@nhbob2023 I'm not so sure that your spine specialists understand TOS, and you have that diagnosis which in itself is hard to get figured out. It is a complex problem when you have TOS and a cervical disc issue. Do you also have spinal cord compression or compression at the nerve roots?

The best specialists for TOS are usually thoracic vascular surgeons. Often TOS is best treated with physical therapy, not specifically PT to strengthen muscles, but myofascial stretching. Generally speaking with TOS, there is compression on the front of the body, perhaps in scalene muscles at the side of the neck, perhaps an extra rib, perhaps under the collar bone or under pec minor. Myofascial release can stretch out and loosen tight tissues on the front of the chest. Since the muscles on your back such as shoulder blade connections need to oppose the tightness on the front of the chest, it does pull scapulae away from where they are supposed to stay, and you may have a forward shoulder position. There may also be possible weakness from nerve compressions due to spine issues.

If you were to have surgery, it will cause scar tissue and that gets tight. My ACDF at C5/C6 did cause tightening that made my TOS worse, and I needed to stretch out that scar tissue, and I continue to do this to maintain my condition and keep TOS from getting worse. This was why coming to Mayo for evaluation of both problems helped me get where I needed to be as they have specialists who understand TOS. I absolutely did need spine surgery, and I had been doing MFR with my PT for several years before that, and as soon as possible in my recovery after spine surgery. MFR helped get me better function. If I overdo with heavy lifting, I kick up TOS and neck muscle spasms, and doing my stretching helps me maintain good ergonomic spine posture to help prevent wear and tear.

Here is our discussion on MFR. I think this may be able to help you, but you need a specialist who is onboard with this type of treatment, and it doesn't sound like your ortho will support this. You can ask for your primary care doctor to write a script for PT with myofascial release because of your diagnosis, and having pain is enough to justify therapy.

Neuropathy - "Myofascial Release Therapy (MFR) for treating compression and pain"
https://connect.mayoclinic.org/discussion/myofascial-release-therapy-mfr-for-treating-compression-and-pain/
Provider search
http://mfrtherapists.com/
I continue to self treat what I can with MFR using several tools and things I've learned from my therapist. In my case, having looser muscles in my neck made it easier for my spine surgeon during surgery, and when it was the right time after surgical healing, MFR helped me prevent tightness and muscle spasms.

Have you heard of myofascial release before?