The Virtual Shoulder and Knee Physical Examination

Abstract

The COVID-19 crisis has forced a sudden and dramatic shift in the way that clinicians interact with their patients, from outpatient encounters to telehealth visits utilizing a variety of internet-based videoconferencing applications. Although many aspects of pre–COVID-19 outpatient sports medicine care will ultimately resume, it is likely that telehealth will persist because of its practicality and because of patient demand for access to efficient and convenient health care. Physical examination is widely considered a critical obstacle to a thorough evaluation of sports medicine patients during telehealth visits. However, a closer reflection suggests that a majority of the examination maneuvers are possible virtually with limited, if any, modifications. Thus, we provide a comprehensive shoulder and knee physical examination for sports medicine telehealth visits, including (1) verbal instructions in layman’s terms that can be provided to the patient before or read verbatim during the visit, (2) multimedia options (narrated videos and annotated presentations) of the shoulder and knee examination that can be provided to patients via screen-share options, and (3) a corresponding checklist to aid in documentation.

The Use of Online Video Consultations in the Aftercare of Orthopedic Patients: a Prospective Case-control Study

“…The examination quality could be increased by handing out a checklist to the patients in advance with preparatory information for the telemedicine consultation (22). Although in the presented study OTC have demonstrated limitations in terms of functional tests of a joint with classic examination methods, it seems that with the help of modi cations to those functional tests and the use of assistive devices, it is possible to make reliable statements about this important component of the examination (21,22). Most importantly, analyzing the established procedures in for each case individually, showed that the OTC recommendations for further treatment were similar to the live consultation recommendations in 96% of the cases.…”

The Virtual Shoulder Physical Exam

“…(f) O’Brien (active compression) test with the thumb pointed down and resistance provided by soup cans in grocery bag ( Supplemental Table 7 ). (g) O’Brien test with thumb pointed up [ 24 ].…”

“…The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Sridhar Pinnamaneni, MD; Joseph D. Lamplot Table 7). (g) O'Brien test with thumb pointed up [24].…”

“…Specifically, many providers feel that in a telehealth visit, it is too difficult to perform exam maneuvers that require manual motor testing for strength, motion assessment, and provocative testing for pain. There is a recent study describing basic physical examination components [ 35 ]; in addition we have recently pubilshed an overview of the telehealth examination of the shoulder and knee elsewhere [ 24 ]. Here, we provide a basic overview.…”

The Knee Examination for Video Telemedicine Encounters

“…We have divided the knee examination into a basic examination (core knee examination) and pathology-specific special testing [ 17 ]. The basic examination includes inspection, palpation, range of motion testing, motor testing, sensory testing, and a peripheral vascular examination [ 3 ].…”