I really believe that people who get TOS from a traumatic injury would benefit better from surgery right away. I got mine from a car accident and went through Feldenkrais, PT, acupuncture, facet joint injections, shoulder surgery, and anything else that they could throw at me for almost two years before I had my surgery. I think that the longer things are compressed the more permanent the damage becomes. That's just my opinion. As far as the rib removal--the first TOS Doc I saw said that based on the scalene block he did, he would remove only the scalene if he didn't see evidence that the rib needed to be removed when he got inside. I ended up having another Doc do the surgery and he removed both....