Hi DDAYMBB,
thankyou for that information. dr sanders mentions that he is now performing the pectoralis minor tenotomy on many of the patients who didnt achieve the desired outcome from their previous scalenectomies. it would be interesting to know how the pectoralis minor is causing compromise to the brachial plexus when prior to a neck injury it wasn't. i live in australia so the doctor options are not relevant. i wished to contact Christine Novak re an article that she co-wrote.
i have a theory about the whole TOS situation. i wish i had the computer skills to design jig saw puzzle shaped boxes where one could list differing aspects of TOS.
Dr Sanders mentions
1) THORACIC OUTLET SYNDROME: A COMMON SEQUELA OF NECK INJURIES
2) worsening of the symptoms when elevating the arm
3) Pectoralis minor syndrome appears in more than half of the patients who have TOS
4) Some of the occupations that we see causing TOS include, working on assembly lines, keyboards, or 10-key pads, as well as filing or stocking shelves overhead
5) pain in the neck, shoulder, and arm; headaches in the back of the head; weakness of the arm and dropping things from the hand
6) The symptoms are often worse at night or when using the arm for work or other activities
7) Abdominal breathing,carried out on a daily basis, are a part of the therapy program

i would then like to add two more boxes
8) typically in patients with TOS, there will be weakness in the middle and lower trapezius muscle and SERRATUS ANTERIOR MUSCLES. from an article called Thoracic Outlet Syndrome from Current Problems in Surgery november 2002 by Novak and McKinnon
9) Perhaps the most important anatomic feature associated with injury is the course of the long thoracic nerve through the fibers of the middle scalene muscle in the supraclavicular region.Several patients in the current study were thought to have sustained an insult to the nerve through direct compression by the middle scalene muscle during contraction while exercising.
dr rahul nath texas nerve and paralysis institute.

i would then rearrange the boxes in this order

1) wry neck (for what ever reason)
2) scalene muscle spasm
3) partial long thoracic nerve compromise
4) serratus anterior weakness
5) scapular instability
6) other scapular stability muscles try and compensate
7) resultant postural changes due to shoulder girdle instability
8) pec minor over compensates for serratus anterior when reaching forward and up. causing pec minor syndrome.
9) rhomboids over compensate and cause thoracic spine tightness
10) to compensate for pressure on brachial plexus (BP) ones head moves forward releasing what would otherwise be acceptable pressure on the BP.
11) occupations which may not have caused the problem (wry neck) now certainly exacerbate the problem because the long thoracic nerve can now be compromised in other ways when the scapula is unstable (the bow stringing affect)
12) shoulder girdle strenghtening programs exacerbate the problem for the same reasons
13) for some (disputed) reason chest breathing occurs further compromising the long thoracic nerve.

this is my theory on the process . i have TOS and after 3yrs i was diagnosed with partial long thoracic nerve palsy causing serratus anterior weakness. obviously the experts have noticed the similar serratus anterior weakness in other TOS sufferers. I cant help but wonder if they are thinking that the significance of the scalene muscle compromise (wry neck) is misplaced. it is not affecting the BP but instead the nerve to a scapula stabilizing muscle which if it is not working properly then causes another compensatory muscle (pec minor) to to the compromising of the BP. i am having trouble convincing people of my theory. thankyou for reading this towelhorse