Hi! I've had similar symptoms since I injured my left shoulder and lower brachial plexus. I was diagnosed with a 60% compression of the artery and vein leading to my left arm in the Fall 2008. I saw my shoulder shoulder doctor when my arm was purple, shrivelled, hurt really bad and was about 20 degrees colder than the other arm. I was sent directly to the hospital (next building) to get vascular studies done as they suspected a blood clot. Even the technician was concerned as she hadn't seen an arm look like that before so she spent extra time and ran extra tests (it was a slow day for them so she could spend the extra time).

Post-surgery:
I have had surgery on the right side to remove an abnormal first rib for neurogenic and vascular TOS. I was not put in a sling or brace. PT was started around 2 months post-op to regain the strength. I think other doctors start the PT sooner. After surgery, each surgeon will have his or her own guidelines/protocol. They do attempt conservative treatment first as surgery is a last result and not everyone fares well with surgery.

For me, the surgery results have been great and I'm glad I did the surgery. Even though I had great results, I'm still scared at the thought of possibly going through it again. I do realize it's a possiblity given the compression on the artery and vein and the fact that I have a cervical rib on that side (didn't have this on the right side). If the compression worsens, I could develop a clot.

What area of the country are you in? I believe there is a list of doctors at the top of this forum. I'd recommend reading old posts to see peoples experiences from surgery. If yours is more vascular in nature (sounds like it), people tend to fair better after surgery. I know someone who had a 9 inch blood clot who had to have her 1st rib removed. She spent a week in the hospital while the clot was dissolved, had surgery once the clot dissolved and was released 2 to 3 days later. She was back to work in two weeks and has had no return of symptoms (surgery was about 4 years ago).