Wow, it sounds like the surgeon you saw was uninformed, how did he "imply" the all or nothing VTOS? I have heard that there is disagreement amongst the medical community as to the definitions of the types of TOS and the prevalence.

Dr. Semonosky's website describes that there are various degrees of each type of TOS.

http://www.tos-syndrome.com/old1/newpage12.htm

On one of the threads here someone also posted a really helpful link to a NIH journal article which describes vascular TOS:

www.ncbi.nlm.nih.gov/pmc/articles/PMC2728415/

I have been examined by so many doctors its not funny. First off, he could have visually inspected the upper chest and neck, in TOS sometimes the area is swollen. Then he could have done a hands on physical examination of your clavicle area. Just above and below the clavicle and at base of your neck he could have felt the subclavian artery. He could also have listened to this area using a stethoscope, and infant sized one is good or even a small portable doppler probe. The stethoscope/doppler probe would be used to listen to your blood vessels, specifically your subclavian artery. He could have listened for an arterial bruit or palpate that area to feel a subclavian artery/axilllary artery "thrill", which is like a vibration that is abnormal because of turbulence in the artery because it is being pinched. A subclavian thrill is abnormal, like a rushing sound. Normally you do not have a bruit. I had a bruit at rest. I think that some doctors can even measure the degree of the bruit with the doppler device, so definitely there is a possibility of the vascular impingement being to various extents, the louder it is the worse it is I think. (Currently I no longer have a subclavian bruit because I had the TOS surgery so the first rib, scalenes and fibrousbands were surgically excised.) You might actually have an arterial aneurysm and he could have palpated and felt a throbbing pulsatile area.

In TOS, the cold and discolored arm could be from vascular spasm which is from sympathetic irritation (the sympathetic nervous system is very important and could cause Cold sensations along with discoloration.) besides just being from physical impingement.

He could have done any number of tests; Adson's test, the Costoclavicular Manoeuvre, and the "Hands-Up" test or "EAST" test. All of these tests show vascular impingement in certain positions.

A helpful diagnostic test would have been a color doppler duplex scan, where they put sensors on your fingertips and then have you do some positional maneuvers like raise your arms at 90, then 180, put your arms down and straighten your shoulders back like in military position.

The journal article above has a photo of the Doppler Duplex Scan result with someone who has vascular component to TOS.

There could also be a vascular Venous TOS called Paget-Schroeder Syndrome, which is when someone who is typically very active and muscular suddenly develops a swollen blue arm, from a venous blockage, and then they have to get blood thinners. This is I think also called effort thrombosis. I think people who present with PSS have to have emergency surgery and have their first rib and scalenes taken out.

Please feel free to correct me, but everything is described in TOS references, even wikipedia!