Anand M. Murthi, MD, FAAOS

The recent events of the pandemic have given us the unique opportunity to adapt to telemedicine. This manuscript aims to determine the diagnostic accuracy of shoulder clinical exam (SCE) vs. a shoulder telehealth examination (STE).  Movement, strength testing and specialty tests for rotator cuff pathology were determined. MRI was the reference standard. There was no significant difference between the overall effectiveness of the SCE and STE. Essentially what this means is STE is not inferior to SCE. We have seen similar findings in our shoulder population during the pandemic when all new patients were seen over telehealth medicine.

I believe this shows that for major pathology such as traumatic and chronic large cuff tears, a STE is effective. What remains difficult and problematic are the subtle injuries and findings, such as crepitation and scapular mechanics, that cannot be easily identified during STE.

Jeffrey S. Abrams, MD

Many orthopedic surgeons and shoulder specialists have utilized telemedicine communication with new and established patients during the past 6 months due to the COVID-19 pandemic. Although there is greater comfort in performing an “in-person” physical examination, the need for social distancing has taken priority. The accuracy of this process requires additional testing. The authors have made a positive comparison of the telehealth clinical examination with the standard shoulder physical examination to determine its ability to properly diagnose patients with a rotator cuff tear.

This study looked at 62 consecutive patients over 40 years of age who had shoulder pain. Although separate individual tests were helpful, the combined history and telemedicine examination provide comparable accuracy to the in-person examination. The diagnosis in these patients were compared to individual MRI studies made on these interviewed patients.

The history and identifiable factors, ie, age and onset, can lead to a diagnosis in a reasonably high number of patients. The outliers can usually be highlighted with select physical examination tests. Some of these tests can be performed via telemedicine examination, others need hands on examination.

For the general population, telemedicine would serve as a screening tool and reach acceptable accuracy. If symptomatic patients do not improve, an imaging study would add accuracy to the diagnosis. The specific treatment recommended continues to benefit from interpersonal relationship between examiner and patient. It is uncertain whether this important feature can be accomplished with this instrument.

The authors studied and confirmed the ability of a telehealth interview and examination to create a working diagnosis with their studied patients. At times when social distancing is important, or when personally visiting a shoulder specialist is difficult, this practice can substitute in the evaluating process. A greater reliance on imaging studies when offering advice is an important feature.