Eagle Syndrome: A Chiropractic Perspective
As chiropractors, we pride ourselves on recognizing subtle patterns that others may overlook—yet some diagnoses, like Eagle Syndrome, require an even more refined level of clinical suspicion. Often masquerading as routine cervicalgia, TMJ dysfunction, or oropharyngeal pain, Eagle Syndrome is a rare yet impactful structural anomaly that can completely alter your treatment strategy. If left undetected, it can lead to unnecessary interventions and prolonged patient suffering. This blog dives into the key clinical signs, exam strategies, imaging considerations, and conservative management techniques that help chiropractors confidently identify and treat this often-missed condition.
Overview
Eagle Syndrome arises from an elongated styloid process or calcified stylohyoid ligament, leading to craniofacial or cervical discomfort. Symptoms often mimic temporomandibular joint disorders, glossopharyngeal neuralgia, or cervicogenic headaches, presenting as unilateral throat pain, dysphagia, otalgia, or a sensation of a foreign body in the throat. Eagle Syndrome affects only about 0.16% of the population. While 4% have an elongated styloid process (>3 cm), only a small number develop symptoms. Women are three times more likely to be affected, with most cases diagnosed in the 30s to 40s age range.
Clinical Assessment
During physical examination, palpation of the tonsillar fossa may reproduce symptoms. Pain exacerbation with head rotation or swallowing is common. Differential diagnosis should exclude TMJ disorders, neuralgias, and cervical spine pathologies. (1)
How to rule out TMD
Mouth Opening Test
Centric Relation Provocation Test
Imaging and Diagnosis
A 3D CT scan is the gold standard for visualizing styloid elongation or ligament calcification. Panoramic radiographs can also aid in diagnosis, but are less definitive.
Chiropractic Management of Eagle Syndrome
Research on the use of spinal manipulation for Eagle Syndrome is limited. However, some case reports and clinical observations suggest that conservative manual therapies, including chiropractic care, may relieve select patients' symptoms.
Case Reports and Clinical Observations
A 2023 case report detailed a chiropractic patient with Eagle Syndrome who experienced significant symptom relief through conservative care. The treatment included gentle cervical mobilization, soft tissue therapy, and postural correction exercises. Imaging confirmed an elongated styloid process, and symptoms improved without surgical intervention. (2)
A 2010 case series examined manual therapy assessments in patients diagnosed with Eagle Syndrome. The findings indicated that targeted manual therapy could alleviate symptoms, though the authors emphasized the need for careful assessment and individualized treatment plans. (3)
Safety Considerations
While some patients may benefit from manual therapies, caution is advised. A reported case highlighted a severe complication where a patient with Eagle Syndrome developed an internal carotid artery pseudoaneurysm following neck manipulation by an unlicensed practitioner. This underscores the importance of thorough evaluation and the potential risks associated with spinal manipulation in individuals with vascular involvement. (4)
Chiropractic Clinical Recommendations for Eagle Syndrome
Before initiating manual therapy, appropriate imaging (e.g., 3D CT scan) must be obtained to assess the styloid process and surrounding structures.
Consider gentle, non-thrust techniques, focusing on soft tissue mobilization and postural correction.
Consider avoiding high-velocity cervical manipulations in patients with Eagle Syndrome or significantly elongated styloid processes.
Collaborate with ENT specialists or maxillofacial surgeons for comprehensive care, particularly if conservative measures are ineffective.
In Summary
No reliable research demonstrates that spinal manipulation is indicated for patients with Eagle Syndrome; this does not mean patients cannot benefit from chiropractic care. Chiropractors should conduct a thorough assessment to identify Eagle Syndrome and develop an individualized treatment plan prioritizing patient safety. Appropriate care may include posture correction, gentle soft tissue work around the affected areas, and targeted rehabilitation, excluding spinal manipulation.
If conservative, non-invasive treatments prove ineffective, referral to an ENT specialist for potential surgical intervention, such as a styloidectomy, should be considered.
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1. Bokhari MR, Graham C, Mohseni M. Eagle Syndrome. [Updated 2023 Jul 29]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing
2. Vernon LF. A Case of Eagle Syndrome in a Chiropractic Patient. Cureus. 2023 May 2;15(5):e38426. doi: 10.7759/cureus.38426.
3. Johnson GM, Rosdy NM, Horton SJ. Manual therapy assessment findings in patients diagnosed with Eagle's Syndrome: a case series. Man Ther. 2011 Apr;16(2):199-202. doi: 10.1016/j.math.2010.09.007.
4. Sayed AG, Aboloyoun H, Makarem YS, Elnaggar A. Internal carotid artery pseudoaneurysm after neck manipulation in a patient with Eagle syndrome. Clin Case Rep. 2024 Apr 29;12(5):e8814. doi: 10.1002/ccr3.8814.
