Disclosures: Amanda Moran, DO: No financial relationships or conflicts of interest

Case Diagnosis: Spinal Cord Compression

Case Description: A 70-year-old male with past medical history of left rotator cuff injury repair, chronic neck, back, and shoulder pain was admitted to the hospital for bilateral lower extremity weakness and left arm tremors. After sustaining a mechanical fall, two months prior to admission, he noticed the inability to floss with both of his hands due to weakness, numbness and tingling in all of his fingers and right leg. He also noticed difficulty with ambulation and cramping in his legs. On exam his left deltoid and hand were visibly atrophied with significant weakness in his left shoulder, wrist, and hand. Sensory deficits were present in the left C5-6 distribution and left L1-S1. About three weeks preceding this admission, the patient had two separate telehealth visits with two separate physicians. Many of these symptoms were documented, however no muscle atrophy was observed and sensation was not assessed.

Setting: Academic HospitalAssessment/

Results: Magnetic resonance imaging (MRI) of the cervical and thoracic spine showed severe central canal stenosis with spinal cord compression at C4-5 requiring C3-7 laminoplasty.

Discussion: Telehealth, apart from its financial and convenience advantages, does pose challenges to providing quality health care. Limitations include the length of time it takes to perform the exam as well as the availability and competency in the use of technology. This case demonstrates a complex patient that would have benefited from in-person evaluation much earlier as muscle wasting and sensory deficits could have been easily recognized during routine examination. Developing a set of screening questions for office staff to ask patients when confirming appointments could be beneficial in identifying patients who should have an in-person appointment. Also setting up clear guidelines for examining patients during telehealth visits can avoid such incidents.

Conclusion: Widespread use of telehealth necessitates the development of strategies to overcome its limitations.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/a-case-of-spinal-cord-compression-highlighting-limitations-of-telehealth/