Virtual Care Sports Medicine Examination Patient Guide

Introduction:

In response to increasing provision of virtual care in sports medicine during the 2020 COVID 19 pandemic.  This guide was developed to help patient during virtual encounters with their physician.

The webpage contains:

1. Brief introductory “how to prepare for your virtual visit” video
2. Video example of the virtual wrist examination.
3. Two guides to virtual examination of the musculoskeletal examination upper and lower extremity
4. Basic troubleshooting table for virtual video consultations and review of tips from video

How to prepare for your virtual video appointment!

 

Example of a virtual wrist examination:

 

Patient Instructions:

Printable PDF versions for Download:

Virtual Examination guide to upper body

Upper Extremity – Patient Instructions

Virtual Examination guide to lower body

Lower Extremity – Patient Instructions

 

Upper Extremity

Sports Medicine Virtual Physical Exam Upper Extremity – Patient Instructions

Pre-Visit Patient Preparation

• • • During the physical exam portion of your visit you will be asked to expose your shoulders, back, and neck as you feel comfortable. • Clothing options to help with this include: ▪ Tank top with thin shoulder straps
  • ▪ Sports bra (female)
  • ▪ Removal of shirt (male)
  • ▪ Other

• • Set up your camera so you have an area large enough to accommodate your wingspan ▪ i.e. arms straight out the side at shoulder height

Patient-directed Palpation Diagram

• The following pages contain diagrams that your physician will refer to that will assist with the palpation portion of your physical examination

• Your physician will ask you to press specific locations on your affected joint based on the labelled pictures and numbers.

• Please let your physician know which of these locations become painful with applied pressure.

Sports Medicine Virtual Physical Exam Upper Extremity – Patient Instructions

Shoulder

Figure 1A – Front of Shoulder

Figure 1B – Side of Shoulder

Figure 1C – Back of Shoulder

2 Elbow

Figure 2A – Front of Elbow

Figure 2B – Outside of Elbow

Figure 2C – Inside of elbow

Figure 2D – Back of elbow

Hand/Wrist

Figure 3A – Palm of Hand

Figure 3B – Pinky Side of Wrist

Figure 3C – Thumb Side of Wrist

Figure 3 D Back of Hand

Lower Extremity

Pre-Visit Patient Preparation

• • Please make sure you are wearing a pair of shorts that goes to about mid-thigh.

• • Set up your camera so you have: o An area large enough to walk/squat
• o An Area to lay down (bed, couch, yoga mat)
• o A stationary chair (i.e no wheels) to sit in so that your feet are flat on the floor
• o A Belt or Thera-band

Patient-directed Palpation Diagram

• • The following pages contain diagrams that your physician will refer to that will assist with the palpation portion of your physical examination

• • Your physician will ask you to press specific locations on your affected joint based on the labelled pictures and numbers.

• • Please let your physician know which of these locations become painful with applied pressure.

Sports Medicine Virtual Physical Exam Lower Extremity – Patient Instructions

Foot/Ankle

Figure 4 A – Front of Ankle/Foot

Figure 4B – Inside of Ankle/Foot

Figure 4C – Outside of Ankle/Foot

Figure 4D –Back of Ankle/Foot

Figure 4E – Bottom of Foot

   

Knee

Figure 5A – Front of Knee

Figure 5B – Inside of Knee

Figure 5C- Outside of Knee

Figure 5D – Back of Knee

   

Hip

Figure 6A – Front of Hip

Figure 6B – Outside of Hip

Figure 6C – Back of Hip

Virtual Video Consultation tips for patients:

What will you need?

1) Dedicated computer/Tablet with stand

2) Phone (for backup)

3) Appropriate clothing

4) Space to move your body freely

Limitations:

There are limitations to the physical examination

Quality of connection and equipment can affect communication

An in-person visit may be necessary after your consultation

Setup:

Confirm your appointment time day before

Start up computer

Find link to virtual appointment

Consider reviewing your injury (timeline, events around injury, location of pain)

AND any testing/appts you may have already had

Clothing/Attire:

Upper limb injury – Tshirt/tank top that allows exposure of shoulder if needed as well as arms, elbows wrists and hands.

Lower limb injury (Hips, knees, ankles) – Shorts are preferred

Day of appointment:

Turn on your computer

Turn off: 

• all unnecessary apps and programs
• all other media (TV, Radios) 

Place phone on vibrate

Clear your space of distractions

Consider your attire for potential virtual examination

Starting appointment:

Log on 15 min before appointment

Turn on lights or open blinds to increase natural light to improve visual

Check equipment (sound, video)

Think about your injury (where it hurts, how long it has been hurting, how it’s affecting your functions)

Trouble shooting

Connection Slow	Turn off non-essential programs and apps	Ask others to shut off devices in home on wifi	Try restarting computer
Camera not working	If no greenlight, try clicking on a camera icon in virtual platform	Try rebooting	Ensure you click “allow” platform permission to use camera
Sound not working	Check sound on computer, and virtual platform	Check headphone jack is inserted fully	Try rebooting – Ensure you click “allow” platform permission to use microphone

Authors:

Dr. Alessandro Francella, Dr. Sari Kraft, Dr. Fahim Merali and Dr. Neil Dilworth (April 30, 2020 PR ND AF)