Clinical assessment of XXXX .

@entity1 @entity73 @entity10795 @entity272
The clinical assessment of @entity1 thought to be suffering from @entity10795 ( @entity10795 ) requires the use of multiple vascular and sensory tests. In a family physician's office, Adson's, Allen's and cold water immersion of the hands are the only feasible vascular tests, while the sensory tests have to be limited to assessing @entity272 and manipulative dexterity. This paper reviews the laboratory tests deemed to be useful in a hospital or clinic facility, and reports on the investigation of 364 @entity1 exposed to hand-arm vibration who were examined in Toronto, Canada during the period 1989-92. A statistical clustering algorithm was used to categorise 138 male subjects according to the results of their diagnostic tests. From the cluster analysis, four vascular and four sensorineural categories of impairment were recognised in @entity1 suffering from @entity10795 . The Stockholm vascular classification stages and the four vascular clusters were found to correspond. The Stockholm sensorineural classification (Stages 1, 2, and 3) correlated with clusters formed from the sensory tests evaluating the sensitivity of the nerve endings and the distal digital branches of the median and ulnar nerves. When the myelinated nerve fibres were affected, as detected by abnormal Tinel's, Phalen's, and nerve conduction tests, an additional cluster group emerged. The subjects with abnormal nerve conduction test results constituted a distinct group with @entity73 , so there is a need for them to be categorised separately i.e. as a Stage 4. It is suggested that a Stage 4 be included in the Stockholm sensorineural classification.
