Examining the Hand in the Video Consultation

Abstract

Background Video consultations could support patient care in hand surgery during social distancing in the COVID-19 era. According to the literature, images of hand and fingers can support telediagnosis in hand emergencies. We present this feasibility study on online video consultation in hand surgery. Methods A structured examination was designed to query the medical history and examine motor skills, sensitivity, strength and function tests of the hand. Thirty examinations on both hands were carried out by online video consultation, then in direct contact and compared with each other. Results With 4560 evaluated range of movement of the hand and finger joints, there was a high correlation between the measurement methods of R = 0.995 (p < 0.0001, confidence interval 0.9946 – 0.9954). In the video-based examination, 84.6% of the measured values showed a deviation of less than 5° compared to the direct examination, 92.8% less than 10° deviation. Good accordance was also found in the patientʼs medical history. An estimating examination of sensitivity, function and strength during video examination is feasible with simple auxiliary aids. Deficits are evident in the detection of scars, in function tests and the absence of haptic findings. Conclusion Online video consultation allows hand examination with sufficient documentation of hand and finger movements (range of motion) and proper evaluation of symptoms. It cannot replace direct examination but complement patient care in hand surgery even beyond the current COVID-19 pandemic.

The Telemedicine-Based Pediatric Examination of the Neck and Upper Limbs: A Narrative Review

“…Patient-reported localization of pain and altered sensation were found to have near-perfect agreement over videoconference when compared to in-person appointments. 91,96 Visual assessment of wrist and finger ROM was found to have good-to-excellent inter-and intrarater reliability and near-perfect agreement with in-person goniometry and inspection. 91,[95][96][97] Given that experience level may impact the reliability of these measurements, we suggest that all ROM assessments be conducted by the same examiner.…”

“…Physicians can also ask patients to hold a full water bottle for resisted wrist ROM, supination/pronation and squeezing of the hand, with the bottle deforming. 91 A simple nerve exam can be conducted by asking the patient to make a "thumbs up", "OK"/perfect sign and abduct the digits, evaluating the branches of the radial, medial and ulnar nerves, respectively. Lastly, physicians can perform a functional assessment by observing handwriting, thumb opposition, pinch strength (eg, lifting a load, opening water bottle, or opening a resealable bag), cylindrical grasp strength (eg, opening a jar) and spherical grasp strength (eg, squeezing a tennis ball).…”

“…Lastly, physicians can perform a functional assessment by observing handwriting, thumb opposition, pinch strength (eg, lifting a load, opening water bottle, or opening a resealable bag), cylindrical grasp strength (eg, opening a jar) and spherical grasp strength (eg, squeezing a tennis ball). 90,91…”

“…95,96 The odd study reported that less than half of scars were noted on inspection over telemedicine, but this was without prior history taking and had no effect on subsequent clinical diagnoses. 91 Furthermore, older scars are harder to identify, and without formal palpation, adequate assessment of skin moisture, turgor and heat are lacking. This can be remedied through active inquiry when inspecting the hands, higher camera resolution and good room lighting.…”

Die Videosprechstunde in einer unfallchirurgisch/orthopädischen Spezialsprechstunde

“…Im Verlauf der Pandemie wurden auch in Deutschland zunehmend Formate und Untersuchungstechniken evaluiert und entwickelt [ 23 , 28 ]. Buvik et al.…”