@windwalker My hands and forearms still get blotchy and if my symptoms get kicked up because of overuse of muscles, my hands can still get a bit cold, but they don't turn as blue any more. Right now they have a mottled appearance on my palms, and yesterday in physical therapy, I was doing exercises to strengthen muscles around my shoulder blades and I ache a bit today. In TOS, the front of the chest is too tight, so you try to loosen the front, and strengthen the muscles in back in the shoulders to hold the shoulder where it belongs instead of it going too far forward. My suggestion would be to look into physical therapy with Myofascial release with a therapist who is familiar with TOS. Thoracic outlet syndrome (TOS) is entrapment of the nerves and vessels where they pass through some small spaces in between the collar bone and rib cage. There are similar types of issues that can happen in the pelvis because of alignment. MFR can loosen things and get it back into better alignment. Our habits of computer and screen time and the posture that goes with it is a contributing factor to a problem like this. Here is the discussion on MFR with lots of information. That would be conservative and it might help. MFR helps a lot of things and gets the body moving again as it should. https://connect.mayoclinic.org/discussion/myofascial-release-therapy-mfr-for-treating-compression-and-pain/