Cervicobrachialgia in a female in her fourth decade of life: Have Eagle's syndrome and thoracic outlet syndrome been considered?
DOI:
https://doi.org/10.23938/ASSN.1146Keywords:
Eagle´s Syndrome, Thoracic Outlet Syndrome, Ankle-Brachial Index, Cervicalgia, ParesthesiaAbstract
Cervicobrachialgia is a common reason for consultation among women in the fourth and fifth decades of life. However, the diagnostic approach is often incomplete, leading to delays in both diagnosis and treatment. We report the case of a 44-year-old woman presenting with left craniocervical pain of several years´ duration, radiating to the left arm and the pectoral and dorsal regions, accompanied by paresthesia. Physical examination revealed findings compatible with Eagle's syndrome (tonsillar fossa) and thoracic outlet syndrome (TOS) (positive Adson, Wright, and Roos tests). Assessment using the ankle-brachial index demonstrated vascular involvement, suggesting a potential new diagnostic approach for TOS. Cranial radiographs showed hyperdevelopment of both mastoid processes, while orthopantomography demonstrated elongation (>5 cm) of the left styloid process, which was confirmed by computed tomography that also revealed a duplicated C3 rib with supraclavicular course, confirming the coexistence of Eagle's syndrome and TOS - an uncommon association in clinical practice.
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1.- Dueñas M, De Sola H, Salazar A, Esquivia A, Rubio S, Failde I. Prevalence and epidemiological characteristics of chronic pain in the Spanish population. Results from the pain barometer. Eur J Pain 2025; 29(1): e4705. https://doi.org/10.1002/ejp.4705
2.- Assiri Ahmed H, Estrugo-Devesa A, Roselló Llabrés X, Egido-Moreno S, López-López J. The prevalence of elongated styloid process in the population of Barcelona: A cross-sectional study & review of literature. BMC Oral Health 2023; 23(1): 674. https://doi.org/10.1186/s12903-023-03405-0
3.- Aydin E, Quliyev H, Cinar C, Bozkaya H, Oran I. Eagle syndrome presenting with neurological symptoms. Turk Neurosurg 2018; 28(2): 219-225. https://doi.org/10.5137/1019-5149.JTN.17905-16.6
4.- Paraskevas G, Poutoglidis A, Lazaridis N, Asouhidou I, Chrysanthou C, Apostolidou E et al. Does the orientation of the styloid process cause Eagle Syndrome? An anatomical study of the styloid process in 72 Greek skulls. Otolaryngol Pol 2022 ;76(4): 12-16. https://doi.org/10.5604/01.3001.0015.8627
5.- Mantovani G, Zangrossi P, Flacco ME, Di Domenico G, Nastro Siniscalchi E, De Ponte FS et al. Styloid jugular nutcracker: The possible role of the styloid process spatial orientation - A preliminary morphometric computed study. Diagnostics (Basel) 2023; 13(2): 298. https://doi.org/10.3390/diagnostics13020298
6.-Wagner FM. [Somatic dysfunction of the cervical spine and its complex clinical picture: The fundamentals of diagnostics of cervicobrachialgia and cervicocephalic syndrome through manual medicine]. Orthopade 2022; 51(4): 263-273. https://doi.org/10.1007/s00132-022-04228-7
7.- Cralle LE, Harris LM, Lum YW, Deery SE, Humphries MD. Thoracic outlet syndrome in females: A systematic review. Semin Vasc Surg 2023; 36(4): 487-491. https://doi.org/10.1053/j.semvascsurg.2023.09.003
8.- Masocatto NO, Da-Matta T, Prozzo TG, Couto WJ, Porfirio G. Thoracic outlet syndrome: A narrative review. Rev Col Bras Cir 2019; 46(5): e20192243. https://doi.org/1590/0100-6991e-20192243
9.- Triantafyllou G, Paschopoulos I, Duparc F, Tsakotos G, Papadopoulos-Manolarakis P, Piagkou M. The anatomy of the stylohyoid chain: A systematic review with meta-analysis. Diagnostics (Basel) 2025; 15(7): 925. https://doi.org/10.3390/diagnostics15070925
10.- Dudde F, Bergmann W, Schuck O, Schunk J, Barbarewicz F. Accuracy in the diagnostics of styloid process - panoramic radiograph vs computed tomography: A comparative study. In Vivo 2024; 38(3): 1390-1396. https://doi.org/10.21873/invivo.13580
11.- Cavanna AC, Giovanis A, Daley A, Feminella R, Chipman R, Onyeukwu V. Thoracic outlet syndrome: A review for the primary care provider. J Osteopath Med 2022; 122(11): 587-599. https://doi.org/10.1515/jom-2021-0276
12.- Kiang S, Boggs HK, Tomihama R. Thoracic outlet syndromes. In: Murga A., Teruya TH, Abou-Zamzam Jr AM, Bianchi C (eds). The vascular surgery in-training examination review (VSITE). Springer, 2023; 157-172. https://doi.org/10.1007/978-3-031-24121-5_10
13.- Illig KA, Donahue D, Duncan A, Freischlag J, Gelabert H, Johansen K et al. Reporting standards of the Society for Vascular Surgery for thoracic outlet syndrome. J Vasc Surg 2016; 64(3): e23-e35. https://doi.org/10.1016/j.jvs.2016.04.039
14.- Nadim B, Alizada S, Gupta S, Steigner ML, Menard MT, Aghayev A. Under pressure: A head-to-toe review of vascular compression syndromes. Clin Radiol 2024; 79(10): 722-735. https://doi.org/10.1016/j.crad.2024.07.006
15.- Frugone-Zambra R, Berzaghi A, Gómez-Álvarez J, Bianchi A, Bortolini S. Eagle and Ernest syndromes: A scoping review. Minerva Dent Oral Sci 2024; 73(2): 119-130. https://doi.org/10.23736/S2724-6329.22.04724-6
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