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I had trauma to my body and pain started the next morning, after 14 years and 22 doctors i was finally properly diagnosed with TOS. My first rib was wrapped around my brachial artery and nerve. The pain is absolutely excruciating and could not sleep. I am a dental assistant and it was so hard to work, but i love my job, so i did it. I was referred to Dr. Julie Freischlag of Johns Hopkins University. She removed my first rib and an extra muscle that was attached to the back of the rib. I have been out of pain since Jan 2004. It was the best thing that could have happened. 8 weeks of not working, but the pain was gone the day of surgery. It even hurt to breath, yawn or sneeze. She is the best and a specialist in TOS, she also has the syndrome. I hope this helps some people.