Clinical ORthopaedic Exam App (CORE): Portable Physical Diagnosis on the iPhone [App Review]

This App recently received a significant update, including a number of suggestions made by the iMedicalApps team and readers. These changes include the ability to email links of useful videos and PubMed links, a “search” feature, and the ability to save particular entries to a “favorites” list.

One of the most enjoyable aspects of orthopedic surgery is the role of physical examination in diagnosis. The patient may tell you their knee (or hip, shoulder, etc) hurts “sometimes”, and if you’re lucky, they might tell you under what conditions. Your job is figure out which of that joint’s particular ligaments, labrum or tendon is injured.

Luckily, for almost every musculoskeletal ailment, there is a specific physical maneuver to discover the underlying problem. Often, there are several maneuvers for each problem. And, therein lies the problem: How do you remember the specifics of each maneuver, its indications, and the positive and negative findings when its been months or more since the last time you used the maneuver?

It’s with a warm welcome that CORE (“Clinical Orthopedic Exam”) arrives. This iPhone medical application packs a significant amount of text and video for a price of $29.99. Hopefully it will help herald in a new generation of bedside clinical decision-making applications.

Continue on for the full review of the Clinical Orthopedic Exam medical app (This app is for primary care providers as well!).

The authors of CORE were ambitious in their scope. They assembled almost 250 physical exam maneuvers, encompassing all the extremities as well as the spine. For each exam, they have included step by step instructions, positive and negative findings and, most critical, a short video clip of the exam being performed. If that’s not enough, they have also included peer-reviewed references and a quick summary of inter and intra-observer reliability for each exam.

The authors have chosen to store the videos on YouTube, no doubt in part to decrease the size of the application but also to allows them flexibility in the future. There is also a remarkably long legal disclaimer that greets you every time you launch the application. Personally, I find it hard to imagine the “my iPhone made me do it” defense but I suppose there is a proud attorney somewhere who wrote that opaque text. (Editor note: Internet access is required in order to view the videos on this application, Wi-Fi, 3G, or EDGE)

What I liked about this app:

• The sheer scope of exams is an impressive achievement. Covering tendinous, neuropathic, ligamentous problems for each body part
• Reporting reliability statistics for each exam is appropriate and admirable
• Navigating by tapping a body part is very intuitive, also appreciated is having the option to navigate textually
• Being able to view the video within the application is good design

What I did not like about this app:

• The descriptions of test statistics are so full of abbreviations, they are difficult to read – this could be improved (perhaps by small pop-ups when tapped?)
• There are a few navigation quirks. For example the “pathology” button duplicates the “back” button. Traversing the statistical explanations is a bit awkward and tests with more than one name still have their own entries, etc
• The application does not remember where you left off, forcing you to click through the disclaimer and navigation every time you enter

What I would like to see in future updates:

• Sound in the videos would be nice – for some of the videos you have to watch a couple of times to figure out what is being done
• Bookmarks so you can choose your favorites
• Anatomical drawings for selected disorders to make the concept underlying the exam clearer
• A text search box for text based navigation.

Conclusion:

CORE is a great addition to the burgeoning collection of medical applications on the iPhone. On their website, the developers state their interest is developing applications that focus on the musculoskeletal system with the motto “Solutions based on evidence not opinion”. Their target users are healthcare providers in orthopedics, neurosurgery, family medicine, physical therapy, rheumatology, among others. If their first application is any indication, it seems we will have more to celebrate in the future.

iMedicalApps Addenum:

We agree with Dr. Wodajo’s overall review of the app, it’s an excellent application for doing the musculoskeletal portion of the physical exam. We’d like to also stress how this is a great medical application for primary care physicians. All primary care physicians know how important a strong musculoskeletal physican exam can be, as they are often the first line for presenting symptoms.

Dr. Wodajo mentions how having the physican exams available on youtube allows the application to be more flexible, but as we mentioned in our Blausen Human Atlas app review, we think it’s important to have the videos built into the app. Many providers might not have internet access available to them, and even portions of hospitals don’t always have a reliable connection. To users without dedicated internet service, we’re hesitant to recommend this application.

However, if you do have dedicated internet (Wi-Fi, 3G, or EDGE), as most providers do, then this is a brilliant application and we’d definitely recommend it.

[itunes]

[website]