This is a basic arteriogram/venogram. This test showed venous TOS for me (nothing arterial or neurogenic), however I find the MRI/MRA is very limited because of the positional limitations of the MRI machine. The Elevated Arm Stress Test showed symptoms of both arterial and neurogenic TOS for me.

Dr. Sam Ahn (formerly of UCLA) is a somewhat controversial vascular surgeon here in Los Angeles. He advocates fluoroscopic angiogram as the best diagnostic test. This allows for greater flexibility in arm positioning as well as a shorter amount of time for imaging (my MRI/MRA was 2:20 total and many complain of worsening symptoms having their arms raised for more than a few minutes). This is a standard test done by many practitioners to check for vascular constriction. The downside is the x-ray radiation, if that is of concern to you.

Dr. Ahn believes that most neurogenic TOS is going to accompany some vascular constriction. Once this area of constriction is identified, he uses a balloon catheter (angioplasty) to decompress this area which should give temporary relief of neurogenic symptoms as well. He uses this as a diagnostic to determine next steps: therapy, scalenectomy, rib resection, or rib resection & scalanectomy. I believe this use of the balloon angioplasty is unique to Dr. Ahn. He told me that he is trying to introduce this to the rest of the TOS practitioners. I'm sure he would be willing to speak to your doctor about it.

Another controversial surgeon (neuro) here named Aaron Filler developed MR Neurography to better image nerves. His website, www.neurography.com indicates that there is a center in London that performs this test. I would assume they also have physicians equipped to treat TOS as well.

All of this being said, each surgeon has their own tests and technique. TOS is largely a clinic diagnosis and there is no gold standard test. Most tests are used to rule out other disorders. I advise everyone to get as many opinions as possible.