Optimizing Orthopedic Care in Limited Resource Settings with eConsults

By Dr. Mickey Lui, DO, MPH, presented as a RubiconMD CME Webinar

Access to timely, high-quality orthopedic care remains a challenge for many patients, particularly in resource-limited and rural settings. With long wait times, limited specialists, and high costs, primary care clinicians are often tasked with managing musculoskeletal (MSK) complaints without immediate specialty support.

That’s where eConsults play a powerful role—enabling frontline clinicians to partner with specialists virtually to ensure safe, efficient, and evidence-based orthopedic care.

In this blog, we highlight practical strategies from Dr. Mickey Lui, DO, MPH, a Physical Medicine & Rehabilitation specialist, on evaluating and managing orthopedic concerns in primary care settings while leveraging eConsults effectively. Watch the full CME on-demand here.

A Framework for MSK Complaints: OLDCARTS

A history-driven approach is key. Dr. Lui recommends using the OLDCARTS framework to guide evaluation:

• Onset: When and how symptoms began
• Location: Where pain is felt
• Duration: How long symptoms have persisted
• Character: Quality of pain (sharp, dull, burning, etc.)
• Aggravating factors
• Relieving factors
• Timing: Constant vs. intermittent symptoms
• Severity

This simple, structured approach helps identify potential red/yellow flags and prioritize patients who may need expedited care.

Shoulder, Knee, and Back Pain: Common Cases in Primary Care

Shoulder Pain

• Yellow flags: severe ROM limitations, pain radiating beyond the shoulder
• Red flags: trauma with deformity, inability to move the arm
• Key exercises: wall walks, scapular squeezes, pendulums

Knee Pain

• Yellow flags: pain >6 weeks, mechanical symptoms, recurrent swelling
• Red flags: inability to bear weight, gross deformity, locked knee
• Key exercises: IT band stretch, glute bridges, heel slides

Low Back Pain

• Yellow flags: persistent pain despite care, psychological distress, passive coping
• Red flags: trauma, night pain, neurological deficits, cancer history
• Key exercises: wall side plank, suitcase carry, cat-cow stretch

These targeted maneuvers and simple home exercises allow patients to start conservative care while awaiting specialist input when needed.

Using eConsults Effectively

Too often, specialists receive vague consults like “low back pain – please eval and treat.” Without history, exam findings, or context, such requests are unhelpful and frustrating.

Instead, Dr. Lui recommends a four-step framework:

1. Screen for red/yellow flags
2. Document simple virtual special tests (shoulder, knee, low back, SI joint)
3. Provide a clear OLDCARTS-based history
4. Trial basic conservative exercises before escalating

This approach ensures eConsults are actionable, collaborative, and efficient, improving patient outcomes while strengthening primary-specialty care relationships.

When to Use eConsults vs. In-Person Care

• Appropriate for eConsults: diagnostic clarification, resource-limited settings, confirmation before in-person referral
• Requires in-person consult: red flags, severe pain unresponsive to care, urgent surgical needs

Final Takeaway

In communities where access to orthopedic specialists is limited, eConsults empower primary care clinicians to provide effective MSK management with confidence. By combining a structured clinical framework, targeted conservative exercises, and clear consult documentation, providers can improve care while minimizing unnecessary referrals.

RubiconMD’s eConsult platform helps bridge these gaps—connecting clinicians with board-certified specialists like Dr. Mickey Lui to deliver timely, patient-centered orthopedic care.

About Dr. Mickey Lui, DO

Dr. Mickey Lui, DO, is a board-certified Physical Medicine and Rehabilitation specialist with expertise in osteopathic manipulative medicine and sports medicine. He received his Doctor of Osteopathic Medicine degree from Touro University California and completed his Physical Medicine and Rehabilitation residency at Loma Linda University Health Education Consortium. Dr. Lui has advanced training in multiple manual therapy techniques including myofascial release, muscle energy, counter strain, facilitated positional release, biodynamics, osteopathy in the cranial field, Primal Reflex Release Technique (PRRT), and Kinesio taping. His clinical interests encompass musculoskeletal medicine, non-surgical orthopedics, regenerative medicine, and pain management, with a unique specialization in sports medicine focusing on combat sports, basketball, and eSports. Dr. Lui’s research has been published in peer-reviewed journals including PM & R and the American Journal of Physical Medicine & Rehabilitation, with contributions on topics ranging from regenerative medicine applications to COVID-19 rehabilitation protocols. He has presented extensively at residency conferences and served as a Resident Ambassador for the American Academy of Physical Medicine and Rehabilitation (AAPM&R). With over 11 years of clinical experience, Dr. Lui maintains a practice focused on comprehensive rehabilitation care.