I really don't know for sure, but my thinking is that I worked so long in pain before I ever had the surgery, that it probably caused a lot of scar tissue, adhesion's, and possibly nerve damage. I only had the scalene's removed because the surgeon didn't feel that the top rib was causing a problem. He seemed confident that the surgery was a success and that I would get better, but it never happened. I'm not sure what the success rate for these surgeries is, but I've heard alot of stories from others that were worse after surgery.