When telehealth expanded during the pandemic, orthopaedics seemed like a bad fit. How do you examine a knee through a screen? How do you feel for a shoulder click over video? The answer is you can't. But it turns out that a surprising amount of orthopaedic care doesn't require hands-on examination, and telehealth has stuck around for good reason.
Here's an honest look at where virtual orthopaedic visits work well, where they fall short, and what to expect if you schedule one.
Where telehealth works
Follow-up appointments. This is the sweet spot. You had surgery six weeks ago, things are going well, and you need a check-in. The surgeon looks at your range of motion on camera, asks about pain and swelling, reviews your PT progress, and clears you for the next phase of recovery. These visits translate well to video. Studies published in the Journal of Bone and Joint Surgery found that patient satisfaction for post-operative telehealth follow-ups was comparable to in-person visits.
Medication management. If you're managing a chronic condition like osteoarthritis or rheumatoid arthritis and need a medication refill or dose adjustment, a video visit handles that efficiently. No need to drive an hour to the office so the doctor can renew your prescription.
Initial consultations for clear-cut problems. You twisted your ankle, went to urgent care, got X-rays showing no fracture, and now you need an orthopaedic opinion on whether you need further treatment. Sending those X-rays ahead and discussing them on video works well. The surgeon can evaluate the imaging, hear your symptoms, and recommend bracing, physical therapy, or an in-person visit if needed.
Pre-surgical planning discussions. Once the surgeon has examined you and reviewed imaging in person, the conversation about surgical options, risks, recovery, and scheduling can happen over video. These are talking-heavy visits. A screen doesn't limit them.
Triage and second opinions. A patient in a rural area, hours from the nearest orthopaedic surgeon, can get an initial assessment via telehealth. The surgeon can review imaging sent ahead of time, hear the history, and determine whether a trip for in-person evaluation is warranted or whether conservative treatment can start immediately.
Physical therapy check-ins. Full PT sessions are better in person, but periodic check-ins to review home exercises and adjust programs work over video. Some patients alternate between in-person and telehealth PT visits, reducing the number of trips.
Where telehealth falls short
Initial evaluations for new problems. If you have shoulder pain that started three months ago and you've never been examined, a video visit has real limitations. The surgeon can't palpate your shoulder, test specific ligaments, assess true strength deficits, or feel for crepitus (grinding). They can watch you move your arm and get a general sense, but they're making decisions with less information.
Some surgeons will do an initial telehealth visit and then bring you in for a focused exam. That can be efficient: the surgeon already knows your story when you walk in.
Acute injuries. If you just injured your knee and can barely walk, you need an in-person evaluation. The surgeon needs to examine the joint for instability, swelling, and specific signs of ligament or meniscus damage.
Injection therapy. Obviously, you can't give a cortisone shot through a screen. If your treatment plan involves injections, that visit is in-person.
Pre-operative physical examination. The clearance exam before surgery, where the surgeon confirms range of motion, skin condition at the surgical site, and overall readiness, needs to be in person.
Complex or uncertain diagnoses. When the surgeon isn't sure what's going on, the physical exam becomes more important. Telehealth works best when the diagnosis is already established or strongly suspected.
What to expect during a telehealth orthopaedic visit
The logistics are straightforward. You'll receive a link via email or patient portal, usually about 15 minutes before the appointment. Click it, allow camera and microphone access, and wait for the provider to join.
Before the visit:
- Send or upload any imaging ahead of time. The visit is much more productive when the surgeon has already reviewed your scans.
- Write down your symptoms and questions, just like an in-person visit.
- Wear clothing that allows easy access to the affected area. Shorts for knee or hip problems. A tank top for shoulder issues.
- Find a well-lit room with stable internet. You may be asked to stand, walk, or move the joint on camera.
During the visit:
- The surgeon will ask you to demonstrate movements. "Show me how far you can bend your knee." "Raise your arm overhead." "Stand up from the chair." This is the telehealth version of the physical exam. It's limited compared to hands-on testing, but it gives the surgeon useful information.
- You might be asked to press on specific areas and report what you feel. "Put your thumb on the bony bump on the outside of your elbow and press. Does that reproduce the pain?"
- The surgeon will review imaging with you, often sharing their screen to show you the X-ray or MRI findings.
Visit length is usually similar to in-person: 10 to 20 minutes for a follow-up, 20 to 30 minutes for a new consultation.
Insurance and cost
Telehealth coverage for orthopaedic visits has stabilized after the pandemic-era expansions. Most commercial insurance plans cover telehealth visits at the same rate as in-person visits. Medicare covers telehealth orthopaedic visits, though geographic and originating-site restrictions have fluctuated. Check with your specific plan.
Your copay is typically the same as an in-person specialist visit. Some plans have lower telehealth copays, but that varies.
Ask the office when scheduling: "Is this visit covered as telehealth under my insurance?" The billing team can verify before your appointment.
When to push for in-person
Even if the office offers a telehealth option, there are situations where you should request an in-person visit:
- You have a new problem that hasn't been physically examined yet
- Your symptoms have changed significantly since your last in-person evaluation
- You're not improving as expected and want a thorough re-examination
- You're a hands-on learner who needs to be physically shown exercises or brace application
- Your internet connection or home setup makes video visits frustrating and unproductive
A good orthopaedic practice will let you choose. If they're pushing telehealth when you want in-person care, or vice versa, that's worth raising with the office.
The hybrid model makes the most sense
The best use of telehealth in orthopaedics isn't replacing in-person care. It's reducing unnecessary trips. If you need six follow-up visits after surgery, maybe three happen in the office and three happen on video. The surgeon examines you at the key milestones and checks in remotely for the routine ones.
For patients in rural areas or with mobility limitations, telehealth removes a real barrier. Driving two hours each way for a ten-minute follow-up is a genuine hardship, and video visits eliminate that when hands-on examination isn't needed.
The remaining limitation is the physical exam, and no amount of technology will replace the information a surgeon gets from putting hands on a joint. Telehealth works best when everyone acknowledges what it can and can't do.