Virtual Video Joint Exam (Updated) Save

Hi, I'm Jack Cush with rheumnow.com. Welcome to my virtual video musculoskeletal examination. Some rules before we start. You need to go over this with a patient. Number one, be at home, not out driving in the car, be in a quiet place.

Any place you can find that's quiet. Second, make sure you have the camera stabilized either it's on your laptop and the lap laptop is upright and stable. Be good if it was elevated with three or four books, or if you're using a hand a cell phone, it needs to be in a holder, in a stand, in a cup, or braced up against a book, because you want the patient to have both hands free. During this examination, you wanna ask the patient, is there anything you wanna show me? Is there one joint that's a problem, something that's new and swollen or painful?

That is where you're gonna have to focus part of your exam. You wanna make sure that you can notice and document a number of different important physical findings that would include redness, swelling, lumps, bumps, bruises, tophi nodules, deformities, and limitation of motion. Include speaking of redness, for patients who have rashes, go ahead, let them try to show you the rash, but it's often not very good on a video exam. Tell them take pictures of rashes, multiple angles, close-up, back far. Same thing for oral lesions.

Take pictures and have them send them into you. Those tend to be way more diagnostic. In addition to the lumps, bumps, bruises, swelling, and whatnot, you can also see things like trigger finger, effusion, nodules, and pain. Look for when the patient winces or verbalizes pain and make note of that. So this exam focuses on inspection, range of motion with contralateral comparison.

It's a game of Simon Says. So Simon says, show me one hand. Tell him not to get too close or too far, find the right range, show me one hand, you can inspect MCPs, PIPs, CMC one. When they have that hand up there, you can then do an MCP squeeze and then a PIP squeeze or finger squeeze and see if they wince or express pain. While their hands are up like this, have them bring the fingers close to the camera so that you can see the nails.

Let me see all the nails. Alright? Look for pitting. Look for onycholysis. Look for fungus, etcetera.

And have them do that with the other hand. So that's the hand exam with the most specific insensitive finding, which is the MCP and PIP squeeze. Next, let's pray, put our hands together, and look for prayer sign. Prayer sign would be when you have contractors, the PIPs, or DIPs usually. Put the hands together.

Tell them to get as tight as possible, then show the top end so you can see whether there's any gaps in there going almost 180 degrees. With the hands still in the prayer position, have them separate the hands this much, and then you can do a finger flexion, again, looking to see they have no problems with their DIPs and PIPs. Tell them get those tight without making a fist, and then tell them to make the fist. So tell them turn towards you, make a fist. Okay?

Have them rake their thumbs across the front to look at CMC one, motion. Have them flex one wrist, flex the other wrist, flex both together. They can extend. While you have the fist up, give them a a fist bump to the camera where you can see the grooves between the MCPs. If there is no groove or dip there, that may be because of synovitis and or swelling.

Okay? Alright. We're done with the hands at this point. You're done flexion extension. Let's look at elbows.

Have them extend their hands out towards the camera. Are they getting those elbows straight? Have them move their arm to the side. Do they have evidence of contracture? And lastly, we're gonna put our hands on our ears and elbows out to look at shoulder range of motion.

That would be ad abduction and external rotation in this position. Have them bring their shoulders back together where you can now see both elbows very, very well, and you're also looking for adduction and internal rotation with this movement. You can lastly examine the TMJ by hands here, open the mouth as far as you can, looking for limited motion or limited oral aperture, neck by doing flexion, extension, lateral bending either way. And then you can end by having them get up and walking so you can see their gait, see if they have any lower extremity problems. They can squat if you think they're having problems with the hip and knee and or weakness.

And they're gonna have to move their camera down and fix it down the ground or have someone else take a picture of what's going on with their knees and feet so you can get a better view of those joints. That's it for the video joint exam. You'll find this useful. And, of course, when a patient has one joint, you're gonna focus more on one joint and have go through more range of motion and more maneuvers with that one joint. That's it.