I am so sorry this happened to you, Officer, and I am sure the others here join me in welcoming you and also thanking you for your years of service. TOS is not an easy thing to learn to live with, by any means.

You mention that, in addition to rotator cuff surgery for your shoulder injury, you've had two nerve injections. May I ask which nerves were injected, and whether the physician used imaging techniques to guide them, like ultrasound with fluoroscopy, for example?

Another question is, did the vascular surgeon who diagnosed you with TOS tell you what type of TOS you have, primarily? (Could be vascular, either arterial [ATOS] or venous [VTOS], or neurogenic [NTOS], so-called "disputed" or "non-disputed" form.) This makes a difference in what your chances are for a good outcome if you do decide to go forward with the first rib resection and/or scalenectomy surgery/s, as well as what type of treatment modalities you're likely to get the most success from.

Speaking from personal experience, as well as what I've been able to gather from the medical literature, the fact that you did not have a positive response to the scalene/pec minor block doesn't necessarily mean that you don't have TOS. Just another one of those confounding things about this crazy disorder!

I had a first rib resection with Dr. Annest in Denver about 9 years ago. Stayed in Denver for a few weeks afterwards, to take advantage of the excellent aftercare available there at that time (PT, OT). As luck would have it, I had an accident shortly after I returned home to Los Angeles, which compromised the results of that surgery, so in all honesty I can't say it did a whole lot for my pain levels, but hopefully it did arrest the ulnar nerve damage that had been causing my hand muscles to atrophy…

Whether or not to have TOS surgery is a tough choice, and should be considered only as a last resort for most of us (unless your case is severe, vascular or true neurogenic, in which case the options are fewer).

There are other, less invasive or non-invasive measures you could try before surgery. I know you've already been through a lot of physical therapy (and are probably sick of it!), but I'm thinking that most of it was probably before your TOS diagnosis. TOS does not respond well to traditional forms of PT: strengthening exercises, Theraband, upper body machines, cervical traction, that whole "no pain, no gain" mindset. In fact, traditional PT can make you even worse!

There is a specific protocol for use with TOS clients which very few PT's are trained in, that incorporates rebalancing certain muscles, addressing trigger points and correcting postural issues and respiratory dysfunction, etc. BEFORE any strengthening begins. I don't claim to be an expert by any means, but there are lots of folks on here who are extremely knowledgable about this. And if it was Dr. Brantigan or Dr. Annest whom you consulted with in Denver, they might be able to hook you up as well. You would definitely need a TOS-savvy PT, before and/or after any TOS surgery/s.

Another procedure which like the scalene/pec minor block, can help to diagnose TOS, but which is also used therapeutically as it can offer months of relief from painful symptoms, involves Botox injections into the so-called "culprit" muscles (anterior scalene, subclavius, pec minor). This is often done in conjunction with a course of PT, in order to see if your symptoms can be managed non-surgically. (At the same time, your body's response to the Botox injections can provide some useful information to your surgeon as to your candidacy for successful TOS surgery.)

Then there's also bodywork, not generally covered by medical insurance (not sure about Workers Comp), but many TOSers find it very helpful: Feldenkreis workers, Hellerworkers, etc. Lots of different techniques. And chiropractic, as Jo mentioned, has been helpful for many.

Each TOS case is different and there is no "one size fits all," unfortunately. I know this is a lot to absorb and it's not just a game-changer, it can be a life-changer. Takes time to get acclimated to what is happening to your body, and it's hard to know what to do next sometimes. I'm glad you've found us.

Knowledge is power, and there is just a ton of information captured in the 'sticky' threads at the top of this forum. If you're interested in a certain aspect, you can use the Forum Search function (located in the upper righthand portion of your screen) to punch in key words where prompted, to pull up threads and posts containing past discussions on here (regarding surgery, for example, or PT, nerve blocks, etc. The possibilities are infinite and thrilling!).

Please keep posting here to let us know how you're doing, OK? We're here to support you should you have any questions or concerns.

Take care and I hope you feel better soon.

Alison