Think Twice: Why TOS Surgery Isn’t Always the Answer Surgery is sometimes necessary — but often patients are convinced to remove ribs or muscles for pain that may be driven by muscle guarding and inflammation. In my clinical experience, clearing the inflammation and treating the specific choke points (scalenes, under-clavicle mechanics, pectoralis minor, hyper-abduction) can produce significant improvement without irreversible surgery. Get broad, non-conflicted opinions before you agree to bone
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