My surgery was supraclavicular. The cervical rib & fibrous band, anterior scalene and a portion of the second scalene were removed, as well as a lot of scar tissue/adhesions. Dr. P had figured he would also remove the first rib, but he said once he got in there that it obviously wasn't needed. This was all on the right side. Currently, my left side feels better, too, which he said could be happening because I'm able to carry my body more normally now, or because with severe nerve compression sometimes the body feels the pain bilaterally, or maybe only because I've been taking it easy during recovery. Time will tell. I have the extra rib on the left, too, so I imagine I'll be under the knife again one of these days, although Dr. P did say some people with bilateral ribs get lucky and don't have to have both sides done.

Dr. Pearl did study with Dr. Urshel, and he has done a lot of TOS surgery. I actually asked him why CC came to him when there is a TOS specialist in St. Louis, and he was very modest (almost bashful, actually) about it, sticking with generalities about everyone having their own criteria for choosing a doctor, etc. but his staff was a little more forthcoming and said that it was because the word is out in the world of professional athletes that, for TOS, Dr. Pearl is the one to see. Apparently he's done quite a few - I don't follow sports at all, so the names meant nothing to me, but my brother-in-law, who is Mr. Baseball Fan, was impressed by the roster and said there were several pitchers on it that apparently returned to their pitching careers afterward. It seems incredible to me that someone with TOS could even think about pitching a ball without wincing, much less pitching in the pros...

On an only-loosely-related note, if anyone is worried about scarring from the supraclavicular approach, be reassured that the incision is minimal (mine is about an inch and a half, it was closed with intradermal sutures that will dissolve and the top layers of skin closed with tissue glue - no external stitches at all), a skilled surgeon can place it so that, in most lights, the incision/scar falls into the shadow of the clavicle and, with this Mederma Scar Therapy stuff, my incision already looks more like I got a severe cat scratch than that I had surgery. Seriously, this stuff is great - it's really pricey, but totally worth it, in my opinion. Although if anyone knows of any off-brand or similar product that works as well but costs less, I'd be interested to know what it is... ;-)