@snowmass I don't know if TOS is ever resolved, but it can be improved. I have done PT with myofascial release since 2010. My hands used to turn purple or bluish and get cold. That doesn't happen anymore. If I get a neck spasm on one side, it can trigger TOS a bit and even cause a contraction in the side of my palm. What really helps a lot is riding my horse just at a walk and sitting up straight while I do it. That works all the core muscles that are supporting my spine, and it is easier to hold a good posture with a stronger spine. I have to do some strength work by grooming the horse, lifting the saddle, etc, and putting the saddle away in my truck when I'm finished and carrying it back into the house.

I've learned to pay attention to when I have tight muscles and do some self treating of fascia by stretching, laying on a ball, foam roller or use something in my hand to push to stretch the skin and hold it and wait for the fascia to unwind. I do a lot at home to self treat and maintain what my therapist has done for me.

Regular PT to strengthen muscles, just makes my TOS worse, and the key to improvement is more stretching to prevent it from tightening up. I also stretch out the scar tissue from my ACDF spine surgery that is located very close to where TOS compression is in my neck.

One option for MFR work would be to do an intensive week at Therapy on the Rocks (locations in Sedona, AZ and a Pennsylvania office) which is the practice of John Barnes and his employees. I have not done it, and there is an expense, but with several therapy sessions per day for a week or more, it may make a difference in faster progress.

Therapy on the Rocks Website. https://therapyontherocks.net/

Am I understanding that you did have surgery for TOS and possibly had scalene muscles removed, and afterward this seems to be increasing your symptoms? TOS can have scar tissue involved, and surgery creates more scar tissue. When my doctor talked to me several years ago about this, he said surgery for TOS does not have a good success rate and recommended against it with MFR therapy instead. If you have surgical scar tissue exacerbating your symptoms, MFR may be beneficial.

There are a couple chiropractors at Mayo listed as doing myofascial release in their rehab center in Rochester (if you search on Mayo website). You may want to look at Therapy on the Rocks for an intensive session as an alternative. You may not need any further consulting to go there for therapy. I don't know which of your options would be more cost effective or your best choice. I was evaluated for TOS in a vascular lab at Mayo when I was there consulting for my spine surgery. They had to decide what was the bigger problem in diagnosing where my symptoms were coming from and I already had a diagnosis for TOS and cervical stenosis. My Mayo spine surgeon signed my scripts for physical therapy for my TOS for several years.

I hope you find an answer that improves things for you. It sounds like scar tissue is causing a big problem. You may also to look at the facebook page of https://www.facebook.com/kjetilMSKN He is the author of the MSKneurology.com .
Jennifer