I'd say when your arms are raised those c ribs are causing more compressions.

Oh man , I remember the burning feelings... I would get it at the "hump" area of my back and all across my shoulders. My fingers didn't tingle but I would get sharp cramps in the back of my hands and my forearm muscles would get very sore and feel strained , took ages to get that resolved.
Mainly because the problem was based up in my neck and PT was only focusing on my hand/arms for RSI like symptoms.
Finally after another evaluation from a more advanced PT she found the true cause and I got the more helpful therapies then.
After those PT sessions were done I found my chiro & an independent PT guy on my own.


For the most part we usually suggest trying good PT first to see if any helps reduce symptoms.

If you can avoid most pain/symptoms by modifying activities I would wait on the surgery.

Most with TOS are in quite severe and constant pain before they finally have surgery.

For now at least you do know that those c ribs are the main culprit, as opposed to those that have soft tissue causes or no obvious anomalies to cause their pain & symptoms.

I would take the time to seek out the best surgeon that you can and have him evaluate your situation, and a good one should also know of an excellent PT place to refer you to.