Hi,
TOS can come from Myofascial trigger points secondary injury. Release of these knots in the impacted muscles can have a dramatic positive improvement to your pain and increased range of motion. An extra cervical rib does not necessarily cause the TOS. An elevate first rib secondary to trigger points pulling the rib up makes the openings smaller and compress nerves and vascular bundles that pass through these openings. I would suggest you investigate Myofascial trigger point therapy before considering surgery because statistically, the results are not usually positive.

The trigger point is a hyper-irritable focus within the muscle or fascia that causes taut bands and characteristic, predictable, referred pain like that seen in the neck muscles. Trigger point referred pain does not follow typical dermatome patterns.
Trigger points cause the muscle to become shorter and tighter. This limits the function and mobility of the muscle which causes weakness, decreased circulation and pain. When injured, most tissues heal, but muscles learn they learn to avoid pain. This muscle memory can produce unexpected pain years after an injury has occurred, especially during times of physical and emotional stress.

Trigger Point overview Myofascial Trigger Point Therapy is a therapeutic discipline and technique used for the relief of myofascial (myo=muscle; fascial=connective tissue) pain and dysfunction. It is a modality resulting from the lifelong medical careers of Drs. Janet Travell and David Simons. Myofascial Trigger Point Therapy is recognized by the American Academy of Pain Management as a modality for the treatment of myofascial pain and dysfunction.

A certified Myofascial Trigger Point therapist will conduct a comprehensive postural evaluation and range of motion testing for specific muscle groups most likely causing your pain and dysfunction.

The actual treatment session begins with a patient history. Your pattern of pain is precisely documented, your range of motion is assessed and your muscles are palpated for the presence of trigger points. When a trigger point is located, a slow sustained pressure is applied. Initially, the trigger point may be very tender, but pain gradually decreases and fades as the muscle begins to relax. The referred pain will decrease and a specific stretch of the muscle will be done. This process of trigger point release and stretch decreases pain and restores normal functioning.

Once the trigger points are resolved in those muscle groups the pain is usually reduced significantly. The therapist will provide you with some easy to perform stretching exercises to keep you pain away and improve strength and range of motion. The therapist will also ask you a lot of questions to identify the perpetuating factors, causes of the trigger point and give suggestions to you to avoid those causes in the future.



Muscles and fascia work together in functional groups. When a muscle in that group gets a trigger point it impacts the function of that group and causes postural dysfunction. Therefore, the whole function groups of muscles and fascia have to be assessed. Many trigger points cause satellite trigger points in predictable patterns.

Tom Myers, wrote a book called "Anatomy Trains" which explains how we are connected from the head to the foot via fascia lines. Fascial is connective tissue that surrounds every tissue, bone and organ in the body.
There are superficial and deep front, lateral, spiral. The fascia and muscles along the fascia lines can develop Trigger points.

In your case you trigger points in your traps, levator scapula, scalene and other muscles in your, neck, upper back, shoulder, upper arms(lateral bicep), chest (pec major and minor) may pull your head forward and rounded shoulders along with winged scapula(?). The pulling of your chest muscles causes a chronic strain on the traps and upper neck muscles called locked long. You can treat the muscle say the traps via different trigger point release techniques with digital (finger pressure), vapor coolant spray/ice and stretch followed by heat, and if these don't work injection into that muscles trigger point. The traps will feel relief for a while then the pain will return because the trigger point has been reactivated by the pull of the chest muscles and most likely shortened rectus abominas, your six pack.

Therefore, the whole body posture (Hip/Pelvis anteriorally rotated?), range of motion and pain pattern/dysfunction must be assessed before treating a single muscle.

Going back to the anatomy lines I would look to see if you are pulled forward and treat the whole frontal line starting at you lower leg, via digital compression with active and passive stretch at the same time, then reassess the range of motion/function and posture. Then I would address your traps and posterior neck muscles to release those trigger points.

If you are interested you can find a therapist in your area. Please use this link
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If you have no one near you I would be glad to research with my network to see if there is a therapist in your area with the proper training to treat you.

You may want to research this type of pain and dysfunction. You may have access through your medical library to the Travell & Simons’ Myofascial Pain and Dysfunction Trigger Point Manual Volume 1: Upper Half of the body and Volume 2: The Lower Extremities ISBN 0-683-08363-5 and ISBN 0683-08367-8. These volumes cover most muscles and associated pain patterns in the body including those which cause your pain. The muscles cause about 90% of all pain felt in the body.

Feel free to contact me for additional information.

You may be interested in reading this earlier thread

Specifically:

"By Dr. Richard J. Sanders, MD : October 30, 2000

The initial treatment of TOS is certain types {or modalities} of physical therapy {PT}. Over the last few years, we have learned that a few modalities of PT are effective, while MANY OTHER modalities are ineffective or can make the symptoms WORSE. The recommendations below are based on the experience of OVER 1000 patients who have received therapy for TOS.

RECOMMENDED MODALITIES:

1.) Neck stretching exercises. Holding each stretch a minimum of 15-20 seconds, using your hands to help hold the head in the stretched position, and NOT trying to stretch through severe pain. If a stretch HURTS, reduce that range of stretch. Do NO MORE than 3 repetitions at one sitting; do this 2-4 times a day or more. The 2 positions that are useful for TOS are: 1) Neck rotation and 2) Head tilting.
2.) Posture correction. Proper posture for people with TOS includes: 1) Head back, 2) Chin down and, 3) Shoulders relaxed in a neutral position, NOT STRETCHED BACK SO THAT THE SHOULDER BLADES APPROACH EACH OTHER, This position should be maintained as much of the time as possible when standing an sitting.
3.) Abdominal breathing: Practice this lying flat on your back on the floor.
4.) Nerve glides.
5.) Feldenkrais method. This is a total body approach of slow gentle movements of arms and spine with an emphasis on learning what motions bring on symptoms in your body and developing ways to avoid these motions. There is a national registry of Feldenkrais practitioners across the United States and practitioners in your area can be found on the Internet by looking up: www.feldenkrais.com

MODALITIES THAT OFTEN DON'T WORK AND CAN MAKE SYMPTOMS WORSE:
1. Strengthening exercises
2. Theraband use
3. Resistance exercises with machines
4. Neck traction
5. Exercises with weights
6. The concept of "No pain - No Gain"

The above are guidelines that have been effective in TOS patients. They will work for many people, but not everyone. Additional modalities of PT are indicated for other conditions that accompany TOS, such as fibromyalgia, shoulder tendonitis, cervical spine strain, and others. Therapy must be individualized and it is best carried out with the guidance of a physical therapist plus additional training in the Feldenkrais method, usually with a different therapist.

Much more information about TOS can be found in my book, "Thoracic Outlet Syndrome - A Common Sequela of Neck Injuries". The book describes the causes, symptoms, methods of diagnosis, treatment, results and complications of treatment, and other aspects of TOS. Because the publisher of the book sold out all his copies and decided not to reprint it, the book is no longer available at stores. "