my outtermost knuckles sometimes get purple-ish, they are not swollen

how can i tell if this from tos or raynauds

Unfortunately, you can't. It's something your doctor + imaging has to determine.

Vasc surgeon i webt to said only athletes get tos blah
So im still hoping pain clinic will help

So frustrating! I used to be an athlete, but I stopped after my shoulder surgeries because they suspected I had Ehler-Danlos syndrome and I didn't want to cause any other joint damage. I think my TOS was caused by the prolonged shoulder injuries I had but the TOS symptoms didn't start up until a couple of years after my shoulder issues had been resolved so I know I didn't provoke TOS by overdoing my work-outs or something.
I hope the pain clinic helps you too. Sounds like you need to see another Vascular surgeon! Did you get your testing/imaging done yet?

ugh no and here's the thing

he's doing the same test i had before..where they just measure the pulse in my fingers

he's very know it all ish and actually said maybe i have carpal tunnel syndrome!!

vasc. surgeons are the worst. im going to bring up my knuckles again but im not sure it's from the tos. it seems like for me to have vascular issues i would have more issues lifting my arms. yesterday i held my arm up over my for 2 minutes and just got tingling but no color changes. ive read people with tos..their hands turn white.

i totally understand what youre going thru, i was never an athlete but i had multiple stretch injuries to my brachial plexus (never went to a doc of course, no health ins) which set this whole thing in motion.

More winged shoulder rt hand turns way more purple
Warmwater does not help

i am not sure if this is related but i started taking a b vitamin complex like six months ago and just last month i experienced my first niacin flush and it happened again today! and it wasnt nearly as bad, i think i'm "detoxing"