Cervicobrachialgia in a female in her fourth decade of life: Have Eagle's syndrome and thoracic outlet syndrome been considered?

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.