The Upper Extremity Virtual Orthopaedic Exam: The Primer for an Evolving Necessity

ABSTRACT

INTRODUCTION: Telehealth evaluations have become routinely incorporated into orthopaedic surgical practice due to the COVID- 19 pandemic. These limit the traditional physical exam, which is critical in evaluating orthopedic patients. Therefore, it is imperative to adapt to a "virtual" physical exam, which has been previously described for the lower extremity. This study aims to assess the feasibility of a virtual exam for the upper extremity and evaluate the necessary infrastructure requirements. METHOD(S) A list of the most common physical exam maneuvers and their specificities and sensitivities for shoulder, elbow, and hand and wrist function was aggregated from a systematic review. A simulation of the patient-physician encounter during a virtual upper extremity exam was performed using the instructions of the virtual tests. Photos of each physical exam maneuver were documented and assessed for feasibility. RESULT(S) Many of the special tests have large ranges for specificity and sensitivity. Out of the 11 tests for shoulder function, 5 for elbow function, and 5 for hand and wrist function evaluated in this study, all tests were feasibly replicated by the patient alone in a virtual setting with minimal common household items. CONCLUSION(S) Our assessment shows that a virtual upper extremity exam remains a feasible option. The specificity and sensitivity ranges of physical exam maneuvers performed in the clinic already vary greatly. Thus, translating these maneuvers to a virtual format will not hinder providers' ability to use the exam findings to guide further workup or advanced imaging for diagnosis and subsequent treatment.