Virtual musculoskeletal examination using telemedicine

One of the biggest barriers to adoption of telemedicine from the perspective of orthopedic care providers is concern about the ability to do an adequate physical examination. Orthopedic surgeons feel the physical exam is of utmost importance when formulating a differential diagnosis and appropriate treatment plan. However, there are also many situations where a "virtual" physical examination may be enough to appropriately treat a patient. Many established patients that we see in person present for a wound check after surgery, to review medical imaging, and for surveillance exam to ensure that he/she is progressing along the treatment plan or discuss a surgical procedure. In these scenarios, a detailed, thorough physical examination may not be necessary. When seeing new patients, we often use telemedicine to not definitively diagnose and treat them, but more as a screening tool to determine if and when an in-person visit is needed (and with whom) and also to order appropriate imaging beforehand. There are many tips and tricks that one can utilize to ensure that the virtual physical examination is as valuable as possible and that the experience is efficient and rewarding for both parties involved. We have found it useful to make a one-page "tip" sheet that the patient receives prior to the telemedicine visit to outline the specific provider's preferences.