@waif Crazy! I actually have 2 cervical ribs. lol (bilateral) which is less common in terms of cervical ribs. Some TOS folks will be thought to have a cervical rib but it ends up actually being an elongated transverse processes (like you mentioned) which can also cause problems like a cervical rib. A fancy 3D ct scan (Mass General developed this test and it was/is only place you could get it) that was done of my brachial plexus showed mine to be bonafide cervical ribs (there is a joint). I only have Neurogenic TOS. My subclavian was significantly compressed, but that still was not considered to be vascular TOS. Thankfully it was not damaged so the decompression surgery fixed that. My surgery consisted of removal of the right cervical rib, removal of the entire 1st rib (sternum to spine), removal of 2 of my scalene muscles, and scar tissue removal. I still have compression on my left side and we planned on doing surgery on that side at some point, but given I've developed so many health problems since it's no longer being considered. Thankfully my left side isn't as bad as my right side (my dominant hand).