Abadin, Andre A.

BACKGROUND: Telehealth evaluations of musculoskeletal conditions have increased due to the stay-at-home policies enacted during the COVID-19 pandemic. Back pain is one of the most common complaints in primary care. While telehealth may never supplant in-person evaluation of back pain, it is imperative in a changing world to learn to perform this evaluation via telephone or video. Virtual visits rely on history-taking and patient self-reported descriptions of pain elicited from self-palpation or specific movements while on the telephone with the clinician. Video examinations provide a unique way of evaluating the lower back compared to telephone because of the ability to visualize the actions of the patient. OBJECTIVE: To create an evaluation pathway for examination of the lumbar spine via telehealth. METHODS: Our group has created a step-by-step evaluation pathway to help physicians direct their patients through typical lumbar examination elements, including inspection, palpation, range of motion, and strength, special, and functional testing. RESULTS: We have developed a table of questions and instructions and a glossary of images of each maneuver to facilitate lumbar spine examination via telemedicine. CONCLUSIONS: This paper provides a guide for extracting clinically relevant information while performing telemedicine examinations of the lumbar spine.

Although calcific tendinopathy of the shoulder is a relatively common clinical diagnosis, calcific tendinopathy of the rectus femoris tendon near its origin at the anterior inferior iliac spine is rare. We present a case of a 53-year-old female avid runner with left hip pain. Clinical evaluation and X-ray imaging led to a diagnosis of calcific tendinopathy of the rectus femoris tendon. The patient was treated conservatively with non-steroidal anti-inflammatory drugs, physical therapy and rest. Calcific tendinopathy of the rectus femoris tendon can occur rarely in active patients and may be a cause of hip pain, responsive to conservative management, but with other treatment options possible if recalcitrant.