hey, not sure how long you have had symptoms for - or what caused them.....but for me things improved greatly when i left the job which made me uncomfortable and often left me with a trememdous feeling of weakness...i worked in an office as an insurance claims advisor - each day was like torture!

5 years since the start of my symptoms and slowly things have improved, with a job as a teaching assistant which offers me great postural flexibility and is not arm/hand intensive in anyway....

I have had lots of pt which focused on posture rather than strengthening, botox in scalenes (just had 3rd round last week) and accepting my limitations and knowing when to give in and rest - these things for me have been essential.

surgery is probably not a great option unless there is an obvious obstruction such as extra rib or other anomoly.