Understanding CT scan

Hi, I am new to this forum having had an MSK specialist suggest I might have ES after 10 months of chronic pain and visits to all the usual therapists you have all seen. I have had a CT scan and am now looking at the images ahead of going back next week to see the consultant. My question is this, I have found an image on my scan that looks exactly like this one https://goo.gl/images/bkH8oH
I am assuming the SP is the pointy out bit in the middle of the screen, the picture isn’t annotated?

If it is the SP, my scan picture shows a left and right sign on the other side, i.e. The SP shown is on the opposite side to all my pain. Can this be right or am I reading the CT wrong. I know I should wait to see the consultant, but really hoping to get the ES diagnosis quickly so I can finally tell people I am not making it all up.

Can you post yours?

Haven’t worked out how to save an image but here is a screen clip. Most of my pain, probably about eighty percent is on the right.

They are so difficult to read unless you know what you are looking for. This is mine. The radiologist marked off the styloids.

We’re not doctors on the site, so can’t give a medical opinion… I don’t get the pic at the bottom where it shows R-L in relation to the main CT image, it doesn’t make sense. I agree with you, that looking at the image towards the base is the cervical vertebrae, the front shows the nose I would think, so the longest styloid seems to be the right one, where you said the worst pain is. Just a note though- the one on the left side looks quite wide, angled & pointy as well. Sometimes when the worst side is removed, symptoms can appear or worsen on the other side, so you may need to be prepared for that; cheerful thought, sorry!
I think that you can probably assume that the styloid process could well be causing your pain, whichever one is which! I’m sure the consultant will talk it through when you have your appt.

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Thank you Jules and Kaytee, reassuring in a funny sort of way. I just want a diagnosis like many on this site, my GP’s diagnosis was that I had just developed a high sensitivity to pain and doubled the pregabalin!

Hi Poppy123,

As strange as it may seem, you can experience symptoms on the side opposite from where the styloid elongation or s-h ligament calcification occurs. It all depends on what nerves are being irritated. Another option is that even though you may not see bilateral elongation in your CT scan, you could have it, & that would explain your symptoms on the side that isn’t showing an elongated styloid. It’s possible the styloid angle is such that you can see it in a different slice of the CT scan even if it’s not visible in the one you’re viewing. As Jules said, you’ll need to see what your doctor says.

It’s good for you to go in informed in case your doctor is dismissive of what the CT scan shows. Be aware that it’s not always the length but also the angle & thickness of the styloid process that can cause problems. In the absence of elongated styloids, calcification on the stylohyoid ligaments can be symptomatic for ES so ask if he sees any of that.

I’m hoping your doctor appointment is helpful for you in getting a diagnosis.

Hi, unfortunately styloid is neither elongated or calcified so probably not ES, despite my having a lot of the symptoms on the list.

Has anybody managed to convert 2D Codonics files to 3D using a freeware application? I have tried a couple but I don’t seem to be able to access the individual files outside of the Codonics app on the CD in order to load them.

Did anyone have a look to see if your stylohyoid ligament is calcified? Even in the absence of an elongated styloid process, a calcified s-h ligament is still diagnosed as Eagle Syndrome & can produce the same symptoms as an elongated styloid process.

I’m a complete technophobe, so don’t know if this will help what you want to do or not, but here we go:

Hi, after reading these great instructions (thank you) I have finally managed to get a 3d view of my styloids. Apparently they are not particularly long but they point posteriorly and there is a small gap between the styloid tip and the transverse process of the C1 vertebra. It is unsure as to whether this is causing all my pain so it is my decision as to whether to go ahead in terms of pain/painkillers or risking an op and it not solving anything. My question is looking at the pictures I can’t see this, from behind I can’t see the right one (where all my pain is) and looking from left/right they both look the same. Would appreciate any thoughts?

Hi Poppy123,

For what it’s worth, your left styloid looks quite a bit longer than your right. To me (not a doctor, here) it does look a bit long. As you’ve probably read on here, it’s not always the length of the styloid or calcified ligament that causes problems. It can be how thick or how angled the styloid/ligament are that cause the problems. You can also experience “cross-over” pain i.e. the left styloid can compress nerves which refer pain to the right side. It is more common to have pain on the side of the problematic styloid/ligament, but it can go both ways.

If your shorter styloid is oddly angled, it certainly could be irritating nerves in the area. I suspect w/ the length of the left one that it could be causing problems as well.

It might be worth it to see one of the more experienced ES UK doctors if you’re able to travel & get an opinion from one of them.

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I agree with you that you can’t see the right one from the back, not sure why though! they do look very pointy, easy to imagine them causing irritation! Not easy to tell the gap between them & the cervical processes, would need someone more qualified than us to interpret that! Sorry we can’t be more helpful…

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I guess the right one hides itself as it is next to the other bone structures and looks like a part of something else:

Oh yes, well spotted!

It is day 4 now Post Op and hope my sharing my experience will be useful to others. No eureka moment yet re improvement in my face, throat and neck pain, apart from the fact I can now fully lift my right arm, could only lift 60 degrees pre op. Hopefully the nerve pain will start to get better over time too.

With regard to the op, I was expecting the worst but from my perspective it has been a lot easier than others have experienced on this site. I was eating normally after the operation and had very little swelling. Pain control so far has just been with paracetamol plus the Pregabalin I was already taking. Also pleasantly surprised with the wound, it was mostly behind my ear and closed with glue so hopefully the scar will be minimal.

I will caveat my experience, my styloid was normal length, however, there was some calcification and it was pointing in the wrong direction, very close to my C1 process.

I would like to thank everyone on this forum, it has really helped me understand the condition and made me feel I wasnt alone and wasn’t imagining all my pain.

Hope that you heal quickly, & I hope that you do se improvements in the pain that you were having, & vascular symptoms. Thinking of you, God Bless & hugs to you!

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Hi Poppy123,

Nerve healing takes time, even up to a year. Expect good things. Your body is designed to heal & that it will do if you take care of it. Go easy for the first month or two so your body can really get to healing. Patience is important while waiting for nerve’s to get better.

So glad you’re doing so well!


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