The importance of proper clinical examination for Quality Orthopaedic Upper limb care: Why teleconsultations may not work in the covid era: Pradeep Balasubramanian Discusses

Dr Pradeep Bala

January 17, 2022

upper limb care

Pradeep Balasubramanian, Dubai, explores some of the most common problems of the upper limb and how a good clinical examination can help to diagnose and treat them properly. Upper limb orthopaedic conditions are the commonest presentations to the GP and general orthopaedic surgeon. Optimal diagnosis and treatment of such conditions requires proper and thorough physical examination after adequate exposure of the affected part, supplemented by correlation with quality imaging reported by an experienced radiologist who was supplied with adequate clinical information.

Pradeep Balasubramanian, Dubai explains that most orthopaedic upper limb conditions requiring diagnosis and treatment, rely on sound decision making based on robust clinical examination. Radiological investigations merely supplement a diagnosis already made or help to narrow down the differential diagnosis to the most likely. In some instances, it may help with planning treatment and providing prognosis to patients.

Many patients walk into the clinic with scan reports, a self-made diagnosis and demand answers to questions arising from part knowledge gained from Dr Google. Just as much as they maybe partly right, most of the time they can be wrong. Pradeep Balasubramanian has seen patients walk in with a GP made x-ray diagnosis of cervical spondylosis where in fact that x-ray finding maybe normal for any person of that age and in-fact they had a frozen shoulder! To quote another example patients maybe very anxious about MRI reports of effusion, synovitis and labral tears in the shoulder where again the diagnosis may in-fact just be one of a frozen shoulder. Alternatively, they have an MRI report of mild cervical disc bulge where in fact the diagnosis was scapular dyskinesia or repetitive stress injury of the upper back.

In a world where time is money, many salaried GPs and general orthopaedic surgeons are pressurized by greedy corporates to maximize their output, leading to them trying to see more patients in lesser time. This has led to their overreliance on investigation reports which is merely a 3rd persons interpretations of images with limited clinical information.


With technology, reports can be sent across from around the globe in seconds. People have access to information at the touch of a finger for a second opinion. The down side to this is of course that the person giving the second opinion has never seen or examined the patient and is blindly relying on the clinical skills of the GP/ Surgeon who ordered the index investigation. This can often lead to incorrect advice being given and incorrect treatment been given.

This is why Pradeep Balasubramanian is cautiously optimistic about teleconsultations and feels that, more often than not, it can lead to wrong advice being given without being able to supplement the consultation with a proper physical examination. While Pradeep Balasubramanian respects local and religious beliefs where women from conservative sects may not consent to physical examination, he has often respectfully referred patients onto female colleagues who maybe able to help. If your physician or surgeon has not adequately examined your upper limb problem, Pradeep Balasubramanian will be able to help with an in person consultation. Of course, in the event of another lockdown, there maybe little  choice but to offer a teleconsultation. The effectiveness of a teleconsultation maybe increased with the presence of a GP on the other side to reconfirm clinical findings. He also hopes that authorities imposing restrictions will take into consideration this aspect of the health of the community while enforcing a decision.

According to Pradeep Balasubramanian Dubai, a shoulder, elbow, and hand surgeon in Dubai, United Arab Emirates, most people are prone to some upper limb injury or condition in their lifetime. Pradeep Balasubramanian of Dubai identifies that these problems may require specialist attention.

After having spent over a decade teaching younger surgeons and orthopaedic residents upper limb examination, Pradeep Balasubramanian Dubai will offer the most thorough treatment individualized to every patients clinical findings. He understands how thorough clinical examination and correlation with imaging findings may help to minimize the error associated with incorrect diagnoses or improper treatment advice.  He recommends an in-person consultation even for a second opinion and advises to bring all old images/ CDs rather than just paper or digital reports of investigations for your shoulder elbow and hand condition. He also reminds people to be cautious of clinics/ hospitals offering teleconsultation which is not supplemented with a proper clinical examination. This needs to be scrutinized in detail before accepting treatment advice.

A mindset change with healthcare service providers, GPs, general orthopaedic surgeons and patients suffering from upper limb orthopaedic conditions is the need of the hour. Health is happiness and Dubai is aiming to be the happiest city in the world to live in. After all there are some things money can’t buy, and orthopaedic upper limb health is one of them!

More About Pradeep Balasubramanian

Pradeep Balasubramanian Dubai is a globally trained shoulder, elbow, and hand surgeon. He attended university in India and has completed three fellowships including 2 in Australia. He currently works as a visiting Shoulder Elbow and Hand surgeon in the Emirate of Dubai in UAE.