Validity of range of motion, muscle strength, sensitivity, and Tinel sign tele-assessment in adults with traumatic brachial plexus injury

Abstract

Background The COVID-19 pandemic and the need for social distancing created challenges for accessing and providing health services. Telemedicine enables prompt evaluation of patients with traumatic brachial plexus injury, even at a distance, without prejudice to the prognosis. The present study aimed to verify the validity of range of motion, muscle strength, sensitivity, and Tinel sign tele-assessment in adults with traumatic brachial plexus injury (TBPI). Methods A cross-sectional study of twenty-one men and women with TBPI admitted for treatment at a Rehabilitation Hospital Network was conducted. The participants were assessed for range of motion, muscle strength, sensitivity, and Tinel sign at two moments: in-person assessment (IPA) and tele-assessment (TA). Results The TA muscle strength tests presented significant and excellent correlations with the IPA (the intra-rater intraclass correlation coefficient, ICC ranged between 0.79 and 1.00 depending on the muscle tested). The agreement between the TA and IPA range of motion tests ranged from substantial to moderate (weighted kappa coefficient of 0.47–0.76 ( p < 0.05) depending on the joint), and the kappa coefficient did not indicate a statistically significant agreement in the range of motion tests of supination, wrist flexors, shoulder flexors, and shoulder external rotators. The agreement between the IPA andTA sensitivity tests of all innervations ranged from substantial to almost perfect (weighted kappa coefficient 0.61–0.83, p < 0.05) except for the C5 innervation, where the kappa coefficient did not indicate a statistically significant agreement. The IPA versus TA Tinel sign test showed a moderate agreement (weighted kappa coefficient of 0.57, p < 0.05). Conclusions The present study demonstrated that muscle strength tele-assessment is valid in adults with TBPI and presented a strong agreement for many components of TA range of motion, sensitivity, and Tinel sign tests.

Unrecognized sciatic lipomatosis of the nerve diagnosed by telehealth: illustrative case

“…We recognize that a virtual examination is not the same as an in-person examination. In this case, although detailed measurements of limb length, grading of motor strength, and even the presence of a Tinel’s sign in the buttock could not be assessed reliably, 18 the key clinical examination finding was the relatively subtle but plainly visible evidence of nerve territory overgrowth. Although we were able to diagnose the rare condition virtually based on our knowledge of it, we recognize that less experienced surgeons may not have been able to do so.…”

A multidisciplinary approach to the management of brachial plexus injuries: experience from the Mayo Clinic over 100 years

“…In addition, during the COVID-19 pandemic, we had to adapt the use of virtual patient visits by video conferencing technology. While not perfectly ideal for clinical examination and determining muscle motor function or other exam findings, virtual evaluations provided the initial step in determining the urgency and severity of the injury by history and gross evaluation by observation of the patient’s motions (Gushikem, et al., 2022). This initial evaluation enabled efficient clinical appointment and surgical scheduling when necessary.…”