Surgical treatment in thoracic outlet syndrome has been known to have devastating complications, especially brachial plexopathy (eg, injury to the long thoracic nerve with scapular winging). Conservative treatment appears to be the most universally accepted approach, with even surgeons recommending a prolonged trial before any operative procedure Complications of surgical tit of thoracic outlet syndromeBrachial plexus injury Injury to long thoracic nerve leading to winging of the scapula Homer's syndrome Vascular injuries — subclavian artery , subclavian vein Air embolus as a result of subclavian vein injury PneumothoraxThoracic Outlet SyndromeThoracic outlet syndrome ( TOS ) refers to compression of the subclavian vessels and nerves of the brachial plexus in the region of the thoracic inlet. ( note that even though the actual site of pathology is the thoracic inlet the condition is called thoracic outlet syndrome ) These neurovascular structures of the upper extremity may be compressed by a variety of structures, such as Bone- cervical rib, abnormal first rib, long transverse process of C7, osteoarthritis Muscles- scalenus Trauma- neck hematoma, bone dislocation, clavicular fracture Fibrous bands- congenital or acquired Neoplasms- Pancoast's tumor emedicine.com writesThe primary cause is believed to be mechanical or postural. Stress, depression, overuse, and habit all can lead to the forward head, droopy shoulder, and collapsed chest posture that allows the thoracic outlet to narrow and compress the neurovascular structures. Accessory ribs or fibrous bands when present, predispose the site to narrow and compression.ManagementInitial method of management is nonsurgical.Physical and occupational therapy:improvements in a postural sitting, standing, and sleeping positions are recommended, along with behavior modification at work. muscle strengthening and stretching exercises superficial or deep heat therapy 50 to 90% of patients can be treated with these nonsurgical measures.Surgeryresection of the first rib, accessory rib or fibrous band, scalenectomy