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Thoracic outlet syndrome (TOS) remains one of the underdiagnosed conditions due to the unavailability of specific tests. The pain of TOS may mimic shoulder pain and or cervical radicular pain. Understanding the pathology and type of TOS is the key to successful management. Although surgery remains the final permanent solution in a conformed case of TOS, conservative therapies do provide great relief from pain. Botox remains one of the modalities in managing TOS pain by relieving the spasm of the scalene group of muscles and thereby alleviating the compression symptoms.