Botox is not a diagnostic test for TOS. A Scalene block is . If you had releif from the scalene block, then that is a pretty good confirmation of TOS. i had the Scalene block which confirmed my TOS diagnosis from Dr. Jordan in L.A.
he was the first dr to use it and it has become the most reliable test. . I also had a brachial plexus MRI which suggested TOS and an EMG/NRV which did not, but I also have a bulging disk. I had a botox injection shortly after my scalene block and that actually made me feel worse, I think i had a bad reaction to the botox and it mad my muscle go into worse spasm then before. You should be able to send your scalene bloc test results to some of the dr's on the list and then try to see who you would like to go see for an exam.

Who did your scalene block and why did they not explain that it was a diagnostic?

just offhand:There are many good dr's closer to you: Dr. Freislag is at Johns Hopkins,Dr. Thompson at barnes jewish hospital in St. Louis , I know you can talk to Dr. Sanders over the phone.I dont know if dr. selmonosky is still around but he was in VA and maybe soeone has taken over for him. They are top in the field and any of them can diagnose you even if you dont have surgery with them. I do not recommend Dr. AHn.Here is the TOS Consortium list: http://surgerydept.wustl.edu/TOS_Consortium.aspx. Any of these would be good.

Pain management and physical therapy is usuallyalways reccommended before surgery,unless it is life threatening. if a dr. recommends it right awa then I would be wary.i was considering surgery but have had good results with pt (See my post in Ando& Aston thread). even though it took awhile to find a good one.Not as good results with pain mgmt,but some of the meds and injections have helped a little and have helped other people