Thank you for your reply. I have had lots of testing done. Ultrasound imaging showed the compression and release which was when John Hopkins (which specialize in TOS) said it was neurogenic. I also had an xray while there to confirm if any of the 1st rib was remaining and there was found to be "residual rib" remaining. What the doctor explained was that she wanted to remove the rest of the rib and scalene, but since the botox went horribly, she said this was no longer a good option since the botox was essentially a dry run for how the surgery would impact me. When I had paget schroetter, my surgeon was amazed at how much scar tissue was present which actually led to the inability to find the clot for hours. I have literally had every single test done in the last year and a half. What I've experienced is this continuous passing my case off to the next specialist because no one can explain why this is happening or what I'm supposed to do. I experience swelling, numbness, and daily pain.