Hi Jason and thanks for your interesting post. It's a bit late where I am right now but let's make a start. You mention weakness. Can you be a little more specific to what seems weak and which actions e.g. arm, hand, shoulder movements. My initial though was also TOS. You cannot really comment on the scan in terms of boney alignment as no one is symmetrical but a rib that is closer to another one (without any birth deformity or injury) could mean that the joint where it attached to the spine could be out of place slightly. Paresthesia and numbness and weakness would point to more nerve involvement but then your EMG studies are normal (shame they were not done when you had more symptoms).

Was there something that you did at the time the symptoms began? Also is there ever any discoloration of the affected arm in comparison to the unaffected arm? I await some of your initial responses and come back to you tomorrow. It could be as simple as a thoracic disc which would not have been found on the MRI of the C-Spine.

Chat again soon