According to the Merck Manual, the diagnosis of thoracic outlet syndrome usually includes all of the following EXCEPT?

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Diagnosing thoracic outlet syndrome involves showing that the neurovascular bundle is being compressed as it passes through the outlet, using a mix of history, provocative maneuvers, and imaging. Provocative tests stress the outlet: the Roos test keeps the arms abducted with active fist opening and closing to reproduce symptoms, while the Adson maneuver changes the thoracic inlet position and deep breath to may transiently reduce the pulse and provoke symptoms. Imaging studies help confirm compression or reveal anatomic contributors, with X-rays, CT, MRI, or vascular duplex ultrasound commonly used to visualize the area and any vascular involvement. A DEXA scan, which assesses bone mineral density, has no role in diagnosing thoracic outlet syndrome.