm is asleep or electric pain.

You’ve posted it fine @JoJomoo ! It does look as if you could well have ES, yes, as your styloids look longer than average & angled, plus you have the symptoms…
We have had quite a few members who’ve had TOS & ES as well, unfortunately! What has the TOS specialist said, have they suggested surgery for that?

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Professional consultation notwithstanding:

I’m reminded of this illustration from the latest edition of Travell’s “Myofascial Pain and Dysfunction”:

The caption is:

Thoracic outlet entrapment by the scalene muscles (medium red). The neurovascular bundle is spread out to show the relations of its component parts. A portion of the clavicle has been removed. The brachial plexus and subclavian artery (dark red) emerge above the first rib and behind the clavicle between the scalenus anterior and scalenus medius muscles. The spinal nerves are numbered on the left, the vertebrae on the right. The T1 nerve lies dorsal to and beneath the subclavian artery. These structures crossing over the first rib can be compressed when the rib becomes elevated. Trigger points in the scalenus anterior and/or the scalenus medius muscles are associated with taut bands that increase muscle tension and elevate the first rib, compressing the neurovascular structures.

The chapter on scalenes has a section on corrective exercises, but I would highly highly recommend consulting with your specialist before attempting. It’s not difficult to make things worse, I’ve found. Also, there are so many ways to move the body, a given specialist would not be able to keep track of all of them. Also, I don’t know whether chiropractors generally are interested in using exercises and such. Do feel free to message me if you’d like me to send you a copy of the chapter.

Just to be precise, the clavicle is sort of part of your shoulder so not entirely clear about the location you’re talking about. By shoulder do you mean like where your upper arm bone socket is? Like from the sternum to corner of your shoulder? If it’d be easier to speak by phone, I’d be happy to chat.

Also, you might be interested to look through these, though their diagnostic precision can be limited:

The caption is:

Composite pain patterns (solid red areas are the essential pain reference zones,
and stippled red areas are the spillover reference zones) in the right scalene muscles
(medium red). A, Scalenus anterior, medius, and posterior. Some TrPs may have only one
essential reference zone. B, Scalenus minimus.

In this case, you seem to be referring to a more stippled area of the pattern rather than the darker areas. This is also not really talking about electric sensations, but I’d have to double-check that.

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@Jules the thoracic dr i saw said i have to wait for specific scans where theyvtake acans of your arms in different positions…its quite a wait. He discussed botox injections. I told him about my face symptoms before i knew about eagles and he said tos woukd/could account for numb neck bit not face and throat…

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@Chan im.so grateful for your time and info. I have atached a rough circle of whete i feel electric…also i have pain in my drltpids and bicep/tricep area. My foream was first to go numb and somd fingers.

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It’s my pleasure… I wouldn’t thank me yet…:sweat:

As it turns out, oddly enough, the arms are innervated by the spinal nerves that come out from the neck. You’d think they’d come out from the thoracic spine rather than the cervical spine, but… evolution something or other…

So, I mean, just on the face of it without any kind of deeper thinking, looks like the brachial plexus, which means like… nerve mesh of the arm, is being impinged or compressed by maybe the scalene muscles which maybe are hypertrophied by overuse. Like the scalenus anterior and the scalenus medius are squeezing the mid-cervical spinal nerves as they exit out from the spinal cord and course through to your finger tips.

There can also be vertebral involvement, like vertebral disc bulging/herniation or bony outgrowths or whatever.

If anyone else has an opinion, certainly would be welcome here, as I’m getting out of my depth very quickly.

I would have questions about how the sensations on the various parts of your arm change relative to movements of your neck. @KoolDude @vdm ?

It might be worth getting an opinion from a physiotherapist or two if the wait time is unbearable, and you’ve got somewhat of a budget to work with. Bring them whatever documentation from the thoracic doc and what not… I’d look to ask about what movements I should be careful about. A good one should be able to get a lot of information from just looking at the way you move, but hopefully not be so certain as to be unwilling to provide written reasons for why they think what they think, not that I’ve ever tried to get such from a PT myself.

Also note that the same book chapter I referenced above has this from the section on “Activation and Perpetuation of Trigger Points” (TrP stands for “myofascial trigger points”, essentially a specific type of inflammatory lesion in muscle/fascial tissue):

A posture or activity that activates a TrP, if not corrected, can also perpetuate it. In any part of the scalene muscles, TrPs may be activated by unaccustomed eccentric loading, eccentric exercise in an unconditioned muscle, or maximal or submaximal concentric loading. Trigger points may also be activated or aggravated when the muscle is placed in a shortened or lengthened position for an extended period of time. Side-sleeping without proper pillow support or sleeping supine with too many pillows may place the scalene muscles in a shortened or lengthened position.

Scalene TrPs are common following a cold with a bad cough, pneumonia, bronchitis, or allergies as all these conditions require the scalene muscles to be overloaded due to their respiratory functions. Scalene TrPs may also be activated by a fall or motor vehicle accident, prolonged pushing or pulling, or lifting and carrying awkwardly large objects with the UEs. Hiking with a heavy backpack for long hours is particularly demanding on the scalene muscles in addition to the upper trapezius, SCM, and pectoralis minor muscles. Playing handheld string instruments such as the violin or wind instruments such as the flute, which require a tilted head and neck position for proper use, may activate scalene TrPs. Swimming may also place the scalene muscles at risk for developing TrPs due to the cardiorespiratory demands, repetitive cervical spine rotation, and UE use.

Biomechanical malalignment such as a tilted shoulder girdle axis due to a leg length discrepancy when standing, a small hemi-pelvis when seated, and a structural or functional scoliosis may also place the scalene muscles at a mechanical disadvantage and overload them. Changes in the rib cage that are common with a structural scoliosis may place increased demands on the scalene muscles during inspiration. Habitual chest breathing and poor diaphragmatic breathing patterns cause repetitive overload in the scalene muscles leading to TrP formation.

Prolonged computer work with improper or awkward workstation setup where an individual spends hours each day with the dominant arm in an elevated, abducted, and slightly internally rotated position while using a mouse can shorten and activate TrPs in all three or four scalene muscles. Visual stressors during computer work may also contribute to TrP formation as this causes an alteration in the head position from a centered neutral posture. In addition, prolonged flexion and side-bending of the neck to hold a phone between the head and a slightly elevated shoulder contributes to the formation of scalene TrPs.

A whiplash-type injury from a motor vehicle accident is likely to activate TrPs in the scalene muscles in addition to several other muscles in the cervical spine and shoulder girdle. In a study by Hong et al, 81% of patients with WAD with a report of pain had at least one active scalene TrP. In a more recent study, Fernandez-Perez et al investigated the prevalence of TrPs in patients with WAD and healthy controls. In individuals with acute WAD they found a high prevalence of active and latent TrPs compared with those in a healthy control group. They also found that subjects with acute WAD and higher levels of disability had more active TrPs resulting in higher reports of pain and widespread pressure hypersensitivity.

The scalene muscles can be affected by movement impairments that produce a severe deviation from the normal pattern of gait. An antalgic gait pattern or limping on a weight-bearing lower extremity (with resultant torso and head adjustments) and lack of normal push-off at the end of the stance phase can activate TrPs in the scalene (and levator scapulae and SCM) muscles, because those muscles contract excessively in their reflexive attempt to compensate for, and/or maintain, equilibrium and efficiency of movement.

Note that a lot of these apply to a lot of other muscles.

I’d be weary of some of the activities listed above.

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@chan i was in a minor car accident in 2021. After this i got dry eye. Then i had physion on my neck. Thought all was ok. Then eyes started hurting more. Last year come all the face numbness and ear/jaw pain and neck pain. Swallow issues as in feeling something stuck in throat and hoarse voice. Dry throat. Numb tongue. Electric ear. Eye pain/vertigo. Scalp pain. Temple pain. 4 months before this was numb forearm…had mri…will attach report. No answers.

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I should mention that a search for “trauma-induced Eagle Syndrome” does yield results. I haven’t reviewed the associated studies carefully enough to comment further.

Are your symptoms responsive to very light cardio, like walking? Some very very gentle rebounding exercises? I’ve been eyeing a set of “bounce boots” myself for vertebral health. There was a study that compared the intervertebral disc height and hydration level in athletes of various sports. Basketball was associated with more disc height and soccer with more disc hydration. A small study in the corner of a Google Scholar search somewhere from Europe I think found that those jump boots produced a small increase in height in subjects and attributed it to postural changes. :man_shrugging:

MR whole spine, MR head

Those are really valuable. :smiley:

If you’d like, I can step through what the report is saying with you, logistics notwithstanding. Do you know how to view your DICOMs? Do you have the files?

The C5-6 note would indicate vertebral involvement, certainly.

The L5-S1 disc lesions whispers axial spondyloarthritis to me, but again, I’d have to dig in for any level of certainty. There’s a paper that strongly hints at the condition’s relevance to Eagle Syndrome, but I’m not aware of any larger study of the association as yet.

I’m convinced though, if that means anything. I’ve got a report saying L5-S1 disc herniation.

Oh and about the unremarkability of the head: based on the radiologist’s use of the word “acute” for the head, I bet I can find stuff. One easy thing to look for based on your vision problems would be optic nerve tortuosity.

Also, depending on the protocol and…um…bounds of the MR studies, you should be able to spot the Eagle Syndrome right there and determine which variant, for example.

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@chan your like a super hero! You would be good to have on the quiz team down the pub! I do have all my scans…4 on cd and the full spine as a download but no idea how to read them…there was over 20 images! My mri was without contrast…im having another mri tomorrow just of my L4 area due to neuro wanting to check for cysts. My swallow and my eyes were always my worse symptoms but then i hate numb neck and my ears go electric with pain (lost hearing for a short time) if i tap the vein on my neck it feels numb and odd. Mu tongue numbness and lip tingles were first symptoms…i had maybe a TIA. But the big problem was when i first got ill last year i went under a ct and they found a masd on my adrenal gland and it was such a red hearing…its just an adenoma but everyone was worried about that and not me saying i cant feel my face or swallow!!!

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hah, i’ve just been in this cage for too long…

Yeah, there’s a learning curve…

So the CDs that hospitals provide always seem to provide a DICOM viewer. DICOM is like the international standard for medical imaging and such. They have varying feature sets, but usually don’t include volume reconstruction, since they often are browser based so that other health professionals don’t have to install anything to view them.

At minimum we’re looking for a DICOMDIR file somewhere and a folder at the same level that if you sort of look in, obviously has all the images based on the nested folders and homogeneity of the file names and types. If you want to send your images to someone that’s not a medical professional that’s what you would zip up. However, the files do contain all your personal information, and volume reconstruction would, for instance, reveal detailed metrics of your face.

So to scrub that, some (or all?) DICOM viewers have like anonymizing functions on export that maybe you’d have to experiment with to be satisfied.

If you’ve got an image from one of your series you’d like annotated, or have questions about, we can probably do a back and forth like that too if you’d like.

I’ve never quite had it this bad, but you’re probably preaching to the choir here.

Are you sure what you’re tapping on is ‘the vein’, and by ‘the vein’ do you mean the internal jugular vein deep to the sternocleidomastoid? Because if your Eagle Syndrome variant is the jugular one rather than, say the carotid artery, or the classic cranial nerve-impinging one, then there is at least one article that suggests that deep vein thrombosis and imminent pulmonary embolism, which is a life-threatening condition, are possible. Severe jugular vein thrombosis is apparently characterized by a sign involving a palpable stiffness of the jugular vein underneath the sternocleidomastoid. There are other signs, IIRC.

But I’m sure that’s not the one right? Any chest pain, difficulty breathing?

Yep. There are a lot of those. Congrats on spotting the styloid processes on the dental x-ray! Some studies on Eagle Syndrome measure end-to-end medicalization duration. I think average is somewhere around seven years, maybe?

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@Chan you have been so so helpful and informative and im so thankful. Its 11pm here in the uk and im off to sleep as up super early to get train to london for mri (back issue) i see you ate from Toronto? Ive been there and have family in milton. I loved canada. I also love ice hockey! Im so grateful to you

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As you may tell, I’ve been itching to talk about this with someone for a long time. Thank you for sharing your case, and good luck to you.

Feel free to contact me at any time.

Good night!

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