Hey you, Fourxlucky! Nice to "meet" you, though I'm sorry to hear of the symptoms (sx) that brought you here…

If I were you, I would get a second opinion from a vascular surgeon before considering any spinal surgery. A couple of the sx you mentioned could be caused by Thoracic Outlet Syndrome (TOS), which is not an orthopedic problem. It is a complex neuromuscular entrapment syndrome. (Sorry, I don't know how to put up the link to our TOS forum here, but it's pretty easy to find if you scroll down.)

Specifically, the muscle wasting and clumsiness in your hand could very well be caused by a lower trunk (C-8/T-1) brachial plexus injury leading to TOS. Also, the parasthesia you mention could be telling. Which fingers are involved? If the pinky and ring finger are symptomatic, that is a classic sign of TOS. And finally, an anatomic anomaly affecting your subclavian vein could very well play into a case of TOS. The genesis and presentation of this illness can be primarily neurogenic, vascular, or both.

There are "sticky threads" at the top of the TOS forum which contain a lot of valuable information, including one listing Doctors and PTs by state with experience in diagnosing and treating TOS. You can also pick up a lot just by reading other TOSers' posts on the forum.

That's it. I think your reluctance to have surgery is healthy and hope you are able to find some noninvasive procedures to help you to feel better and learn how to manage this thing. TOS is very tough to diagnose, and notoriously difficult to treat, so you really do need someone who specializes in this area of medicine to consult on your case. If you continue with PT, make sure the therapist is knowledgable about TOS, as the usual forms of physical therapy are contraindicated here. In the meantime, there are lots of articles, websites and other sources of good information for you to explore about TOS, to see if any of it "fits."

I wish you the best of luck, and look forward to seeing you post more about your condition and how things are going for you.

Alison