Orthopedics provided through telemedicine. It sounds counterintuitive: Orthopedic practice — think injured knee, low back pain, torn rotator cuff — how exactly does it work remotely?Historically, physicians have used palpation during orthopaedic appointments — How to feel with fingers during physical examination — Gain insight into the patient’s painful area and identify the underlying problem causing the pain.
Necessity, however, is the mother of invention. The pandemic has forced many fields of medicine to go virtual, and orthopedics is no exception. Plastic surgeon Miho Tanaka of Massachusetts General Hospital recently spoke to MedCity News about how her plastic surgery practice has not only adapted to telemedicine, but how its success has prompted her practice to stick with the technology in times of crisis .
An in-person orthopaedic visit typically includes front-end paperwork, followed by an X-ray or MRI, followed by a physical exam, where the doctor palpates the problem area to determine the root cause, all culminating in a discussion of where to go next. Going virtual means looking at how to solve the physical side of the problem. In fact, during the pandemic, the physical part was the sticking point that had to be handled tactfully at first.
“X-rays and MRIs can show pathology, but we’re locating the actual pain and inflammation [with palpations or resistance],” Tanaka said. “[We have transferred these] technology into a virtual format. “
Interestingly Research Supports the efficacy of virtual measurement of range of motion, which is a major component of the physical part of the visit.other research Learn It also shows that even knowing things like knee angle, a high-speed connection is sufficient.
Tanaka’s practice has implemented a variety of protocols to help virtual visits run smoothly. For example, patients receive guidance on how to prepare for a virtual visit, ranging from having enough high-speed internet for a video call to how to prepare the physical space around them so doctors can assess the patient’s movement (e.g., needing to be 6 feet from the camera, The camera is 2 feet off the ground to prevent knee injuries) to having household items on hand as heavy items (like a water bottle, about 1 pound, or a stapler, about 1/2 a pound). If the patient has an injured knee, shorts are required so the doctor can see the knee properly. This preparation enables orthopaedic surgeons to effectively assess patients and help appointments go smoothly.
In virtual physics, the orthopaedic surgeon does not palpate the area, but guides the patient through certain movements and assesses her mobility or lack of mobility, especially comparing one side to the other, to understand the impact of the injury. This can include self-palpation or resistance work.
“This means being able to assess how the patient is [she] walk, how [her] Knee moves, even what [her] The power is in a different place [her] body and what [her] function in [her] Limbs,” Tanaka said. “And then on top of that, we can do things like share screens, check X-rays, or any MRI. [the patient has had done] Then have a discussion. “
Tanaka found that virtual visits actually had significant advantages over face-to-face visits. For example, during telehealth video calls, doctors can use 2D measurements to quickly quantify a patient’s range of motion, such as from a good knee to an injured knee. Tanaka added that this measurement can be done in person, but requires more steps and is not accurate to the millimeter.
Furthermore, the option of virtual visits does benefit the orthopaedic population. Tanaka has several patients in the area who used to travel to her for evaluation and treatment. But if someone has a burnt knee, for example, she may not be able to travel easily in a plane or car and have to use that knee to actually go to the doctor. With virtual visits, patients can meet with doctors without leaving their homes. There’s an added bonus of not having to pay for travel.
Virtualization has another benefit: the patient can see her face. Current safety protocols for in-person visits include doctors wearing masks and other protective gear. However, these are not necessary for telemedicine. Tanaka added that seeing the doctor’s face can be helpful and build trust when discussing surgery or recovery timelines.
In addition, if the patient or family member is at high risk of contracting Covid, telemedicine allows the patient to take no additional risk of exposure, Tanaka said. In addition, she added, patient wait times in telehealth are different than in-person appointments.
She noted that Tanaka does have to obtain additional licenses in other states to treat out-of-state patients, which could deter some orthopaedic surgeons.
“With new patient assessments and tests, I think there are still some limitations there [with the palpations and physical]so the approach is to understand and explain the limitations so that the patient can decide whether to [she] Do you want to start virtualizing,” Tanaka said.
Despite the power of technology and the protocols she painstakingly crafted, if a patient can have a physical visit, Tanaka would prefer to conduct the first visit in person, while subsequent events can be done virtually,
Photo: Maria Symchych-Navrotska, Getty Images
