Orthopedics delivered via telehealth. It sounds counterintuitive: how exactly can an orthopedic practice – think injured knee, lower back pain, rotator cuff tear – work remotely? Historically, during orthopedic appointments, doctors use palpations — the method of feeling with fingers during a physical examination — to hone in on the patient’s area of pain and to identify the underlying issue causing it.
However, necessity is the mother of invention. The pandemic forced many areas of medicine to go virtual, and orthopedics was no exception. Miho Tanaka, an orthopedic surgeon at Massachusetts General Hospital, spoke with MedCity News recently in an interview where she weighed in on how her orthopedic practice not only adapted to telemedicine, but how its success prompted her practice to stick with the technology once the crisis period abated.
Orthopedic in-person visits typically include front end paperwork, followed by X-rays or MRIs, then a physical exam where the doctor palpates the problem area to identify the root cause, all culminating in a discussion about where to go next. Going virtual means working how to address the physical aspect. In fact, during the pandemic the physical portion was the sticking point practices initially had to finesse.
“X-rays and MRIs can show pathology, but we are locating actual pain and inflammation [with palpations or resistance],” said Tanaka. “[We have transferred these] techniques to a virtual format.”
What’s interesting is that research supports the efficacy of virtually measuring range of motion, which is a major component of the physical portion of the visit. Other research studies also show that even for things like understanding knee angle, a high-speed connection is sufficient.
Tanaka’s practice has implemented several protocols to help virtual visits run smoothly. For example, patients receive directions on how to prepare for the virtual visit, including everything from having adequate high-speed internet for a video call to how to prepare the physical space around them so the doctor can assess the patient’s movement (e.g. one needs to be 6 feet back from the camera and have the camera 2 feet off the ground, for a knee injury) to having household items to use as weights on hand (like a water bottle, which is roughly 1 pound, or a stapler, which is approximately 1/2 a pound). If the patient has a knee injury, shorts are necessary so the doctor can properly see the knee. This prep work allows the orthopedist to assess the patient effectively and to help the appointment run smoothly.
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