{"version":"1.0.0","segments":[{"speaker":"Charles Goldfarb","startTime":3.6,"endTime":5.97,"body":"Welcome to the"},{"speaker":"Charles Goldfarb","startTime":3.6,"endTime":5.97,"body":"upper hand podcast where Chuck"},{"speaker":"Charles Goldfarb","startTime":6.0,"endTime":7.53,"body":"and Chris talk Hand Surgery."},{"speaker":"Chris Dy","startTime":7.89,"endTime":9.69,"body":"We are two hand"},{"speaker":"Chris Dy","startTime":7.89,"endTime":9.69,"body":"surgeons at Washington"},{"speaker":"Chris Dy","startTime":9.69,"endTime":12.33,"body":"University in St. Louis here to"},{"speaker":"Chris Dy","startTime":9.69,"endTime":12.33,"body":"talk about all things hand"},{"speaker":"Chris Dy","startTime":12.33,"endTime":14.64,"body":"surgery related from technical"},{"speaker":"Chris Dy","startTime":12.33,"endTime":14.64,"body":"to personal."},{"speaker":"Charles Goldfarb","startTime":15.33,"endTime":17.43,"body":"Please"},{"speaker":"Charles Goldfarb","startTime":15.33,"endTime":17.43,"body":"subscribe, wherever you get your"},{"speaker":"Charles Goldfarb","startTime":17.43,"endTime":18.0,"body":"podcasts."},{"speaker":"Chris Dy","startTime":18.93,"endTime":21.3,"body":"And thank you in"},{"speaker":"Chris Dy","startTime":18.93,"endTime":21.3,"body":"advance for leaving a review and"},{"speaker":"Chris Dy","startTime":21.3,"endTime":23.58,"body":"leaving a rating wherever you"},{"speaker":"Chris Dy","startTime":21.3,"endTime":23.58,"body":"get your podcast."},{"speaker":"Charles Goldfarb","startTime":25.11,"endTime":25.98,"body":"Oh, hey,"},{"speaker":"Charles Goldfarb","startTime":25.11,"endTime":25.98,"body":"Chris."},{"speaker":"Chris Dy","startTime":26.43,"endTime":27.39,"body":"Hey, Chuck, how are"},{"speaker":"Chris Dy","startTime":26.43,"endTime":27.39,"body":"you?"},{"speaker":"Charles Goldfarb","startTime":28.08,"endTime":29.28,"body":"I'm doing"},{"speaker":"Charles Goldfarb","startTime":28.08,"endTime":29.28,"body":"really well. What about"},{"speaker":"Charles Goldfarb","startTime":29.28,"endTime":29.82,"body":"yourself?"},{"speaker":"Chris Dy","startTime":30.06,"endTime":32.73,"body":"Oh, fantastic."},{"speaker":"Chris Dy","startTime":30.06,"endTime":32.73,"body":"Fantastic. Always good to be"},{"speaker":"Chris Dy","startTime":32.73,"endTime":34.83,"body":"here recording again. And then"},{"speaker":"Chris Dy","startTime":32.73,"endTime":34.83,"body":"we're gonna get into one of your"},{"speaker":"Chris Dy","startTime":34.83,"endTime":36.12,"body":"favorite topics today."},{"speaker":"Charles Goldfarb","startTime":36.45,"endTime":40.53,"body":"We are you"},{"speaker":"Charles Goldfarb","startTime":36.45,"endTime":40.53,"body":"know, I, I love elbow. That's"},{"speaker":"Charles Goldfarb","startTime":40.53,"endTime":43.8,"body":"the teaser? And what type of"},{"speaker":"Charles Goldfarb","startTime":40.53,"endTime":43.8,"body":"elbow we're going to discuss,"},{"speaker":"Charles Goldfarb","startTime":43.8,"endTime":45.72,"body":"you'll have to just hang on and"},{"speaker":"Charles Goldfarb","startTime":43.8,"endTime":45.72,"body":"see."},{"speaker":"Chris Dy","startTime":46.2,"endTime":48.81,"body":"Is it that little bity"},{"speaker":"Chris Dy","startTime":46.2,"endTime":48.81,"body":"elbow that you posted on social"},{"speaker":"Chris Dy","startTime":48.81,"endTime":50.88,"body":"media recently? Or is it"},{"speaker":"Chris Dy","startTime":48.81,"endTime":50.88,"body":"something more than that?"},{"speaker":"Charles Goldfarb","startTime":50.97,"endTime":52.5,"body":"Did you like"},{"speaker":"Charles Goldfarb","startTime":50.97,"endTime":52.5,"body":"that? It was little bity. I"},{"speaker":"Charles Goldfarb","startTime":52.5,"endTime":56.28,"body":"didn't know when I printed the"},{"speaker":"Charles Goldfarb","startTime":52.5,"endTime":56.28,"body":"3d model. I had to say I'd like"},{"speaker":"Charles Goldfarb","startTime":56.28,"endTime":57.72,"body":"life size, not miniatures."},{"speaker":"Chris Dy","startTime":60.119,"endTime":61.889,"body":"Objects in mirror are"},{"speaker":"Chris Dy","startTime":60.119,"endTime":61.889,"body":"closer or larger,"},{"speaker":"Charles Goldfarb","startTime":62.61,"endTime":65.13,"body":"or whatever is"},{"speaker":"Charles Goldfarb","startTime":62.61,"endTime":65.13,"body":"so true."},{"speaker":"Chris Dy","startTime":66.39,"endTime":70.65,"body":"So I'm really exciting"},{"speaker":"Chris Dy","startTime":66.39,"endTime":70.65,"body":"stuff for the podcast. We are I"},{"speaker":"Chris Dy","startTime":70.65,"endTime":76.17,"body":"guess we're a solid two years"},{"speaker":"Chris Dy","startTime":70.65,"endTime":76.17,"body":"and seven months into recording"},{"speaker":"Chris Dy","startTime":76.17,"endTime":80.55,"body":"and releasing episodes."},{"speaker":"Chris Dy","startTime":76.17,"endTime":80.55,"body":"Amazingly, we're still here. And"},{"speaker":"Chris Dy","startTime":80.55,"endTime":83.85,"body":"I would say our podcast is"},{"speaker":"Chris Dy","startTime":80.55,"endTime":83.85,"body":"thriving, because we are about"},{"speaker":"Chris Dy","startTime":83.85,"endTime":86.49,"body":"to reach a very exciting"},{"speaker":"Chris Dy","startTime":83.85,"endTime":86.49,"body":"download milestone."},{"speaker":"Charles Goldfarb","startTime":87.0,"endTime":90.36,"body":"It's really, I"},{"speaker":"Charles Goldfarb","startTime":87.0,"endTime":90.36,"body":"think, pretty incredible that we"},{"speaker":"Charles Goldfarb","startTime":90.36,"endTime":93.39,"body":"are by the time this podcast"},{"speaker":"Charles Goldfarb","startTime":90.36,"endTime":93.39,"body":"actually drops we will be well"},{"speaker":"Charles Goldfarb","startTime":93.39,"endTime":95.13,"body":"past this milestone of"},{"speaker":"Chris Dy","startTime":96.0,"endTime":98.58,"body":"200,000 downloads."},{"speaker":"Charles Goldfarb","startTime":99.359,"endTime":102.059,"body":"Yeah. So first"},{"speaker":"Charles Goldfarb","startTime":99.359,"endTime":102.059,"body":"of all, thank you. Thank you to"},{"speaker":"Charles Goldfarb","startTime":102.059,"endTime":107.219,"body":"the listeners. And thanks to"},{"speaker":"Charles Goldfarb","startTime":102.059,"endTime":107.219,"body":"Chris. This has been super fun."},{"speaker":"Charles Goldfarb","startTime":107.219,"endTime":111.869,"body":"And I hope we have another"},{"speaker":"Charles Goldfarb","startTime":107.219,"endTime":111.869,"body":"200,000 is, you know enough"},{"speaker":"Charles Goldfarb","startTime":111.869,"endTime":116.999,"body":"fodder for more downloads, but"},{"speaker":"Charles Goldfarb","startTime":111.869,"endTime":116.999,"body":"I'm really proud. And I hope we"},{"speaker":"Charles Goldfarb","startTime":116.999,"endTime":120.389,"body":"can stay engaging. But we want"},{"speaker":"Charles Goldfarb","startTime":116.999,"endTime":120.389,"body":"to celebrate this."},{"speaker":"Chris Dy","startTime":120.72,"endTime":122.67,"body":"Yes, we absolutely"},{"speaker":"Chris Dy","startTime":120.72,"endTime":122.67,"body":"should. I wanted to thank the"},{"speaker":"Chris Dy","startTime":122.67,"endTime":125.94,"body":"goal for our children for"},{"speaker":"Chris Dy","startTime":122.67,"endTime":125.94,"body":"clicking 200,000 times over the"},{"speaker":"Chris Dy","startTime":125.94,"endTime":129.39,"body":"last two and a half years. I'm"},{"speaker":"Chris Dy","startTime":125.94,"endTime":129.39,"body":"sure they're very exhausted now."},{"speaker":"Chris Dy","startTime":129.42,"endTime":133.38,"body":"But seriously, it is. It is a"},{"speaker":"Chris Dy","startTime":129.42,"endTime":133.38,"body":"it's been a treat. Thank you"},{"speaker":"Chris Dy","startTime":133.38,"endTime":137.01,"body":"Chuck for being a fantastic"},{"speaker":"Chris Dy","startTime":133.38,"endTime":137.01,"body":"partner. And the listeners of"},{"speaker":"Chris Dy","startTime":137.01,"endTime":140.16,"body":"course, you keep us going you"},{"speaker":"Chris Dy","startTime":137.01,"endTime":140.16,"body":"keep us energized, we keep"},{"speaker":"Chris Dy","startTime":140.16,"endTime":145.11,"body":"getting reviews and emails that"},{"speaker":"Chris Dy","startTime":140.16,"endTime":145.11,"body":"just you know, make this a joy."},{"speaker":"Chris Dy","startTime":145.23,"endTime":147.3,"body":"To be very honest, we talked in"},{"speaker":"Chris Dy","startTime":145.23,"endTime":147.3,"body":"the last episode about"},{"speaker":"Chris Dy","startTime":147.3,"endTime":150.48,"body":"leadership stuff and how"},{"speaker":"Chris Dy","startTime":147.3,"endTime":150.48,"body":"sometimes you just run out of"},{"speaker":"Chris Dy","startTime":150.48,"endTime":152.55,"body":"gas on stuff and this is one of"},{"speaker":"Chris Dy","startTime":150.48,"endTime":152.55,"body":"those things where you know,"},{"speaker":"Chris Dy","startTime":152.55,"endTime":154.8,"body":"there is a little bit of inertia"},{"speaker":"Chris Dy","startTime":152.55,"endTime":154.8,"body":"sometimes to kind of get things"},{"speaker":"Chris Dy","startTime":154.8,"endTime":158.73,"body":"going. But once we do it feels"},{"speaker":"Chris Dy","startTime":154.8,"endTime":158.73,"body":"really good. And you know, I"},{"speaker":"Chris Dy","startTime":158.73,"endTime":162.36,"body":"wanted to share our view if"},{"speaker":"Chris Dy","startTime":158.73,"endTime":162.36,"body":"that's okay with everybody. So"},{"speaker":"Chris Dy","startTime":162.36,"endTime":166.92,"body":"we've got a great review. This"},{"speaker":"Chris Dy","startTime":162.36,"endTime":166.92,"body":"one is from Joe Bisante. Joe is"},{"speaker":"Chris Dy","startTime":167.1,"endTime":171.42,"body":"an OT-CHT he in New Jersey, he"},{"speaker":"Chris Dy","startTime":167.1,"endTime":171.42,"body":"gave us five stars. So thank"},{"speaker":"Chris Dy","startTime":171.42,"endTime":174.78,"body":"you, Joe. He says his pod our"},{"speaker":"Chris Dy","startTime":171.42,"endTime":174.78,"body":"podcast is his go to for both"},{"speaker":"Chris Dy","startTime":174.78,"endTime":178.71,"body":"hand surgery therapy topics. And"},{"speaker":"Chris Dy","startTime":174.78,"endTime":178.71,"body":"for entertaining banter. That's"},{"speaker":"Chris Dy","startTime":178.71,"endTime":181.74,"body":"clearly Chuck. I love how you"},{"speaker":"Chris Dy","startTime":178.71,"endTime":181.74,"body":"collaborate with your hand"},{"speaker":"Chris Dy","startTime":181.74,"endTime":186.21,"body":"therapists and how much you"},{"speaker":"Chris Dy","startTime":181.74,"endTime":186.21,"body":"value. How much value you place"},{"speaker":"Chris Dy","startTime":186.21,"endTime":189.3,"body":"in their expertise and"},{"speaker":"Chris Dy","startTime":186.21,"endTime":189.3,"body":"experience. Both of you are"},{"speaker":"Chris Dy","startTime":189.3,"endTime":192.81,"body":"unquestioned experts in"},{"speaker":"Chris Dy","startTime":189.3,"endTime":192.81,"body":"disciplines, yet present present"},{"speaker":"Chris Dy","startTime":192.81,"endTime":195.57,"body":"complex material in an"},{"speaker":"Chris Dy","startTime":192.81,"endTime":195.57,"body":"understandable and relatable"},{"speaker":"Chris Dy","startTime":195.57,"endTime":200.28,"body":"manner. So Joe, thank you."},{"speaker":"Chris Dy","startTime":195.57,"endTime":200.28,"body":"You're a established therapist"},{"speaker":"Chris Dy","startTime":200.28,"endTime":202.8,"body":"in New Jersey and you work at"},{"speaker":"Chris Dy","startTime":200.28,"endTime":202.8,"body":"the Rothman Institute. So we"},{"speaker":"Chris Dy","startTime":202.8,"endTime":206.22,"body":"know you've got some academic"},{"speaker":"Chris Dy","startTime":202.8,"endTime":206.22,"body":"chops as well. So we appreciate"},{"speaker":"Chris Dy","startTime":206.22,"endTime":207.24,"body":"your writing that review. Thank"},{"speaker":"Chris Dy","startTime":206.22,"endTime":207.24,"body":"you."},{"speaker":"Charles Goldfarb","startTime":207.72,"endTime":210.12,"body":"Yeah, thank"},{"speaker":"Charles Goldfarb","startTime":207.72,"endTime":210.12,"body":"you so much. And before Chris"},{"speaker":"Charles Goldfarb","startTime":210.12,"endTime":213.42,"body":"and I talked about the"},{"speaker":"Charles Goldfarb","startTime":210.12,"endTime":213.42,"body":"celebratory giveaway, I want to"},{"speaker":"Charles Goldfarb","startTime":213.42,"endTime":217.68,"body":"share the contents of another"},{"speaker":"Charles Goldfarb","startTime":213.42,"endTime":217.68,"body":"email. Because one of you, Dr."},{"speaker":"Charles Goldfarb","startTime":217.68,"endTime":221.97,"body":"Terry Light, call this out. And"},{"speaker":"Charles Goldfarb","startTime":217.68,"endTime":221.97,"body":"we like that we know we don't"},{"speaker":"Charles Goldfarb","startTime":221.97,"endTime":224.88,"body":"always have all the answers. And"},{"speaker":"Charles Goldfarb","startTime":221.97,"endTime":224.88,"body":"we know there's got to be"},{"speaker":"Charles Goldfarb","startTime":224.88,"endTime":228.18,"body":"bloopers out there that, you"},{"speaker":"Charles Goldfarb","startTime":224.88,"endTime":228.18,"body":"know, we could laugh at and"},{"speaker":"Charles Goldfarb","startTime":228.18,"endTime":232.83,"body":"celebrate. But I made a mistake."},{"speaker":"Charles Goldfarb","startTime":228.18,"endTime":232.83,"body":"And Terry called me on it and"},{"speaker":"Chris Dy","startTime":232.89,"endTime":235.92,"body":"love others. We have a"},{"speaker":"Chris Dy","startTime":232.89,"endTime":235.92,"body":"fact checking listener group. I"},{"speaker":"Chris Dy","startTime":235.92,"endTime":236.46,"body":"love that."},{"speaker":"Charles Goldfarb","startTime":237.0,"endTime":241.08,"body":"Love it. So my"},{"speaker":"Charles Goldfarb","startTime":237.0,"endTime":241.08,"body":"mistake was I referenced George"},{"speaker":"Charles Goldfarb","startTime":241.14,"endTime":247.65,"body":"Kettlecamp in regard to sagittal"},{"speaker":"Charles Goldfarb","startTime":241.14,"endTime":247.65,"body":"band injuries. And the reality"},{"speaker":"Charles Goldfarb","startTime":247.65,"endTime":252.36,"body":"was a couple of things. First of"},{"speaker":"Charles Goldfarb","startTime":247.65,"endTime":252.36,"body":"all, it's not George cattle camp"},{"speaker":"Charles Goldfarb","startTime":252.36,"endTime":255.63,"body":"and if Dr. Kettlecamp as a"},{"speaker":"Charles Goldfarb","startTime":252.36,"endTime":255.63,"body":"listener, I very much apologize."},{"speaker":"Charles Goldfarb","startTime":256.29,"endTime":261.12,"body":"His name is Donald Kettlecamp."},{"speaker":"Charles Goldfarb","startTime":256.29,"endTime":261.12,"body":"And he was at the University of"},{"speaker":"Charles Goldfarb","startTime":261.12,"endTime":265.02,"body":"Iowa and wrote a paper with"},{"speaker":"Charles Goldfarb","startTime":261.12,"endTime":265.02,"body":"Adrienne Flatt and Robert"},{"speaker":"Charles Goldfarb","startTime":265.02,"endTime":268.47,"body":"Moulds. And it talked about"},{"speaker":"Charles Goldfarb","startTime":265.02,"endTime":268.47,"body":"sagittal banditry. So we got the"},{"speaker":"Charles Goldfarb","startTime":268.47,"endTime":273.63,"body":"generalities of the citation"},{"speaker":"Charles Goldfarb","startTime":268.47,"endTime":273.63,"body":"correct. But we made a mistake"},{"speaker":"Charles Goldfarb","startTime":273.66,"endTime":277.77,"body":"and I think the other"},{"speaker":"Charles Goldfarb","startTime":273.66,"endTime":277.77,"body":"interesting thing is Terry's"},{"speaker":"Charles Goldfarb","startTime":277.77,"endTime":282.48,"body":"follow up email where he said"},{"speaker":"Charles Goldfarb","startTime":277.77,"endTime":282.48,"body":"and I agree with this fame is"},{"speaker":"Charles Goldfarb","startTime":282.51,"endTime":287.43,"body":"fleeting. Dr. Kettle camp was on"},{"speaker":"Charles Goldfarb","startTime":282.51,"endTime":287.43,"body":"the American Board of orthopedic"},{"speaker":"Charles Goldfarb","startTime":287.43,"endTime":293.37,"body":"surgery from 1980 to 1986. He"},{"speaker":"Charles Goldfarb","startTime":287.43,"endTime":293.37,"body":"was the frickin AOA president in"},{"speaker":"Charles Goldfarb","startTime":293.37,"endTime":299.55,"body":"1990 and some I like to think of"},{"speaker":"Charles Goldfarb","startTime":293.37,"endTime":299.55,"body":"myself as a student of history"},{"speaker":"Charles Goldfarb","startTime":299.55,"endTime":303.66,"body":"of the field screwed up his"},{"speaker":"Charles Goldfarb","startTime":299.55,"endTime":303.66,"body":"name. So my apologies. And thank"},{"speaker":"Charles Goldfarb","startTime":303.66,"endTime":304.98,"body":"you, Terry for calling me out."},{"speaker":"Chris Dy","startTime":306.24,"endTime":310.11,"body":"It's amazing. For all"},{"speaker":"Chris Dy","startTime":306.24,"endTime":310.11,"body":"the things we talked about in"},{"speaker":"Chris Dy","startTime":310.11,"endTime":313.2,"body":"the last episode for all the"},{"speaker":"Chris Dy","startTime":310.11,"endTime":313.2,"body":"things that we strive for all"},{"speaker":"Chris Dy","startTime":313.2,"endTime":316.5,"body":"the accolades that some of us"},{"speaker":"Chris Dy","startTime":313.2,"endTime":316.5,"body":"shoot for, at the end of the"},{"speaker":"Chris Dy","startTime":316.5,"endTime":321.45,"body":"day, only your family is going"},{"speaker":"Chris Dy","startTime":316.5,"endTime":321.45,"body":"to remember making sure you"},{"speaker":"Chris Dy","startTime":321.45,"endTime":324.9,"body":"prioritize that. But Terry,"},{"speaker":"Chris Dy","startTime":321.45,"endTime":324.9,"body":"thank you for for pointing that"},{"speaker":"Chris Dy","startTime":324.9,"endTime":328.74,"body":"out. And I'm glad Dr. Kettlecamp"},{"speaker":"Chris Dy","startTime":324.9,"endTime":328.74,"body":"has been given his his shine"},{"speaker":"Chris Dy","startTime":329.79,"endTime":334.05,"body":"through through an email from"},{"speaker":"Chris Dy","startTime":329.79,"endTime":334.05,"body":"you, Terry. So Chuck, what"},{"speaker":"Chris Dy","startTime":334.05,"endTime":337.74,"body":"should we give away to celebrate"},{"speaker":"Chris Dy","startTime":334.05,"endTime":337.74,"body":"200,000 downloads?"},{"speaker":"Charles Goldfarb","startTime":338.4,"endTime":342.48,"body":"Well, I think"},{"speaker":"Charles Goldfarb","startTime":338.4,"endTime":342.48,"body":"one thing that we have, that"},{"speaker":"Charles Goldfarb","startTime":342.66,"endTime":348.69,"body":"I've been not so great about"},{"speaker":"Charles Goldfarb","startTime":342.66,"endTime":348.69,"body":"fully utilizing are books, and I"},{"speaker":"Charles Goldfarb","startTime":348.69,"endTime":351.81,"body":"read lots of books. But when you"},{"speaker":"Charles Goldfarb","startTime":348.69,"endTime":351.81,"body":"and I edit books, we typically"},{"speaker":"Charles Goldfarb","startTime":351.81,"endTime":357.09,"body":"get a copy of the book. And so I"},{"speaker":"Charles Goldfarb","startTime":351.81,"endTime":357.09,"body":"think that you and I would each"},{"speaker":"Charles Goldfarb","startTime":357.27,"endTime":362.91,"body":"like to provide a signed copy of"},{"speaker":"Charles Goldfarb","startTime":357.27,"endTime":362.91,"body":"a recent textbook that we have"},{"speaker":"Charles Goldfarb","startTime":362.91,"endTime":368.58,"body":"either edited or contributed to,"},{"speaker":"Charles Goldfarb","startTime":362.91,"endTime":368.58,"body":"and make it available for a"},{"speaker":"Charles Goldfarb","startTime":368.61,"endTime":369.87,"body":"survey winner."},{"speaker":"Chris Dy","startTime":370.56,"endTime":373.77,"body":"That Chuck, what kind"},{"speaker":"Chris Dy","startTime":370.56,"endTime":373.77,"body":"of narcissistic ideas who came"},{"speaker":"Chris Dy","startTime":373.83,"endTime":377.43,"body":"up with that idea? You think"},{"speaker":"Chris Dy","startTime":373.83,"endTime":377.43,"body":"people are gonna want a book"},{"speaker":"Chris Dy","startTime":377.43,"endTime":379.74,"body":"signed by one of us? Hey,"},{"speaker":"Chris Dy","startTime":377.43,"endTime":379.74,"body":"listen,"},{"speaker":"Charles Goldfarb","startTime":379.74,"endTime":382.05,"body":"it's a free"},{"speaker":"Charles Goldfarb","startTime":379.74,"endTime":382.05,"body":"book. And it wasn't. But it's a"},{"speaker":"Charles Goldfarb","startTime":382.05,"endTime":383.46,"body":"free book. So I think"},{"speaker":"Chris Dy","startTime":383.46,"endTime":386.46,"body":"one of us came up with"},{"speaker":"Chris Dy","startTime":383.46,"endTime":386.46,"body":"that idea. I think that'd be a"},{"speaker":"Chris Dy","startTime":386.46,"endTime":388.83,"body":"fun thing to do. It's literally"},{"speaker":"Chris Dy","startTime":386.46,"endTime":388.83,"body":"the only thing we have. But we"},{"speaker":"Chris Dy","startTime":388.83,"endTime":390.96,"body":"still get asked about mugs. And"},{"speaker":"Chris Dy","startTime":388.83,"endTime":390.96,"body":"I think there are a couple of"},{"speaker":"Chris Dy","startTime":390.96,"endTime":395.04,"body":"left. So maybe maybe those will"},{"speaker":"Chris Dy","startTime":390.96,"endTime":395.04,"body":"make their way out to so Chuck,"},{"speaker":"Chris Dy","startTime":395.04,"endTime":400.5,"body":"how does one enter into this"},{"speaker":"Chris Dy","startTime":395.04,"endTime":400.5,"body":"drawing for the textbook"},{"speaker":"Chris Dy","startTime":400.5,"endTime":401.13,"body":"package,"},{"speaker":"Charles Goldfarb","startTime":401.16,"endTime":402.93,"body":"I'm not going"},{"speaker":"Charles Goldfarb","startTime":401.16,"endTime":402.93,"body":"to disclose that on the air,"},{"speaker":"Charles Goldfarb","startTime":402.93,"endTime":407.07,"body":"Chris, here's what I'm going to"},{"speaker":"Charles Goldfarb","startTime":402.93,"endTime":407.07,"body":"do. If you have not signed up"},{"speaker":"Charles Goldfarb","startTime":407.07,"endTime":411.18,"body":"for our email newsletter, and I"},{"speaker":"Charles Goldfarb","startTime":407.07,"endTime":411.18,"body":"promise we will not spam me too"},{"speaker":"Charles Goldfarb","startTime":411.18,"endTime":413.91,"body":"much. I'll send a couple emails"},{"speaker":"Charles Goldfarb","startTime":411.18,"endTime":413.91,"body":"about this, go to the show"},{"speaker":"Charles Goldfarb","startTime":413.91,"endTime":418.2,"body":"notes. The signup is there. And"},{"speaker":"Charles Goldfarb","startTime":413.91,"endTime":418.2,"body":"if you sign up, there'll be more"},{"speaker":"Charles Goldfarb","startTime":418.2,"endTime":423.54,"body":"information to come in the in"},{"speaker":"Charles Goldfarb","startTime":418.2,"endTime":423.54,"body":"the weeks ahead about how to"},{"speaker":"Charles Goldfarb","startTime":423.57,"endTime":429.06,"body":"qualify for the drawing for a"},{"speaker":"Charles Goldfarb","startTime":423.57,"endTime":429.06,"body":"textbook or mug. We're also"},{"speaker":"Charles Goldfarb","startTime":429.06,"endTime":432.66,"body":"going to set up a new survey"},{"speaker":"Charles Goldfarb","startTime":429.06,"endTime":432.66,"body":"because we want to understand"},{"speaker":"Charles Goldfarb","startTime":432.66,"endTime":435.87,"body":"what you like and don't like"},{"speaker":"Charles Goldfarb","startTime":432.66,"endTime":435.87,"body":"about our podcast. And so"},{"speaker":"Charles Goldfarb","startTime":436.11,"endTime":441.12,"body":"they'll be two bits of"},{"speaker":"Charles Goldfarb","startTime":436.11,"endTime":441.12,"body":"information. And both will be"},{"speaker":"Charles Goldfarb","startTime":441.12,"endTime":443.94,"body":"available in the show notes. And"},{"speaker":"Charles Goldfarb","startTime":441.12,"endTime":443.94,"body":"we would really, really"},{"speaker":"Charles Goldfarb","startTime":443.94,"endTime":445.71,"body":"appreciate your interaction with"},{"speaker":"Charles Goldfarb","startTime":443.94,"endTime":445.71,"body":"that."},{"speaker":"Chris Dy","startTime":446.49,"endTime":450.54,"body":"Absolutely. So please,"},{"speaker":"Chris Dy","startTime":446.49,"endTime":450.54,"body":"please sign up for for that on"},{"speaker":"Chris Dy","startTime":450.54,"endTime":455.22,"body":"the show notes and help us"},{"speaker":"Chris Dy","startTime":450.54,"endTime":455.22,"body":"celebrate a huge milestone. Now,"},{"speaker":"Chris Dy","startTime":455.43,"endTime":458.25,"body":"I can't think of a better way to"},{"speaker":"Chris Dy","startTime":455.43,"endTime":458.25,"body":"celebrate than to give chuck a"},{"speaker":"Chris Dy","startTime":458.25,"endTime":462.03,"body":"topic that he just loves it. You"},{"speaker":"Chris Dy","startTime":458.25,"endTime":462.03,"body":"know, he really tried to pull in"},{"speaker":"Chris Dy","startTime":462.03,"endTime":464.37,"body":"some perineal nerve and I said,"},{"speaker":"Chris Dy","startTime":462.03,"endTime":464.37,"body":"You know what, Chuck, our"},{"speaker":"Chris Dy","startTime":464.37,"endTime":467.97,"body":"listeners are not ready for that"},{"speaker":"Chris Dy","startTime":464.37,"endTime":467.97,"body":"yet. It's a lower extremity."},{"speaker":"Chris Dy","startTime":468.0,"endTime":470.67,"body":"It's a nerve, you're really"},{"speaker":"Chris Dy","startTime":468.0,"endTime":470.67,"body":"going to push some people away."},{"speaker":"Chris Dy","startTime":470.67,"endTime":472.89,"body":"And he said we could talk about"},{"speaker":"Chris Dy","startTime":470.67,"endTime":472.89,"body":"ligament injuries and stuff. I"},{"speaker":"Chris Dy","startTime":472.89,"endTime":476.16,"body":"said, Okay, maybe one day, but"},{"speaker":"Chris Dy","startTime":472.89,"endTime":476.16,"body":"how about we talk about"},{"speaker":"Chris Dy","startTime":476.16,"endTime":478.98,"body":"something that you love,"},{"speaker":"Chris Dy","startTime":476.16,"endTime":478.98,"body":"potholes in the elbow?"},{"speaker":"Charles Goldfarb","startTime":479.94,"endTime":482.19,"body":"I do like"},{"speaker":"Charles Goldfarb","startTime":479.94,"endTime":482.19,"body":"potholes not in the St. Louis"},{"speaker":"Charles Goldfarb","startTime":482.19,"endTime":487.26,"body":"streets, which they have way too"},{"speaker":"Charles Goldfarb","startTime":482.19,"endTime":487.26,"body":"many. And don't let Chris valea"},{"speaker":"Charles Goldfarb","startTime":487.29,"endTime":491.67,"body":"y'all, he wants to always talk"},{"speaker":"Charles Goldfarb","startTime":487.29,"endTime":491.67,"body":"about nerve. But I think we're"},{"speaker":"Charles Goldfarb","startTime":491.67,"endTime":494.22,"body":"gonna talk about elbow OCDs, and"},{"speaker":"Charles Goldfarb","startTime":491.67,"endTime":494.22,"body":"it's gonna be a focused"},{"speaker":"Charles Goldfarb","startTime":494.22,"endTime":498.45,"body":"discussion. I know all the"},{"speaker":"Charles Goldfarb","startTime":494.22,"endTime":498.45,"body":"listeners won't necessarily like"},{"speaker":"Charles Goldfarb","startTime":498.48,"endTime":500.82,"body":"the topic, but I'll tell you"},{"speaker":"Charles Goldfarb","startTime":498.48,"endTime":500.82,"body":"this. I think there's some"},{"speaker":"Charles Goldfarb","startTime":500.82,"endTime":505.53,"body":"generalities from this, and some"},{"speaker":"Charles Goldfarb","startTime":500.82,"endTime":505.53,"body":"frustrations with this, that"},{"speaker":"Charles Goldfarb","startTime":505.53,"endTime":509.04,"body":"maybe we'll you know, everyone"},{"speaker":"Charles Goldfarb","startTime":505.53,"endTime":509.04,"body":"will appreciate. So let me share"},{"speaker":"Charles Goldfarb","startTime":509.04,"endTime":515.25,"body":"a case with you maybe as a way"},{"speaker":"Charles Goldfarb","startTime":509.04,"endTime":515.25,"body":"to get going. I have a 13 year"},{"speaker":"Charles Goldfarb","startTime":515.25,"endTime":523.71,"body":"old female who is into cheer."},{"speaker":"Charles Goldfarb","startTime":515.25,"endTime":523.71,"body":"And that always, for me at least"},{"speaker":"Charles Goldfarb","startTime":523.71,"endTime":527.13,"body":"takes some digging to understand"},{"speaker":"Charles Goldfarb","startTime":523.71,"endTime":527.13,"body":"really what that means. You"},{"speaker":"Charles Goldfarb","startTime":527.13,"endTime":529.38,"body":"know, gymnastics is pretty easy."},{"speaker":"Charles Goldfarb","startTime":527.13,"endTime":529.38,"body":"You know, I'm a level nine"},{"speaker":"Charles Goldfarb","startTime":529.38,"endTime":531.99,"body":"gymnasts, I do this, and that"},{"speaker":"Charles Goldfarb","startTime":529.38,"endTime":531.99,"body":"with cheer has all kinds of"},{"speaker":"Charles Goldfarb","startTime":531.99,"endTime":535.11,"body":"gradations. But she's very"},{"speaker":"Charles Goldfarb","startTime":531.99,"endTime":535.11,"body":"active, and she does tumbling as"},{"speaker":"Charles Goldfarb","startTime":535.11,"endTime":538.77,"body":"part of her chair. And she does"},{"speaker":"Charles Goldfarb","startTime":535.11,"endTime":538.77,"body":"stunning west part of her chair."},{"speaker":"Charles Goldfarb","startTime":538.77,"endTime":541.68,"body":"So she's very active and was a"},{"speaker":"Charles Goldfarb","startTime":538.77,"endTime":541.68,"body":"previous gymnast, and she's"},{"speaker":"Charles Goldfarb","startTime":541.68,"endTime":547.02,"body":"developed right elbow pain. And"},{"speaker":"Charles Goldfarb","startTime":541.68,"endTime":547.02,"body":"her elbow actually lacks"},{"speaker":"Charles Goldfarb","startTime":547.05,"endTime":552.78,"body":"extension. So her elbow motion"},{"speaker":"Charles Goldfarb","startTime":547.05,"endTime":552.78,"body":"is 35 to 140. And her rotation"},{"speaker":"Charles Goldfarb","startTime":552.78,"endTime":556.77,"body":"is full. She does not have"},{"speaker":"Charles Goldfarb","startTime":552.78,"endTime":556.77,"body":"mechanical symptoms, but she has"},{"speaker":"Charles Goldfarb","startTime":556.77,"endTime":560.4,"body":"some pain and she can't"},{"speaker":"Charles Goldfarb","startTime":556.77,"endTime":560.4,"body":"straighten her elbow, and she's"},{"speaker":"Charles Goldfarb","startTime":560.4,"endTime":560.91,"body":"frustrated."},{"speaker":"Chris Dy","startTime":561.72,"endTime":564.75,"body":"Now, was there a"},{"speaker":"Chris Dy","startTime":561.72,"endTime":564.75,"body":"specific injury traumatic"},{"speaker":"Chris Dy","startTime":564.75,"endTime":567.03,"body":"episode antecedent event that"},{"speaker":"Chris Dy","startTime":564.75,"endTime":567.03,"body":"led to this?"},{"speaker":"Charles Goldfarb","startTime":567.48,"endTime":571.41,"body":"She had some"},{"speaker":"Charles Goldfarb","startTime":567.48,"endTime":571.41,"body":"pain or aching pain in the elbow"},{"speaker":"Charles Goldfarb","startTime":571.62,"endTime":575.16,"body":"over a couple of months, but"},{"speaker":"Charles Goldfarb","startTime":571.62,"endTime":575.16,"body":"there was not one specific"},{"speaker":"Charles Goldfarb","startTime":575.16,"endTime":580.02,"body":"event, just a realization over"},{"speaker":"Charles Goldfarb","startTime":575.16,"endTime":580.02,"body":"time that she couldn't fully"},{"speaker":"Charles Goldfarb","startTime":580.02,"endTime":580.8,"body":"straighten her elbow."},{"speaker":"Chris Dy","startTime":581.1,"endTime":583.05,"body":"How does one go that"},{"speaker":"Chris Dy","startTime":581.1,"endTime":583.05,"body":"long without being able to"},{"speaker":"Chris Dy","startTime":583.08,"endTime":584.91,"body":"noticing that you can't"},{"speaker":"Chris Dy","startTime":583.08,"endTime":584.91,"body":"straighten your elbow?"},{"speaker":"Charles Goldfarb","startTime":585.27,"endTime":588.45,"body":"I certainly"},{"speaker":"Charles Goldfarb","startTime":585.27,"endTime":588.45,"body":"would expect there was a"},{"speaker":"Charles Goldfarb","startTime":588.45,"endTime":591.48,"body":"critical event but she didn't"},{"speaker":"Charles Goldfarb","startTime":588.45,"endTime":591.48,"body":"remember it. And it didn't cause"},{"speaker":"Charles Goldfarb","startTime":591.48,"endTime":595.53,"body":"pain. And I'll say this is not"},{"speaker":"Charles Goldfarb","startTime":591.48,"endTime":595.53,"body":"the common scenario. The common"},{"speaker":"Charles Goldfarb","startTime":595.53,"endTime":599.88,"body":"scenario is full motion, maybe"},{"speaker":"Charles Goldfarb","startTime":595.53,"endTime":599.88,"body":"some mechanical symptoms like"},{"speaker":"Charles Goldfarb","startTime":599.88,"endTime":603.63,"body":"some clicking or even some"},{"speaker":"Charles Goldfarb","startTime":599.88,"endTime":603.63,"body":"catching or locking. But this is"},{"speaker":"Charles Goldfarb","startTime":603.63,"endTime":606.78,"body":"real. And this is how this young"},{"speaker":"Charles Goldfarb","startTime":603.63,"endTime":606.78,"body":"lady presented."},{"speaker":"Chris Dy","startTime":608.28,"endTime":611.67,"body":"Okay, so are you the"},{"speaker":"Chris Dy","startTime":608.28,"endTime":611.67,"body":"first person she's seen for"},{"speaker":"Chris Dy","startTime":611.67,"endTime":615.54,"body":"this? How many people have these"},{"speaker":"Chris Dy","startTime":611.67,"endTime":615.54,"body":"patients typically seen before"},{"speaker":"Chris Dy","startTime":615.54,"endTime":619.68,"body":"they get to the Tsar, the guru,"},{"speaker":"Chris Dy","startTime":615.54,"endTime":619.68,"body":"The Wizard of Oz Chuck Goldfarb."},{"speaker":"Charles Goldfarb","startTime":620.88,"endTime":622.77,"body":"highly"},{"speaker":"Charles Goldfarb","startTime":620.88,"endTime":622.77,"body":"variable. But they've almost"},{"speaker":"Charles Goldfarb","startTime":622.77,"endTime":625.92,"body":"always seen at least another"},{"speaker":"Charles Goldfarb","startTime":622.77,"endTime":625.92,"body":"physician, maybe an APP, this"},{"speaker":"Charles Goldfarb","startTime":625.92,"endTime":630.15,"body":"young lady had seen a physician"},{"speaker":"Charles Goldfarb","startTime":625.92,"endTime":630.15,"body":"who recommended rest for this."},{"speaker":"Charles Goldfarb","startTime":631.38,"endTime":635.31,"body":"And unfortunately, that that"},{"speaker":"Charles Goldfarb","startTime":631.38,"endTime":635.31,"body":"wasn't the right answer, when"},{"speaker":"Charles Goldfarb","startTime":635.31,"endTime":638.28,"body":"you really lack motion or have"},{"speaker":"Charles Goldfarb","startTime":635.31,"endTime":638.28,"body":"significant mechanical symptoms,"},{"speaker":"Charles Goldfarb","startTime":638.58,"endTime":642.81,"body":"I don't believe rest is the"},{"speaker":"Charles Goldfarb","startTime":638.58,"endTime":642.81,"body":"answer. Just to kind of go down"},{"speaker":"Charles Goldfarb","startTime":642.81,"endTime":647.46,"body":"that pathway, rest might be the"},{"speaker":"Charles Goldfarb","startTime":642.81,"endTime":647.46,"body":"answer for kids with those CDs,"},{"speaker":"Charles Goldfarb","startTime":647.46,"endTime":652.62,"body":"Once diagnosed, if there's no"},{"speaker":"Charles Goldfarb","startTime":647.46,"endTime":652.62,"body":"displacement of the OCD, and if"},{"speaker":"Charles Goldfarb","startTime":652.62,"endTime":656.79,"body":"the child is younger, especially"},{"speaker":"Charles Goldfarb","startTime":652.62,"endTime":656.79,"body":"rest, and giving the body a"},{"speaker":"Charles Goldfarb","startTime":656.79,"endTime":658.53,"body":"chance to heal can be super"},{"speaker":"Charles Goldfarb","startTime":656.79,"endTime":658.53,"body":"helpful."},{"speaker":"Chris Dy","startTime":659.19,"endTime":661.83,"body":"So rewind back for me,"},{"speaker":"Chris Dy","startTime":659.19,"endTime":661.83,"body":"and let's talk about you know,"},{"speaker":"Chris Dy","startTime":661.83,"endTime":665.07,"body":"the differential and how you get"},{"speaker":"Chris Dy","startTime":661.83,"endTime":665.07,"body":"to the right diagnosis on your"},{"speaker":"Chris Dy","startTime":665.07,"endTime":667.71,"body":"questioning because I think of"},{"speaker":"Chris Dy","startTime":665.07,"endTime":667.71,"body":"you know, an adolescent athlete."},{"speaker":"Chris Dy","startTime":668.46,"endTime":670.32,"body":"And even if they're not a"},{"speaker":"Chris Dy","startTime":668.46,"endTime":670.32,"body":"thrower, or maybe it is"},{"speaker":"Chris Dy","startTime":670.32,"endTime":672.93,"body":"something that is more of an"},{"speaker":"Chris Dy","startTime":670.32,"endTime":672.93,"body":"overuse kind of thing, and how"},{"speaker":"Chris Dy","startTime":672.93,"endTime":677.01,"body":"do you distinguish an overuse"},{"speaker":"Chris Dy","startTime":672.93,"endTime":677.01,"body":"kind of thing? versus kind of"},{"speaker":"Chris Dy","startTime":677.01,"endTime":680.01,"body":"pain inhibition versus an actual"},{"speaker":"Chris Dy","startTime":677.01,"endTime":680.01,"body":"OCD? Like, what are the"},{"speaker":"Chris Dy","startTime":680.01,"endTime":682.98,"body":"questions that you are asking on"},{"speaker":"Chris Dy","startTime":680.01,"endTime":682.98,"body":"your history that are going to"},{"speaker":"Chris Dy","startTime":682.98,"endTime":684.0,"body":"lead you down this route?"},{"speaker":"Charles Goldfarb","startTime":684.54,"endTime":686.13,"body":"It's a great"},{"speaker":"Charles Goldfarb","startTime":684.54,"endTime":686.13,"body":"point, it's a great point, you"},{"speaker":"Charles Goldfarb","startTime":686.13,"endTime":688.77,"body":"do want to understand the timing"},{"speaker":"Charles Goldfarb","startTime":686.13,"endTime":688.77,"body":"and the material, you know, kind"},{"speaker":"Charles Goldfarb","startTime":688.77,"endTime":691.65,"body":"of what happened? And then you"},{"speaker":"Charles Goldfarb","startTime":688.77,"endTime":691.65,"body":"don't always get a great answer."},{"speaker":"Charles Goldfarb","startTime":691.68,"endTime":694.86,"body":"But that's an important part of"},{"speaker":"Charles Goldfarb","startTime":691.68,"endTime":694.86,"body":"the history. If it is a gymnast,"},{"speaker":"Charles Goldfarb","startTime":694.86,"endTime":697.17,"body":"you want to understand what"},{"speaker":"Charles Goldfarb","startTime":694.86,"endTime":697.17,"body":"level what do they do if it's a"},{"speaker":"Charles Goldfarb","startTime":697.17,"endTime":700.59,"body":"baseball player, you want to"},{"speaker":"Charles Goldfarb","startTime":697.17,"endTime":700.59,"body":"understand how many innings"},{"speaker":"Charles Goldfarb","startTime":700.59,"endTime":703.32,"body":"they're throwing, and what type"},{"speaker":"Charles Goldfarb","startTime":700.59,"endTime":703.32,"body":"of pitches they throw? Those are"},{"speaker":"Charles Goldfarb","startTime":703.32,"endTime":706.53,"body":"all super important. You"},{"speaker":"Charles Goldfarb","startTime":703.32,"endTime":706.53,"body":"understand one, understand"},{"speaker":"Charles Goldfarb","startTime":706.53,"endTime":709.17,"body":"what's been done, you know, what"},{"speaker":"Charles Goldfarb","startTime":706.53,"endTime":709.17,"body":"have you tried, have you tried"},{"speaker":"Charles Goldfarb","startTime":709.17,"endTime":714.0,"body":"rest what is rest mean? And just"},{"speaker":"Charles Goldfarb","startTime":709.17,"endTime":714.0,"body":"kind of go down those pathways."},{"speaker":"Charles Goldfarb","startTime":714.0,"endTime":717.69,"body":"And so it's not necessarily"},{"speaker":"Charles Goldfarb","startTime":714.0,"endTime":717.69,"body":"super quick. And then you really"},{"speaker":"Charles Goldfarb","startTime":717.69,"endTime":720.72,"body":"have to do a careful exam. And"},{"speaker":"Charles Goldfarb","startTime":717.69,"endTime":720.72,"body":"so on my exam, I focused on a"},{"speaker":"Charles Goldfarb","startTime":720.72,"endTime":724.05,"body":"couple of things. Even though I"},{"speaker":"Charles Goldfarb","startTime":720.72,"endTime":724.05,"body":"might hear that there's no pain"},{"speaker":"Charles Goldfarb","startTime":724.05,"endTime":726.78,"body":"or here that pain is lateral, I"},{"speaker":"Charles Goldfarb","startTime":724.05,"endTime":726.78,"body":"still focus on the medial elbow"},{"speaker":"Charles Goldfarb","startTime":726.78,"endTime":730.68,"body":"to start, I examine the UCL"},{"speaker":"Charles Goldfarb","startTime":726.78,"endTime":730.68,"body":"moving valgus stress test, I"},{"speaker":"Charles Goldfarb","startTime":730.68,"endTime":735.27,"body":"examined the older nerve, I"},{"speaker":"Charles Goldfarb","startTime":730.68,"endTime":735.27,"body":"examined the triceps, and then I"},{"speaker":"Charles Goldfarb","startTime":735.27,"endTime":738.3,"body":"go laterally, and I examined the"},{"speaker":"Charles Goldfarb","startTime":735.27,"endTime":738.3,"body":"gutter. I want to feel the"},{"speaker":"Charles Goldfarb","startTime":738.3,"endTime":741.36,"body":"radial capital or joint, I want"},{"speaker":"Charles Goldfarb","startTime":738.3,"endTime":741.36,"body":"to make sure there's no nerve"},{"speaker":"Charles Goldfarb","startTime":741.36,"endTime":744.63,"body":"pathology. So comprehensive"},{"speaker":"Charles Goldfarb","startTime":741.36,"endTime":744.63,"body":"exam, which can thankfully be"},{"speaker":"Charles Goldfarb","startTime":744.63,"endTime":748.32,"body":"done pretty quickly. I will say"},{"speaker":"Charles Goldfarb","startTime":744.63,"endTime":748.32,"body":"I'm babbling. I will say one of"},{"speaker":"Charles Goldfarb","startTime":748.32,"endTime":752.61,"body":"the things that I found that"},{"speaker":"Charles Goldfarb","startTime":748.32,"endTime":752.61,"body":"super interest lately is this"},{"speaker":"Charles Goldfarb","startTime":752.61,"endTime":756.21,"body":"pain inhibition can be a real"},{"speaker":"Charles Goldfarb","startTime":752.61,"endTime":756.21,"body":"thing in the very young"},{"speaker":"Charles Goldfarb","startTime":756.21,"endTime":760.35,"body":"adolescent, and that often is"},{"speaker":"Charles Goldfarb","startTime":756.21,"endTime":760.35,"body":"nerve related. And the nerve"},{"speaker":"Charles Goldfarb","startTime":760.35,"endTime":763.5,"body":"findings can be subtle. And then"},{"speaker":"Charles Goldfarb","startTime":760.35,"endTime":763.5,"body":"our experience that is Dr."},{"speaker":"Charles Goldfarb","startTime":763.5,"endTime":765.63,"body":"Wall's experience in mind, the"},{"speaker":"Charles Goldfarb","startTime":763.5,"endTime":765.63,"body":"ulnar nerve can often be the"},{"speaker":"Charles Goldfarb","startTime":765.63,"endTime":768.78,"body":"culprit. And so again, a careful"},{"speaker":"Charles Goldfarb","startTime":765.63,"endTime":768.78,"body":"exam is super important."},{"speaker":"Chris Dy","startTime":770.01,"endTime":772.92,"body":"If you just bring the"},{"speaker":"Chris Dy","startTime":770.01,"endTime":772.92,"body":"nerve into this, that's great. I"},{"speaker":"Charles Goldfarb","startTime":772.95,"endTime":775.32,"body":"did I do"},{"speaker":"Charles Goldfarb","startTime":772.95,"endTime":775.32,"body":"respect the nerve and those that"},{"speaker":"Charles Goldfarb","startTime":775.32,"endTime":776.49,"body":"care for nerves I do."},{"speaker":"Chris Dy","startTime":778.47,"endTime":782.1,"body":"So when you're"},{"speaker":"Chris Dy","startTime":778.47,"endTime":782.1,"body":"examining what are the specific"},{"speaker":"Chris Dy","startTime":782.1,"endTime":784.41,"body":"things when you're assessing"},{"speaker":"Chris Dy","startTime":782.1,"endTime":784.41,"body":"ready capital or joint when"},{"speaker":"Chris Dy","startTime":784.41,"endTime":786.93,"body":"you're assessing the gutters,"},{"speaker":"Chris Dy","startTime":784.41,"endTime":786.93,"body":"you know, other any classic"},{"speaker":"Chris Dy","startTime":786.93,"endTime":790.14,"body":"moves that are very helpful to"},{"speaker":"Chris Dy","startTime":786.93,"endTime":790.14,"body":"you, or any moves that you have"},{"speaker":"Chris Dy","startTime":790.14,"endTime":791.67,"body":"determined, are helpful."},{"speaker":"Charles Goldfarb","startTime":792.57,"endTime":795.93,"body":"Big palpation,"},{"speaker":"Charles Goldfarb","startTime":792.57,"endTime":795.93,"body":"for me is the main one. And so"},{"speaker":"Charles Goldfarb","startTime":795.93,"endTime":799.23,"body":"when I say when I think about"},{"speaker":"Charles Goldfarb","startTime":795.93,"endTime":799.23,"body":"the lateral elbow, I think about"},{"speaker":"Charles Goldfarb","startTime":799.23,"endTime":802.11,"body":"I started the lateral Epicon"},{"speaker":"Charles Goldfarb","startTime":799.23,"endTime":802.11,"body":"dial and just palpating directly"},{"speaker":"Charles Goldfarb","startTime":802.11,"endTime":807.09,"body":"there. And then if you if you"},{"speaker":"Charles Goldfarb","startTime":802.11,"endTime":807.09,"body":"just let your fingers slide"},{"speaker":"Charles Goldfarb","startTime":807.15,"endTime":810.54,"body":"posterior to lateral of a condo,"},{"speaker":"Charles Goldfarb","startTime":807.15,"endTime":810.54,"body":"you fall into what I call the"},{"speaker":"Charles Goldfarb","startTime":810.54,"endTime":813.99,"body":"lateral gutter, and that's the"},{"speaker":"Charles Goldfarb","startTime":810.54,"endTime":813.99,"body":"joint. And so in an old patient"},{"speaker":"Charles Goldfarb","startTime":813.99,"endTime":820.77,"body":"like me, that could indicate"},{"speaker":"Charles Goldfarb","startTime":813.99,"endTime":820.77,"body":"arthritis. In a younger patient,"},{"speaker":"Charles Goldfarb","startTime":820.86,"endTime":823.53,"body":"it could indicate synovitis and"},{"speaker":"Charles Goldfarb","startTime":820.86,"endTime":823.53,"body":"some type of intra articular"},{"speaker":"Charles Goldfarb","startTime":823.53,"endTime":827.67,"body":"pathology, you can then go back"},{"speaker":"Charles Goldfarb","startTime":823.53,"endTime":827.67,"body":"to lateral condyle and slide a"},{"speaker":"Charles Goldfarb","startTime":827.67,"endTime":831.27,"body":"little distal rotate the radial"},{"speaker":"Charles Goldfarb","startTime":827.67,"endTime":831.27,"body":"head, feel the radial capital or"},{"speaker":"Charles Goldfarb","startTime":831.27,"endTime":834.36,"body":"joint and for most with a"},{"speaker":"Charles Goldfarb","startTime":831.27,"endTime":834.36,"body":"symptomatic OCD, that's where"},{"speaker":"Charles Goldfarb","startTime":834.36,"endTime":837.9,"body":"they feel pain. And then you do"},{"speaker":"Charles Goldfarb","startTime":834.36,"endTime":837.9,"body":"have to differentiate this"},{"speaker":"Charles Goldfarb","startTime":837.9,"endTime":840.63,"body":"different populations. But if"},{"speaker":"Charles Goldfarb","startTime":837.9,"endTime":840.63,"body":"you feel that lateral a condyle"},{"speaker":"Charles Goldfarb","startTime":840.81,"endTime":844.47,"body":"and go just anterior then you're"},{"speaker":"Charles Goldfarb","startTime":840.81,"endTime":844.47,"body":"in lateral epicondylitis turf."},{"speaker":"Charles Goldfarb","startTime":845.67,"endTime":847.74,"body":"And then if you go a little"},{"speaker":"Charles Goldfarb","startTime":845.67,"endTime":847.74,"body":"distal, as you know, we'll talk"},{"speaker":"Charles Goldfarb","startTime":847.74,"endTime":852.42,"body":"about that inward again, you can"},{"speaker":"Charles Goldfarb","startTime":847.74,"endTime":852.42,"body":"follow the radial tunnel. And so"},{"speaker":"Charles Goldfarb","startTime":852.87,"endTime":856.35,"body":"the four things I think about"},{"speaker":"Charles Goldfarb","startTime":852.87,"endTime":856.35,"body":"latterly are joint based issues,"},{"speaker":"Charles Goldfarb","startTime":856.56,"endTime":861.15,"body":"ligament based issues, tendon"},{"speaker":"Charles Goldfarb","startTime":856.56,"endTime":861.15,"body":"based issues like tennis elbow,"},{"speaker":"Charles Goldfarb","startTime":861.18,"endTime":863.19,"body":"and then finally, radial tunnel."},{"speaker":"Chris Dy","startTime":863.46,"endTime":866.61,"body":"How do you then go to"},{"speaker":"Chris Dy","startTime":863.46,"endTime":866.61,"body":"work these patients up? Does"},{"speaker":"Chris Dy","startTime":866.61,"endTime":871.32,"body":"every patient get radiographs?"},{"speaker":"Chris Dy","startTime":866.61,"endTime":871.32,"body":"And then how often are those"},{"speaker":"Chris Dy","startTime":871.32,"endTime":874.17,"body":"going to inform management for"},{"speaker":"Chris Dy","startTime":871.32,"endTime":874.17,"body":"you? And then when are you"},{"speaker":"Chris Dy","startTime":874.17,"endTime":875.64,"body":"moving towards advanced imaging?"},{"speaker":"Charles Goldfarb","startTime":876.809,"endTime":879.269,"body":"Everyone gets"},{"speaker":"Charles Goldfarb","startTime":876.809,"endTime":879.269,"body":"a radiograph sometimes bilateral"},{"speaker":"Charles Goldfarb","startTime":879.269,"endTime":882.599,"body":"if I think it will be helpful."},{"speaker":"Charles Goldfarb","startTime":879.269,"endTime":882.599,"body":"Usually the radiographs are"},{"speaker":"Charles Goldfarb","startTime":882.599,"endTime":886.709,"body":"helpful but they probably don't"},{"speaker":"Charles Goldfarb","startTime":882.599,"endTime":886.709,"body":"tell the whole story. So if"},{"speaker":"Charles Goldfarb","startTime":886.709,"endTime":890.489,"body":"you're really concerned about an"},{"speaker":"Charles Goldfarb","startTime":886.709,"endTime":890.489,"body":"OCD and MRI is almost always"},{"speaker":"Charles Goldfarb","startTime":890.489,"endTime":894.419,"body":"indicated in my mind, and"},{"speaker":"Charles Goldfarb","startTime":890.489,"endTime":894.419,"body":"insurance companies. Don't fight"},{"speaker":"Charles Goldfarb","startTime":894.419,"endTime":896.579,"body":"us too much on this one,"},{"speaker":"Charles Goldfarb","startTime":894.419,"endTime":896.579,"body":"although we'll get come back to"},{"speaker":"Charles Goldfarb","startTime":896.579,"endTime":901.229,"body":"insurance companies later. But"},{"speaker":"Charles Goldfarb","startTime":896.579,"endTime":901.229,"body":"the MRI usually tells detail is"},{"speaker":"Charles Goldfarb","startTime":901.229,"endTime":906.059,"body":"it is the OCD, you know, how big"},{"speaker":"Charles Goldfarb","startTime":901.229,"endTime":906.059,"body":"is it? Number one? Does it"},{"speaker":"Charles Goldfarb","startTime":906.059,"endTime":909.359,"body":"involve a lateral wall? Number"},{"speaker":"Charles Goldfarb","startTime":906.059,"endTime":909.359,"body":"two? Is there a loose fragment"},{"speaker":"Charles Goldfarb","startTime":909.359,"endTime":914.189,"body":"number three? You know, how does"},{"speaker":"Charles Goldfarb","startTime":909.359,"endTime":914.189,"body":"it guide potential treatment was"},{"speaker":"Charles Goldfarb","startTime":914.189,"endTime":916.919,"body":"the, you know the depth of the"},{"speaker":"Charles Goldfarb","startTime":914.189,"endTime":916.919,"body":"cartilage issue. So lots of"},{"speaker":"Charles Goldfarb","startTime":916.919,"endTime":919.949,"body":"information we could talk about"},{"speaker":"Charles Goldfarb","startTime":916.919,"endTime":919.949,"body":"this ad nauseam. But the MRI for"},{"speaker":"Charles Goldfarb","startTime":919.949,"endTime":920.879,"body":"me is always helpful."},{"speaker":"Chris Dy","startTime":921.299,"endTime":924.299,"body":"So before we get too"},{"speaker":"Chris Dy","startTime":921.299,"endTime":924.299,"body":"far into this, can you define"},{"speaker":"Chris Dy","startTime":924.299,"endTime":926.819,"body":"what an OCD is for the"},{"speaker":"Chris Dy","startTime":924.299,"endTime":926.819,"body":"listeners, because we have"},{"speaker":"Chris Dy","startTime":926.819,"endTime":929.819,"body":"people of varying backgrounds"},{"speaker":"Chris Dy","startTime":926.819,"endTime":929.819,"body":"and training levels, etc?"},{"speaker":"Charles Goldfarb","startTime":930.65,"endTime":933.59,"body":"Yeah, it I"},{"speaker":"Charles Goldfarb","startTime":930.65,"endTime":933.59,"body":"think different people use it to"},{"speaker":"Charles Goldfarb","startTime":933.59,"endTime":937.13,"body":"mean different things. So it"},{"speaker":"Charles Goldfarb","startTime":933.59,"endTime":937.13,"body":"could be a stick can drag this"},{"speaker":"Charles Goldfarb","startTime":937.16,"endTime":943.97,"body":"to seconds, or it could be"},{"speaker":"Charles Goldfarb","startTime":937.16,"endTime":943.97,"body":"osteochondral defect. And there"},{"speaker":"Charles Goldfarb","startTime":943.97,"endTime":946.88,"body":"may be some out there who are"},{"speaker":"Charles Goldfarb","startTime":943.97,"endTime":946.88,"body":"laughing at me, but I use those"},{"speaker":"Charles Goldfarb","startTime":947.0,"endTime":951.62,"body":"somewhat interchangeably. The"},{"speaker":"Charles Goldfarb","startTime":947.0,"endTime":951.62,"body":"defect obviously implies an OCD,"},{"speaker":"Charles Goldfarb","startTime":951.62,"endTime":955.58,"body":"which is using the osteochondral"},{"speaker":"Charles Goldfarb","startTime":951.62,"endTime":955.58,"body":"defect implies a bigger displays"},{"speaker":"Charles Goldfarb","startTime":955.58,"endTime":958.07,"body":"lesion in my mind, but I think"},{"speaker":"Charles Goldfarb","startTime":955.58,"endTime":958.07,"body":"people use those terms"},{"speaker":"Charles Goldfarb","startTime":958.07,"endTime":962.09,"body":"interchangeably. Both is OCD."},{"speaker":"Charles Goldfarb","startTime":958.07,"endTime":962.09,"body":"But the reality is, this is a"},{"speaker":"Charles Goldfarb","startTime":963.92,"endTime":970.1,"body":"death of subchondral bone and"},{"speaker":"Charles Goldfarb","startTime":963.92,"endTime":970.1,"body":"subsequent pathology to the"},{"speaker":"Charles Goldfarb","startTime":970.1,"endTime":974.18,"body":"overlying cartilage. And I think"},{"speaker":"Charles Goldfarb","startTime":970.1,"endTime":974.18,"body":"most people believe there's"},{"speaker":"Charles Goldfarb","startTime":974.18,"endTime":978.92,"body":"likely a genetic component,"},{"speaker":"Charles Goldfarb","startTime":974.18,"endTime":978.92,"body":"there's a hypovascular issue."},{"speaker":"Charles Goldfarb","startTime":979.49,"endTime":984.38,"body":"There's a trauma or repetitive"},{"speaker":"Charles Goldfarb","startTime":979.49,"endTime":984.38,"body":"trauma issue in many, and"},{"speaker":"Charles Goldfarb","startTime":984.38,"endTime":988.82,"body":"sometimes there's an acute"},{"speaker":"Charles Goldfarb","startTime":984.38,"endTime":988.82,"body":"trauma event in some. And so all"},{"speaker":"Charles Goldfarb","startTime":988.82,"endTime":993.5,"body":"those factors come into play."},{"speaker":"Charles Goldfarb","startTime":988.82,"endTime":993.5,"body":"But ultimately, if you get an"},{"speaker":"Charles Goldfarb","startTime":993.5,"endTime":997.97,"body":"OCD, then unfortunately, it can"},{"speaker":"Charles Goldfarb","startTime":993.5,"endTime":997.97,"body":"be a difficult difficult problem"},{"speaker":"Charles Goldfarb","startTime":997.97,"endTime":1002.62,"body":"for a young child, who is often"},{"speaker":"Charles Goldfarb","startTime":997.97,"endTime":1002.62,"body":"very involved in athletics."},{"speaker":"Chris Dy","startTime":1003.16,"endTime":1005.62,"body":"What happens if the"},{"speaker":"Chris Dy","startTime":1003.16,"endTime":1005.62,"body":"OCD goes untreated? Is it"},{"speaker":"Chris Dy","startTime":1005.62,"endTime":1008.86,"body":"something like a like a snack or"},{"speaker":"Chris Dy","startTime":1005.62,"endTime":1008.86,"body":"like escape one non union that"},{"speaker":"Chris Dy","startTime":1008.86,"endTime":1011.35,"body":"we think predictably would go on"},{"speaker":"Chris Dy","startTime":1008.86,"endTime":1011.35,"body":"to a specific pattern of"},{"speaker":"Chris Dy","startTime":1011.35,"endTime":1012.1,"body":"arthritis?"},{"speaker":"Charles Goldfarb","startTime":1013.36,"endTime":1016.33,"body":"I think if you"},{"speaker":"Charles Goldfarb","startTime":1013.36,"endTime":1016.33,"body":"have an OCD, and you don't rest,"},{"speaker":"Charles Goldfarb","startTime":1016.36,"endTime":1019.12,"body":"then you risk. I don't think"},{"speaker":"Charles Goldfarb","startTime":1016.36,"endTime":1019.12,"body":"there's any good natural history"},{"speaker":"Charles Goldfarb","startTime":1019.12,"endTime":1022.03,"body":"studies that I know of the best"},{"speaker":"Charles Goldfarb","startTime":1019.12,"endTime":1022.03,"body":"literature's from our Japanese"},{"speaker":"Charles Goldfarb","startTime":1022.03,"endTime":1025.03,"body":"friends who seem to have a"},{"speaker":"Charles Goldfarb","startTime":1022.03,"endTime":1025.03,"body":"higher incidence and incidence"},{"speaker":"Charles Goldfarb","startTime":1025.03,"endTime":1028.75,"body":"of this and perhaps related to,"},{"speaker":"Charles Goldfarb","startTime":1025.03,"endTime":1028.75,"body":"you know, baseball fanaticism."},{"speaker":"Charles Goldfarb","startTime":1029.74,"endTime":1035.17,"body":"But I think it's safe to say if"},{"speaker":"Charles Goldfarb","startTime":1029.74,"endTime":1035.17,"body":"you have an OCD and don't rest"},{"speaker":"Charles Goldfarb","startTime":1035.17,"endTime":1038.32,"body":"and continue the trauma, you"},{"speaker":"Charles Goldfarb","startTime":1035.17,"endTime":1038.32,"body":"will, it will lead to a"},{"speaker":"Charles Goldfarb","startTime":1038.32,"endTime":1042.37,"body":"displaced fragment, which can"},{"speaker":"Charles Goldfarb","startTime":1038.32,"endTime":1042.37,"body":"cause joint problems and"},{"speaker":"Charles Goldfarb","startTime":1042.37,"endTime":1046.03,"body":"ultimately require treatment."},{"speaker":"Charles Goldfarb","startTime":1042.37,"endTime":1046.03,"body":"Whereas early on if you rest"},{"speaker":"Charles Goldfarb","startTime":1046.03,"endTime":1049.45,"body":"appropriately, and what does"},{"speaker":"Charles Goldfarb","startTime":1046.03,"endTime":1049.45,"body":"that mean, six months, probably,"},{"speaker":"Charles Goldfarb","startTime":1049.69,"endTime":1052.78,"body":"some would argue even longer"},{"speaker":"Charles Goldfarb","startTime":1049.69,"endTime":1052.78,"body":"periods of respite that gets"},{"speaker":"Charles Goldfarb","startTime":1052.78,"endTime":1054.4,"body":"really hard for our population."},{"speaker":"Chris Dy","startTime":1055.15,"endTime":1056.83,"body":"When do you pull the"},{"speaker":"Chris Dy","startTime":1055.15,"endTime":1056.83,"body":"trigger on the MRI, if you know,"},{"speaker":"Chris Dy","startTime":1056.83,"endTime":1058.96,"body":"you're gonna know if the rest of"},{"speaker":"Chris Dy","startTime":1056.83,"endTime":1058.96,"body":"them initially did? Do the rest?"},{"speaker":"Chris Dy","startTime":1058.96,"endTime":1061.57,"body":"First, keep the clinical"},{"speaker":"Chris Dy","startTime":1058.96,"endTime":1061.57,"body":"suspicion in your head, maybe"},{"speaker":"Chris Dy","startTime":1061.57,"endTime":1064.09,"body":"talk about it with the family?"},{"speaker":"Chris Dy","startTime":1061.57,"endTime":1064.09,"body":"Or do you get the MRI for the"},{"speaker":"Chris Dy","startTime":1064.09,"endTime":1064.36,"body":"job?"},{"speaker":"Charles Goldfarb","startTime":1065.17,"endTime":1067.9,"body":"For me, in our"},{"speaker":"Charles Goldfarb","startTime":1065.17,"endTime":1067.9,"body":"role as a tertiary care center,"},{"speaker":"Charles Goldfarb","startTime":1067.9,"endTime":1070.33,"body":"often with the patients seen"},{"speaker":"Charles Goldfarb","startTime":1067.9,"endTime":1070.33,"body":"several different providers"},{"speaker":"Charles Goldfarb","startTime":1070.33,"endTime":1073.78,"body":"before seeing us, I get the MRI"},{"speaker":"Charles Goldfarb","startTime":1070.33,"endTime":1073.78,"body":"at the start. And I think you"},{"speaker":"Charles Goldfarb","startTime":1073.78,"endTime":1077.71,"body":"kind of have to to understand"},{"speaker":"Charles Goldfarb","startTime":1073.78,"endTime":1077.71,"body":"what's possible. Is it possible"},{"speaker":"Charles Goldfarb","startTime":1077.71,"endTime":1081.34,"body":"that this will heal? Or the"},{"speaker":"Charles Goldfarb","startTime":1077.71,"endTime":1081.34,"body":"growth plates open to increase"},{"speaker":"Charles Goldfarb","startTime":1081.34,"endTime":1085.36,"body":"the chances of healing? Is there"},{"speaker":"Charles Goldfarb","startTime":1081.34,"endTime":1085.36,"body":"a loose body that you couldn't"},{"speaker":"Charles Goldfarb","startTime":1085.36,"endTime":1087.49,"body":"appreciate on the X ray, you"},{"speaker":"Charles Goldfarb","startTime":1085.36,"endTime":1087.49,"body":"kind of want to know all those"},{"speaker":"Charles Goldfarb","startTime":1087.49,"endTime":1092.08,"body":"things. And then if it's an if"},{"speaker":"Charles Goldfarb","startTime":1087.49,"endTime":1092.08,"body":"it's a nondisplaced, OCD, and"},{"speaker":"Charles Goldfarb","startTime":1092.08,"endTime":1094.96,"body":"the family is reasonable, and I"},{"speaker":"Charles Goldfarb","startTime":1092.08,"endTime":1094.96,"body":"would push them to be"},{"speaker":"Charles Goldfarb","startTime":1094.96,"endTime":1097.39,"body":"reasonable, then you give it a"},{"speaker":"Charles Goldfarb","startTime":1094.96,"endTime":1097.39,"body":"period of rest? And you"},{"speaker":"Charles Goldfarb","startTime":1097.39,"endTime":1100.06,"body":"explained that you can't promise"},{"speaker":"Charles Goldfarb","startTime":1097.39,"endTime":1100.06,"body":"it'll heal. But that's your"},{"speaker":"Charles Goldfarb","startTime":1100.06,"endTime":1102.49,"body":"hope? And I think I think it"},{"speaker":"Charles Goldfarb","startTime":1100.06,"endTime":1102.49,"body":"does, I think there's a good"},{"speaker":"Charles Goldfarb","startTime":1102.49,"endTime":1106.03,"body":"chance for for the right kind of"},{"speaker":"Charles Goldfarb","startTime":1102.49,"endTime":1106.03,"body":"OCD to heal. But then,"},{"speaker":"Charles Goldfarb","startTime":1106.24,"endTime":1108.55,"body":"obviously, you have a group of"},{"speaker":"Charles Goldfarb","startTime":1106.24,"endTime":1108.55,"body":"patients where it doesn't heal,"},{"speaker":"Charles Goldfarb","startTime":1108.55,"endTime":1109.6,"body":"or it's too late."},{"speaker":"Chris Dy","startTime":1110.26,"endTime":1112.54,"body":"And is it ever too big"},{"speaker":"Chris Dy","startTime":1110.26,"endTime":1112.54,"body":"to heal? To not heal?"},{"speaker":"Charles Goldfarb","startTime":1112.81,"endTime":1115.48,"body":"I don't know."},{"speaker":"Charles Goldfarb","startTime":1112.81,"endTime":1115.48,"body":"I mean, certainly the size of"},{"speaker":"Charles Goldfarb","startTime":1115.48,"endTime":1121.24,"body":"this lesion matters a lot. I"},{"speaker":"Charles Goldfarb","startTime":1115.48,"endTime":1121.24,"body":"think many of them will heal"},{"speaker":"Charles Goldfarb","startTime":1121.24,"endTime":1123.94,"body":"despite their size, if they're"},{"speaker":"Charles Goldfarb","startTime":1121.24,"endTime":1123.94,"body":"just in the right biological"},{"speaker":"Charles Goldfarb","startTime":1123.94,"endTime":1127.42,"body":"situation, a young enough"},{"speaker":"Charles Goldfarb","startTime":1123.94,"endTime":1127.42,"body":"patient who really does respect"},{"speaker":"Charles Goldfarb","startTime":1127.42,"endTime":1132.4,"body":"it and stay off of the elbow."},{"speaker":"Charles Goldfarb","startTime":1127.42,"endTime":1132.4,"body":"Yeah, and then so the way I"},{"speaker":"Charles Goldfarb","startTime":1132.4,"endTime":1137.29,"body":"think about these is, I think,"},{"speaker":"Charles Goldfarb","startTime":1132.4,"endTime":1137.29,"body":"pretty straightforward. If the"},{"speaker":"Charles Goldfarb","startTime":1137.29,"endTime":1142.03,"body":"fragment is displaced, then"},{"speaker":"Charles Goldfarb","startTime":1137.29,"endTime":1142.03,"body":"surgery is indicated. And if I"},{"speaker":"Charles Goldfarb","startTime":1142.03,"endTime":1145.18,"body":"think about surgery, and"},{"speaker":"Charles Goldfarb","startTime":1142.03,"endTime":1145.18,"body":"certainly there's some gray"},{"speaker":"Charles Goldfarb","startTime":1145.18,"endTime":1150.22,"body":"areas, but when I think about"},{"speaker":"Charles Goldfarb","startTime":1145.18,"endTime":1150.22,"body":"surgery, I think about can I"},{"speaker":"Charles Goldfarb","startTime":1150.25,"endTime":1155.17,"body":"repair the fragment? Can I"},{"speaker":"Charles Goldfarb","startTime":1150.25,"endTime":1155.17,"body":"stimulate a marrow response and"},{"speaker":"Charles Goldfarb","startTime":1155.17,"endTime":1160.24,"body":"get fibrocartilage replacement"},{"speaker":"Charles Goldfarb","startTime":1155.17,"endTime":1160.24,"body":"of the last hyaline cartilage?"},{"speaker":"Charles Goldfarb","startTime":1160.99,"endTime":1165.04,"body":"Or do I have to think about ways"},{"speaker":"Charles Goldfarb","startTime":1160.99,"endTime":1165.04,"body":"to bring in new bone and"},{"speaker":"Charles Goldfarb","startTime":1165.04,"endTime":1167.86,"body":"cartilage to get this thing to"},{"speaker":"Charles Goldfarb","startTime":1165.04,"endTime":1167.86,"body":"heal to give the kid the best"},{"speaker":"Charles Goldfarb","startTime":1167.86,"endTime":1169.27,"body":"chance of a good outcome?"},{"speaker":"Chris Dy","startTime":1169.63,"endTime":1173.23,"body":"When you talk about"},{"speaker":"Chris Dy","startTime":1169.63,"endTime":1173.23,"body":"displacement? Because it's death"},{"speaker":"Chris Dy","startTime":1173.23,"endTime":1178.48,"body":"of subchondral bone? Is it just"},{"speaker":"Chris Dy","startTime":1173.23,"endTime":1178.48,"body":"that the you have a sinking in"},{"speaker":"Chris Dy","startTime":1178.51,"endTime":1182.14,"body":"of the area on top of which you"},{"speaker":"Chris Dy","startTime":1178.51,"endTime":1182.14,"body":"have the subchondral bone death?"},{"speaker":"Chris Dy","startTime":1182.2,"endTime":1185.23,"body":"Or is it actual displacement in"},{"speaker":"Chris Dy","startTime":1182.2,"endTime":1185.23,"body":"sense of maybe it's riding high"},{"speaker":"Chris Dy","startTime":1185.23,"endTime":1188.41,"body":"and shifting out, you know,"},{"speaker":"Chris Dy","startTime":1185.23,"endTime":1188.41,"body":"causing an actual area for you"},{"speaker":"Chris Dy","startTime":1188.41,"endTime":1191.53,"body":"know, point loading of that"},{"speaker":"Chris Dy","startTime":1188.41,"endTime":1191.53,"body":"specific displace fragment or is"},{"speaker":"Chris Dy","startTime":1191.53,"endTime":1193.15,"body":"it more point loading and"},{"speaker":"Chris Dy","startTime":1191.53,"endTime":1193.15,"body":"barriers around it?"},{"speaker":"Charles Goldfarb","startTime":1193.9,"endTime":1197.11,"body":"Yeah, I think"},{"speaker":"Charles Goldfarb","startTime":1193.9,"endTime":1197.11,"body":"it's a matter of you do get"},{"speaker":"Charles Goldfarb","startTime":1197.11,"endTime":1200.41,"body":"loading around it. It's just a"},{"speaker":"Charles Goldfarb","startTime":1197.11,"endTime":1200.41,"body":"matter of will the car village"},{"speaker":"Charles Goldfarb","startTime":1200.41,"endTime":1204.46,"body":"fragment break off, and"},{"speaker":"Charles Goldfarb","startTime":1200.41,"endTime":1204.46,"body":"typically is just that overlying"},{"speaker":"Charles Goldfarb","startTime":1204.46,"endTime":1208.51,"body":"cartilage which breaks off and"},{"speaker":"Charles Goldfarb","startTime":1204.46,"endTime":1208.51,"body":"the underlying bone just stays"},{"speaker":"Charles Goldfarb","startTime":1208.51,"endTime":1212.89,"body":"on healthy and sits there. And"},{"speaker":"Charles Goldfarb","startTime":1208.51,"endTime":1212.89,"body":"so the primary treatment, the so"},{"speaker":"Charles Goldfarb","startTime":1212.89,"endTime":1217.33,"body":"called to Bremen and micro"},{"speaker":"Charles Goldfarb","startTime":1212.89,"endTime":1217.33,"body":"fracture is simply about giving,"},{"speaker":"Charles Goldfarb","startTime":1217.36,"endTime":1222.04,"body":"creating channels of bleeding"},{"speaker":"Charles Goldfarb","startTime":1217.36,"endTime":1222.04,"body":"bone that will allow progenitor"},{"speaker":"Charles Goldfarb","startTime":1222.04,"endTime":1226.27,"body":"cells to populate this area and"},{"speaker":"Charles Goldfarb","startTime":1222.04,"endTime":1226.27,"body":"create fibrocartilage, which is"},{"speaker":"Charles Goldfarb","startTime":1226.27,"endTime":1230.68,"body":"can be a sufficient substitute"},{"speaker":"Charles Goldfarb","startTime":1226.27,"endTime":1230.68,"body":"cartilage to get get kids back"},{"speaker":"Charles Goldfarb","startTime":1230.8,"endTime":1234.85,"body":"back to play. So pretty cool,"},{"speaker":"Charles Goldfarb","startTime":1230.8,"endTime":1234.85,"body":"and really can work. And we've"},{"speaker":"Charles Goldfarb","startTime":1234.85,"endTime":1237.64,"body":"done a few studies in this area,"},{"speaker":"Charles Goldfarb","startTime":1234.85,"endTime":1237.64,"body":"and many others have done"},{"speaker":"Charles Goldfarb","startTime":1237.64,"endTime":1240.46,"body":"studies in this area,"},{"speaker":"Charles Goldfarb","startTime":1237.64,"endTime":1240.46,"body":"demonstrating that this micro"},{"speaker":"Charles Goldfarb","startTime":1240.46,"endTime":1243.1,"body":"fracture for the elbow really"},{"speaker":"Charles Goldfarb","startTime":1240.46,"endTime":1243.1,"body":"can be successful."},{"speaker":"Chris Dy","startTime":1243.61,"endTime":1246.4,"body":"How for those of for"},{"speaker":"Chris Dy","startTime":1243.61,"endTime":1246.4,"body":"those listeners that have"},{"speaker":"Chris Dy","startTime":1246.4,"endTime":1249.01,"body":"trained in orthopedics, how"},{"speaker":"Chris Dy","startTime":1246.4,"endTime":1249.01,"body":"different are these elbow OCD"},{"speaker":"Chris Dy","startTime":1249.01,"endTime":1251.53,"body":"lesions from the ones that are"},{"speaker":"Chris Dy","startTime":1249.01,"endTime":1251.53,"body":"encountered in in the knee?"},{"speaker":"Charles Goldfarb","startTime":1252.55,"endTime":1253.81,"body":"I don't know"},{"speaker":"Charles Goldfarb","startTime":1252.55,"endTime":1253.81,"body":"that they're fundamentally"},{"speaker":"Charles Goldfarb","startTime":1253.81,"endTime":1257.92,"body":"different. I think they're less"},{"speaker":"Charles Goldfarb","startTime":1253.81,"endTime":1257.92,"body":"worrisome because you're not"},{"speaker":"Charles Goldfarb","startTime":1257.92,"endTime":1261.19,"body":"theoretically, weight bearing on"},{"speaker":"Charles Goldfarb","startTime":1257.92,"endTime":1261.19,"body":"the elbow, at least you don't"},{"speaker":"Charles Goldfarb","startTime":1261.19,"endTime":1264.73,"body":"have to wait bear on the elbow."},{"speaker":"Charles Goldfarb","startTime":1261.19,"endTime":1264.73,"body":"So I think they're a little bit"},{"speaker":"Charles Goldfarb","startTime":1264.73,"endTime":1268.0,"body":"of less stress. And we certainly"},{"speaker":"Charles Goldfarb","startTime":1264.73,"endTime":1268.0,"body":"learned a lot of lessons from"},{"speaker":"Charles Goldfarb","startTime":1268.0,"endTime":1271.06,"body":"treatment of elbow, I'm sorry,"},{"speaker":"Charles Goldfarb","startTime":1268.0,"endTime":1271.06,"body":"treatment of Neo CDs and shaking"},{"speaker":"Charles Goldfarb","startTime":1271.06,"endTime":1275.44,"body":"those lessons to the elbow. At"},{"speaker":"Charles Goldfarb","startTime":1271.06,"endTime":1275.44,"body":"least, you know, we haven't"},{"speaker":"Charles Goldfarb","startTime":1275.47,"endTime":1278.17,"body":"really taken all the lessons"},{"speaker":"Charles Goldfarb","startTime":1275.47,"endTime":1278.17,"body":"from the knee, but but some of"},{"speaker":"Charles Goldfarb","startTime":1278.17,"endTime":1278.92,"body":"the key ones."},{"speaker":"Chris Dy","startTime":1279.28,"endTime":1282.25,"body":"So what are the"},{"speaker":"Chris Dy","startTime":1279.28,"endTime":1282.25,"body":"different treatment options. And"},{"speaker":"Chris Dy","startTime":1282.25,"endTime":1284.98,"body":"you know, we've talked a little"},{"speaker":"Chris Dy","startTime":1282.25,"endTime":1284.98,"body":"bit about rest, is there any"},{"speaker":"Chris Dy","startTime":1284.98,"endTime":1288.73,"body":"role for you know, injections of"},{"speaker":"Chris Dy","startTime":1284.98,"endTime":1288.73,"body":"any sort, whether that's steroid"},{"speaker":"Chris Dy","startTime":1288.73,"endTime":1291.82,"body":"hyaluronic acid, or some disco"},{"speaker":"Chris Dy","startTime":1288.73,"endTime":1291.82,"body":"supplementation, and then talk"},{"speaker":"Chris Dy","startTime":1291.82,"endTime":1294.25,"body":"to me about the different"},{"speaker":"Chris Dy","startTime":1291.82,"endTime":1294.25,"body":"surgical options and when to use"},{"speaker":"Chris Dy","startTime":1294.25,"endTime":1294.7,"body":"those."},{"speaker":"Charles Goldfarb","startTime":1295.15,"endTime":1296.47,"body":"Yeah, I"},{"speaker":"Charles Goldfarb","startTime":1295.15,"endTime":1296.47,"body":"personally don't believe there's"},{"speaker":"Charles Goldfarb","startTime":1296.47,"endTime":1300.61,"body":"any role for injections. There's"},{"speaker":"Charles Goldfarb","startTime":1296.47,"endTime":1300.61,"body":"no literature support that I saw"},{"speaker":"Charles Goldfarb","startTime":1300.64,"endTime":1304.48,"body":"a great family last week who"},{"speaker":"Charles Goldfarb","startTime":1300.64,"endTime":1304.48,"body":"came down from few hours away,"},{"speaker":"Charles Goldfarb","startTime":1304.81,"endTime":1307.27,"body":"four or five hours away, and"},{"speaker":"Charles Goldfarb","startTime":1304.81,"endTime":1307.27,"body":"they had gotten injections in"},{"speaker":"Charles Goldfarb","startTime":1307.27,"endTime":1309.97,"body":"the elbow, and they felt better."},{"speaker":"Charles Goldfarb","startTime":1307.27,"endTime":1309.97,"body":"And then they had these"},{"speaker":"Charles Goldfarb","startTime":1310.0,"endTime":1313.48,"body":"displaced OCDs and they weren't"},{"speaker":"Charles Goldfarb","startTime":1310.0,"endTime":1313.48,"body":"going to heal. And so it creates"},{"speaker":"Charles Goldfarb","startTime":1313.48,"endTime":1316.51,"body":"this artificial sense of things"},{"speaker":"Charles Goldfarb","startTime":1313.48,"endTime":1316.51,"body":"are better. And I think that can"},{"speaker":"Charles Goldfarb","startTime":1316.51,"endTime":1319.42,"body":"lead to more damage being done,"},{"speaker":"Charles Goldfarb","startTime":1316.51,"endTime":1319.42,"body":"honestly. So I'm not a big fan"},{"speaker":"Charles Goldfarb","startTime":1319.42,"endTime":1322.75,"body":"of injecting kids joints"},{"speaker":"Charles Goldfarb","startTime":1319.42,"endTime":1322.75,"body":"anyways, sometimes I'll do one"},{"speaker":"Charles Goldfarb","startTime":1322.75,"endTime":1326.47,"body":"in the right situation. But not"},{"speaker":"Charles Goldfarb","startTime":1322.75,"endTime":1326.47,"body":"for me, there's no injection"},{"speaker":"Charles Goldfarb","startTime":1326.5,"endTime":1331.42,"body":"that's appropriate for this"},{"speaker":"Charles Goldfarb","startTime":1326.5,"endTime":1331.42,"body":"issue. Not even PRP, not even"},{"speaker":"Charles Goldfarb","startTime":1331.42,"endTime":1338.02,"body":"our friend PRP, I get that one a"},{"speaker":"Charles Goldfarb","startTime":1331.42,"endTime":1338.02,"body":"lot. So you know, the hardest"},{"speaker":"Charles Goldfarb","startTime":1338.02,"endTime":1342.61,"body":"ones of these are when you have"},{"speaker":"Charles Goldfarb","startTime":1338.02,"endTime":1342.61,"body":"pain, failed conservative"},{"speaker":"Charles Goldfarb","startTime":1342.61,"endTime":1345.97,"body":"treatment. And the when you go"},{"speaker":"Charles Goldfarb","startTime":1342.61,"endTime":1345.97,"body":"into your elbow scope, the"},{"speaker":"Charles Goldfarb","startTime":1345.97,"endTime":1350.56,"body":"overlying cartilage looks"},{"speaker":"Charles Goldfarb","startTime":1345.97,"endTime":1350.56,"body":"intact. And then you probe it"},{"speaker":"Charles Goldfarb","startTime":1350.68,"endTime":1354.16,"body":"and it's loose or flakes off and"},{"speaker":"Charles Goldfarb","startTime":1350.68,"endTime":1354.16,"body":"you just get this sinking"},{"speaker":"Charles Goldfarb","startTime":1354.16,"endTime":1357.85,"body":"feeling in your stomach where"},{"speaker":"Charles Goldfarb","startTime":1354.16,"endTime":1357.85,"body":"you're taking away what appears"},{"speaker":"Charles Goldfarb","startTime":1357.85,"endTime":1361.72,"body":"to be healthy cartilage that has"},{"speaker":"Charles Goldfarb","startTime":1357.85,"endTime":1361.72,"body":"absolutely no support beneath"},{"speaker":"Charles Goldfarb","startTime":1361.72,"endTime":1366.49,"body":"it. And so you create the lesion"},{"speaker":"Charles Goldfarb","startTime":1361.72,"endTime":1366.49,"body":"in some respects. And then you"},{"speaker":"Charles Goldfarb","startTime":1366.49,"endTime":1370.0,"body":"ask the body to heal this with"},{"speaker":"Charles Goldfarb","startTime":1366.49,"endTime":1370.0,"body":"new cartilage but that that"},{"speaker":"Charles Goldfarb","startTime":1370.03,"endTime":1375.01,"body":"unsupported cartilage over the"},{"speaker":"Charles Goldfarb","startTime":1370.03,"endTime":1375.01,"body":"dead bone does not heal."},{"speaker":"Chris Dy","startTime":1375.43,"endTime":1377.98,"body":"And so you mentioned"},{"speaker":"Chris Dy","startTime":1375.43,"endTime":1377.98,"body":"you mentioned inspection on"},{"speaker":"Chris Dy","startTime":1377.98,"endTime":1381.46,"body":"arthroscopy is there ever is it"},{"speaker":"Chris Dy","startTime":1377.98,"endTime":1381.46,"body":"always arthroscopy? Is there"},{"speaker":"Chris Dy","startTime":1381.46,"endTime":1385.72,"body":"ever a role for an open surgery?"},{"speaker":"Chris Dy","startTime":1381.46,"endTime":1385.72,"body":"Or is arthroscopy just part of"},{"speaker":"Chris Dy","startTime":1385.72,"endTime":1389.02,"body":"the not only treatment diagnosis"},{"speaker":"Chris Dy","startTime":1385.72,"endTime":1389.02,"body":"or confirming the diagnosis"},{"speaker":"Chris Dy","startTime":1389.02,"endTime":1390.55,"body":"establishing prognosis?"},{"speaker":"Charles Goldfarb","startTime":1391.09,"endTime":1394.0,"body":"I think it's,"},{"speaker":"Charles Goldfarb","startTime":1391.09,"endTime":1394.0,"body":"it's, it's got to be"},{"speaker":"Charles Goldfarb","startTime":1394.0,"endTime":1396.4,"body":"arthroscopy. I mean, you"},{"speaker":"Charles Goldfarb","startTime":1394.0,"endTime":1396.4,"body":"certainly could open an a\u0026e a"},{"speaker":"Charles Goldfarb","startTime":1396.4,"endTime":1398.65,"body":"splitting approach. The elbow"},{"speaker":"Charles Goldfarb","startTime":1396.4,"endTime":1398.65,"body":"was part of what we did for this"},{"speaker":"Charles Goldfarb","startTime":1398.65,"endTime":1402.91,"body":"young lady. But I think"},{"speaker":"Charles Goldfarb","startTime":1398.65,"endTime":1402.91,"body":"arthroscopy is the tool, because"},{"speaker":"Charles Goldfarb","startTime":1402.91,"endTime":1406.78,"body":"you can really get information"},{"speaker":"Charles Goldfarb","startTime":1402.91,"endTime":1406.78,"body":"about the whole joint, you can"},{"speaker":"Charles Goldfarb","startTime":1406.78,"endTime":1409.54,"body":"do breed inflammation, or"},{"speaker":"Charles Goldfarb","startTime":1406.78,"endTime":1409.54,"body":"synovitis. And you can really"},{"speaker":"Charles Goldfarb","startTime":1409.54,"endTime":1410.92,"body":"assess the area of concern."},{"speaker":"Chris Dy","startTime":1412.21,"endTime":1416.17,"body":"So you mentioned about"},{"speaker":"Chris Dy","startTime":1412.21,"endTime":1416.17,"body":"microfracture techniques, maybe"},{"speaker":"Chris Dy","startTime":1416.17,"endTime":1418.93,"body":"even bringing in some, you know,"},{"speaker":"Chris Dy","startTime":1416.17,"endTime":1418.93,"body":"a plug or something like that."},{"speaker":"Chris Dy","startTime":1418.93,"endTime":1421.39,"body":"How do you what are the"},{"speaker":"Chris Dy","startTime":1418.93,"endTime":1421.39,"body":"different surgical techniques"},{"speaker":"Chris Dy","startTime":1421.39,"endTime":1422.89,"body":"that you use? And when do you"},{"speaker":"Chris Dy","startTime":1421.39,"endTime":1422.89,"body":"use them?"},{"speaker":"Charles Goldfarb","startTime":1423.7,"endTime":1424.81,"body":"I would say"},{"speaker":"Charles Goldfarb","startTime":1423.7,"endTime":1424.81,"body":"the most common is a"},{"speaker":"Charles Goldfarb","startTime":1424.81,"endTime":1429.22,"body":"microfracture at least in my"},{"speaker":"Charles Goldfarb","startTime":1424.81,"endTime":1429.22,"body":"hands. If OCD and it's some of"},{"speaker":"Charles Goldfarb","startTime":1429.22,"endTime":1431.53,"body":"this is these numbers are"},{"speaker":"Charles Goldfarb","startTime":1429.22,"endTime":1431.53,"body":"somewhat arbitrary, because it"},{"speaker":"Charles Goldfarb","startTime":1431.53,"endTime":1434.74,"body":"does depend on the size of the"},{"speaker":"Charles Goldfarb","startTime":1431.53,"endTime":1434.74,"body":"child and, and the growth plates"},{"speaker":"Charles Goldfarb","startTime":1434.74,"endTime":1438.4,"body":"in the lake. But as a general"},{"speaker":"Charles Goldfarb","startTime":1434.74,"endTime":1438.4,"body":"principle, the lesion is less"},{"speaker":"Charles Goldfarb","startTime":1438.4,"endTime":1442.15,"body":"than one centimeter in diameter."},{"speaker":"Charles Goldfarb","startTime":1438.4,"endTime":1442.15,"body":"In the center of the capitellum,"},{"speaker":"Charles Goldfarb","startTime":1442.18,"endTime":1446.44,"body":"I will try a micro fracture once"},{"speaker":"Charles Goldfarb","startTime":1442.18,"endTime":1446.44,"body":"it gets more laterally, and that"},{"speaker":"Charles Goldfarb","startTime":1446.44,"endTime":1450.52,"body":"kind of the kind of the elbow"},{"speaker":"Charles Goldfarb","startTime":1446.44,"endTime":1450.52,"body":"where the capitellum you know,"},{"speaker":"Charles Goldfarb","startTime":1450.82,"endTime":1455.17,"body":"ends. That lateral wall is"},{"speaker":"Charles Goldfarb","startTime":1450.82,"endTime":1455.17,"body":"really important for stability,"},{"speaker":"Charles Goldfarb","startTime":1455.17,"endTime":1458.08,"body":"you don't want the radial head"},{"speaker":"Charles Goldfarb","startTime":1455.17,"endTime":1458.08,"body":"escaping, because that creates a"},{"speaker":"Charles Goldfarb","startTime":1458.08,"endTime":1461.2,"body":"whole nother set of problems."},{"speaker":"Charles Goldfarb","startTime":1458.08,"endTime":1461.2,"body":"And so if it's centered in the"},{"speaker":"Charles Goldfarb","startTime":1461.23,"endTime":1464.83,"body":"capitellum, micro and small"},{"speaker":"Charles Goldfarb","startTime":1461.23,"endTime":1464.83,"body":"enough lesion on microfracture"},{"speaker":"Charles Goldfarb","startTime":1464.86,"endTime":1467.56,"body":"is appropriate when you get more"},{"speaker":"Charles Goldfarb","startTime":1464.86,"endTime":1467.56,"body":"than a centimeter in size, then"},{"speaker":"Charles Goldfarb","startTime":1467.56,"endTime":1471.49,"body":"you have bigger problems. One of"},{"speaker":"Charles Goldfarb","startTime":1467.56,"endTime":1471.49,"body":"the tricks and challenges that"},{"speaker":"Charles Goldfarb","startTime":1471.49,"endTime":1477.25,"body":"we have is that insurance"},{"speaker":"Charles Goldfarb","startTime":1471.49,"endTime":1477.25,"body":"companies largely refuse to pay"},{"speaker":"Charles Goldfarb","startTime":1477.58,"endTime":1482.92,"body":"for an OATS procedure. So notes"},{"speaker":"Charles Goldfarb","startTime":1477.58,"endTime":1482.92,"body":"is when you take essentially an"},{"speaker":"Charles Goldfarb","startTime":1482.92,"endTime":1487.93,"body":"osteochondral autograft plug."},{"speaker":"Charles Goldfarb","startTime":1482.92,"endTime":1487.93,"body":"You can do you can use an"},{"speaker":"Charles Goldfarb","startTime":1487.93,"endTime":1491.68,"body":"allografts. But for me I like to"},{"speaker":"Charles Goldfarb","startTime":1487.93,"endTime":1491.68,"body":"take a plug of bone and"},{"speaker":"Charles Goldfarb","startTime":1491.68,"endTime":1497.11,"body":"cartilage from the knee from the"},{"speaker":"Charles Goldfarb","startTime":1491.68,"endTime":1497.11,"body":"lateral proximal cartilaginous"},{"speaker":"Charles Goldfarb","startTime":1497.11,"endTime":1502.09,"body":"portion of the of the knee and"},{"speaker":"Charles Goldfarb","startTime":1497.11,"endTime":1502.09,"body":"the beauty of this approach is"},{"speaker":"Charles Goldfarb","startTime":1502.09,"endTime":1507.64,"body":"that it's okay, it's it heals"},{"speaker":"Charles Goldfarb","startTime":1502.09,"endTime":1507.64,"body":"quickly, reliably. And you can"},{"speaker":"Charles Goldfarb","startTime":1507.64,"endTime":1510.49,"body":"essentially take a one"},{"speaker":"Charles Goldfarb","startTime":1507.64,"endTime":1510.49,"body":"centimeter plug or bigger or two"},{"speaker":"Charles Goldfarb","startTime":1510.49,"endTime":1514.42,"body":"plugs, and you essentially put"},{"speaker":"Charles Goldfarb","startTime":1510.49,"endTime":1514.42,"body":"those in the capital them create"},{"speaker":"Charles Goldfarb","startTime":1514.42,"endTime":1517.12,"body":"a smooth surface. And what"},{"speaker":"Charles Goldfarb","startTime":1514.42,"endTime":1517.12,"body":"you're asking the body to do is"},{"speaker":"Charles Goldfarb","startTime":1517.12,"endTime":1520.36,"body":"heal the deep bone. That's why"},{"speaker":"Charles Goldfarb","startTime":1517.12,"endTime":1520.36,"body":"you harvest a centimeter deep"},{"speaker":"Charles Goldfarb","startTime":1520.36,"endTime":1523.09,"body":"blood or something like that."},{"speaker":"Charles Goldfarb","startTime":1520.36,"endTime":1523.09,"body":"And you ask the body to heal the"},{"speaker":"Charles Goldfarb","startTime":1523.18,"endTime":1527.02,"body":"bone to bone deep, and then the"},{"speaker":"Charles Goldfarb","startTime":1523.18,"endTime":1527.02,"body":"cartilage stays alive on the"},{"speaker":"Charles Goldfarb","startTime":1527.02,"endTime":1531.64,"body":"surface. And you can It's"},{"speaker":"Charles Goldfarb","startTime":1527.02,"endTime":1531.64,"body":"remarkable, it's a reliable"},{"speaker":"Charles Goldfarb","startTime":1531.64,"endTime":1534.91,"body":"technique, it's probably the"},{"speaker":"Charles Goldfarb","startTime":1531.64,"endTime":1534.91,"body":"most reliable technique in my"},{"speaker":"Charles Goldfarb","startTime":1534.91,"endTime":1539.02,"body":"mind. It does require going to"},{"speaker":"Charles Goldfarb","startTime":1534.91,"endTime":1539.02,"body":"another joint insurance"},{"speaker":"Charles Goldfarb","startTime":1539.02,"endTime":1543.85,"body":"companies routinely fight this"},{"speaker":"Charles Goldfarb","startTime":1539.02,"endTime":1543.85,"body":"and often deny it. And there's"},{"speaker":"Charles Goldfarb","startTime":1543.85,"endTime":1546.67,"body":"literature supporting it. It's"},{"speaker":"Charles Goldfarb","startTime":1543.85,"endTime":1546.67,"body":"one of my greatest frustrations"},{"speaker":"Charles Goldfarb","startTime":1546.67,"endTime":1548.56,"body":"with interacting with insurance"},{"speaker":"Charles Goldfarb","startTime":1546.67,"endTime":1548.56,"body":"companies."},{"speaker":"Chris Dy","startTime":1549.79,"endTime":1553.45,"body":"Is that is it that"},{"speaker":"Chris Dy","startTime":1549.79,"endTime":1553.45,"body":"they think that it doesn't work?"},{"speaker":"Chris Dy","startTime":1553.45,"endTime":1554.95,"body":"Or they're just I mean, we can"},{"speaker":"Chris Dy","startTime":1553.45,"endTime":1554.95,"body":"probably get into the whole"},{"speaker":"Chris Dy","startTime":1554.95,"endTime":1557.95,"body":"thing about insurance companies,"},{"speaker":"Chris Dy","startTime":1554.95,"endTime":1557.95,"body":"you have, have there been payers"},{"speaker":"Chris Dy","startTime":1557.95,"endTime":1560.08,"body":"that have changed over the last"},{"speaker":"Chris Dy","startTime":1557.95,"endTime":1560.08,"body":"couple of years and actually"},{"speaker":"Chris Dy","startTime":1560.08,"endTime":1561.46,"body":"started to accept it?"},{"speaker":"Charles Goldfarb","startTime":1562.0,"endTime":1565.27,"body":"To my"},{"speaker":"Charles Goldfarb","startTime":1562.0,"endTime":1565.27,"body":"knowledge? No, I can't say that"},{"speaker":"Charles Goldfarb","startTime":1565.27,"endTime":1568.6,"body":"every insurance company rejects"},{"speaker":"Charles Goldfarb","startTime":1565.27,"endTime":1568.6,"body":"it. But I every time I scheduled"},{"speaker":"Charles Goldfarb","startTime":1568.6,"endTime":1572.11,"body":"this case, it seems to be"},{"speaker":"Charles Goldfarb","startTime":1568.6,"endTime":1572.11,"body":"rejected. I do a peer to peer"},{"speaker":"Charles Goldfarb","startTime":1572.11,"endTime":1575.14,"body":"and like you said, or someone"},{"speaker":"Charles Goldfarb","startTime":1572.11,"endTime":1575.14,"body":"said recently, in a discussion,"},{"speaker":"Charles Goldfarb","startTime":1575.38,"endTime":1578.74,"body":"you have the peer to peer, but"},{"speaker":"Charles Goldfarb","startTime":1575.38,"endTime":1578.74,"body":"you the reality is you're just"},{"speaker":"Charles Goldfarb","startTime":1578.74,"endTime":1581.02,"body":"wasting your breath. Because"},{"speaker":"Charles Goldfarb","startTime":1578.74,"endTime":1581.02,"body":"they're gonna say, well, it's"},{"speaker":"Charles Goldfarb","startTime":1581.02,"endTime":1583.66,"body":"considered experimental, we can"},{"speaker":"Charles Goldfarb","startTime":1581.02,"endTime":1583.66,"body":"approve this. And that's what"},{"speaker":"Charles Goldfarb","startTime":1583.66,"endTime":1586.66,"body":"they say. And it's not"},{"speaker":"Charles Goldfarb","startTime":1583.66,"endTime":1586.66,"body":"experimental. And there's good"},{"speaker":"Charles Goldfarb","startTime":1587.26,"endTime":1590.38,"body":"orthopedic science to support"},{"speaker":"Charles Goldfarb","startTime":1587.26,"endTime":1590.38,"body":"it. And there's good anecdotal"},{"speaker":"Charles Goldfarb","startTime":1590.38,"endTime":1593.95,"body":"evidence that it works. And yet,"},{"speaker":"Charles Goldfarb","startTime":1590.38,"endTime":1593.95,"body":"we can't always get it approved."},{"speaker":"Charles Goldfarb","startTime":1593.95,"endTime":1598.36,"body":"And so it's frustrating because"},{"speaker":"Charles Goldfarb","startTime":1593.95,"endTime":1598.36,"body":"it's a great, great operation."},{"speaker":"Chris Dy","startTime":1599.02,"endTime":1601.42,"body":"So do you typically"},{"speaker":"Chris Dy","startTime":1599.02,"endTime":1601.42,"body":"harvest the plug on your own? Do"},{"speaker":"Chris Dy","startTime":1601.42,"endTime":1604.45,"body":"you involve one of our sports"},{"speaker":"Chris Dy","startTime":1601.42,"endTime":1604.45,"body":"partners? And where do you take"},{"speaker":"Chris Dy","startTime":1604.45,"endTime":1606.4,"body":"it from the knee without it"},{"speaker":"Chris Dy","startTime":1604.45,"endTime":1606.4,"body":"being an issue in the knee? You"},{"speaker":"Chris Dy","startTime":1606.4,"endTime":1608.98,"body":"mentioned kind of the proximal"},{"speaker":"Chris Dy","startTime":1606.4,"endTime":1608.98,"body":"lateral aspect, right?"},{"speaker":"Charles Goldfarb","startTime":1609.58,"endTime":1611.2,"body":"Yeah. So you"},{"speaker":"Charles Goldfarb","startTime":1609.58,"endTime":1611.2,"body":"know, the first couple times I"},{"speaker":"Charles Goldfarb","startTime":1611.2,"endTime":1613.24,"body":"did this, I worked with my"},{"speaker":"Charles Goldfarb","startTime":1611.2,"endTime":1613.24,"body":"sports partners, but it's not"},{"speaker":"Charles Goldfarb","startTime":1613.24,"endTime":1618.52,"body":"hard. It's a lateral para"},{"speaker":"Charles Goldfarb","startTime":1613.24,"endTime":1618.52,"body":"patellar approach. Actually,"},{"speaker":"Charles Goldfarb","startTime":1618.52,"endTime":1621.79,"body":"it's not exactly accurately"},{"speaker":"Charles Goldfarb","startTime":1618.52,"endTime":1621.79,"body":"stated. It's a lateral approach"},{"speaker":"Charles Goldfarb","startTime":1622.15,"endTime":1625.93,"body":"to the patella, and then you use"},{"speaker":"Charles Goldfarb","startTime":1622.15,"endTime":1625.93,"body":"one of the Z retractors retract"},{"speaker":"Charles Goldfarb","startTime":1625.93,"endTime":1630.31,"body":"the patella. There are great"},{"speaker":"Charles Goldfarb","startTime":1625.93,"endTime":1630.31,"body":"kits designed for harvesting the"},{"speaker":"Charles Goldfarb","startTime":1630.31,"endTime":1636.37,"body":"plug in is that very proximal"},{"speaker":"Charles Goldfarb","startTime":1630.31,"endTime":1636.37,"body":"lateral cartilage on the"},{"speaker":"Charles Goldfarb","startTime":1636.37,"endTime":1640.12,"body":"anterior surface of the knee."},{"speaker":"Charles Goldfarb","startTime":1636.37,"endTime":1640.12,"body":"And it's non weight bearing it"},{"speaker":"Charles Goldfarb","startTime":1640.12,"endTime":1643.78,"body":"doesn't have any interaction"},{"speaker":"Charles Goldfarb","startTime":1640.12,"endTime":1643.78,"body":"with the patella. And so, you"},{"speaker":"Charles Goldfarb","startTime":1643.78,"endTime":1647.29,"body":"know, occasionally, it is a"},{"speaker":"Charles Goldfarb","startTime":1643.78,"endTime":1647.29,"body":"fresh source of frustration for"},{"speaker":"Charles Goldfarb","startTime":1647.29,"endTime":1650.26,"body":"kids, but almost always is"},{"speaker":"Charles Goldfarb","startTime":1647.29,"endTime":1650.26,"body":"extraordinarily well tolerated."},{"speaker":"Charles Goldfarb","startTime":1650.56,"endTime":1655.48,"body":"So fun surgery, effective"},{"speaker":"Charles Goldfarb","startTime":1650.56,"endTime":1655.48,"body":"surgery. And I really like doing"},{"speaker":"Charles Goldfarb","startTime":1655.48,"endTime":1657.52,"body":"it when we can, you know, make"},{"speaker":"Charles Goldfarb","startTime":1655.48,"endTime":1657.52,"body":"it happen."},{"speaker":"Chris Dy","startTime":1658.75,"endTime":1662.2,"body":"So the question, the"},{"speaker":"Chris Dy","startTime":1658.75,"endTime":1662.2,"body":"question is, do you wear loops"},{"speaker":"Chris Dy","startTime":1662.23,"endTime":1663.34,"body":"when you're harvesting?"},{"speaker":"Charles Goldfarb","startTime":1664.09,"endTime":1665.77,"body":"For sure don't"},{"speaker":"Charles Goldfarb","startTime":1664.09,"endTime":1665.77,"body":"wouldn't you?"},{"speaker":"Chris Dy","startTime":1666.67,"endTime":1668.98,"body":"Of course, I wear"},{"speaker":"Chris Dy","startTime":1666.67,"endTime":1668.98,"body":"loops when I nail femur."},{"speaker":"Charles Goldfarb","startTime":1670.12,"endTime":1673.42,"body":"I feel naked"},{"speaker":"Charles Goldfarb","startTime":1670.12,"endTime":1673.42,"body":"in the operating room without my"},{"speaker":"Charles Goldfarb","startTime":1673.42,"endTime":1676.06,"body":"loops. And I get made fun of and"},{"speaker":"Charles Goldfarb","startTime":1673.42,"endTime":1676.06,"body":"I'm fine."},{"speaker":"Chris Dy","startTime":1676.96,"endTime":1678.73,"body":"I was doing a wrist"},{"speaker":"Chris Dy","startTime":1676.96,"endTime":1678.73,"body":"scope recently and I had my"},{"speaker":"Chris Dy","startTime":1678.73,"endTime":1680.53,"body":"loops on or going right. I was"},{"speaker":"Chris Dy","startTime":1678.73,"endTime":1680.53,"body":"like, Well, you don't?"},{"speaker":"Charles Goldfarb","startTime":1682.23,"endTime":1684.51,"body":"Yeah, it just"},{"speaker":"Charles Goldfarb","startTime":1682.23,"endTime":1684.51,"body":"I need that weight. I need that"},{"speaker":"Charles Goldfarb","startTime":1684.51,"endTime":1686.61,"body":"comfort. I absolutely wear my"},{"speaker":"Charles Goldfarb","startTime":1684.51,"endTime":1686.61,"body":"lips."},{"speaker":"Chris Dy","startTime":1686.85,"endTime":1689.7,"body":"I was gonna ask when"},{"speaker":"Chris Dy","startTime":1686.85,"endTime":1689.7,"body":"you when you inset the plug? Is"},{"speaker":"Chris Dy","startTime":1689.7,"endTime":1692.4,"body":"it purely interference fit? Are"},{"speaker":"Chris Dy","startTime":1689.7,"endTime":1692.4,"body":"there any additional forms of"},{"speaker":"Chris Dy","startTime":1692.4,"endTime":1694.14,"body":"fixation? How are you doing"},{"speaker":"Chris Dy","startTime":1692.4,"endTime":1694.14,"body":"that?"},{"speaker":"Charles Goldfarb","startTime":1694.35,"endTime":1696.945,"body":"Interference"},{"speaker":"Charles Goldfarb","startTime":1694.35,"endTime":1696.945,"body":"fit-, never had a problem knock"},{"speaker":"Charles Goldfarb","startTime":1697.004,"endTime":1700.66,"body":"on wood and sounds you have to"},{"speaker":"Charles Goldfarb","startTime":1697.004,"endTime":1700.66,"body":"contour it a little bit because"},{"speaker":"Charles Goldfarb","startTime":1700.719,"endTime":1703.963,"body":"you know, the capsule was"},{"speaker":"Charles Goldfarb","startTime":1700.719,"endTime":1703.963,"body":"curved. And this is sort of a"},{"speaker":"Charles Goldfarb","startTime":1704.022,"endTime":1707.738,"body":"flat piece of bone and cartilage"},{"speaker":"Charles Goldfarb","startTime":1704.022,"endTime":1707.738,"body":"you're harvesting. But yeah, I"},{"speaker":"Charles Goldfarb","startTime":1707.797,"endTime":1710.863,"body":"see the appeal of Sports"},{"speaker":"Charles Goldfarb","startTime":1707.797,"endTime":1710.863,"body":"Medicine. Obviously, I like"},{"speaker":"Charles Goldfarb","startTime":1710.922,"endTime":1714.284,"body":"wrist scopes and elbow scopes."},{"speaker":"Charles Goldfarb","startTime":1710.922,"endTime":1714.284,"body":"And I like working with my"},{"speaker":"Charles Goldfarb","startTime":1714.343,"endTime":1718.0,"body":"sports partners. And you and I"},{"speaker":"Charles Goldfarb","startTime":1714.343,"endTime":1718.0,"body":"are gonna have a future episode"},{"speaker":"Charles Goldfarb","startTime":1718.059,"endTime":1721.833,"body":"about that. To close the book on"},{"speaker":"Charles Goldfarb","startTime":1718.059,"endTime":1721.833,"body":"this, maybe this topic and this"},{"speaker":"Charles Goldfarb","startTime":1721.892,"endTime":1725.431,"body":"patient, this young lady had a"},{"speaker":"Charles Goldfarb","startTime":1721.892,"endTime":1725.431,"body":"really interesting thing. She"},{"speaker":"Charles Goldfarb","startTime":1725.49,"endTime":1729.088,"body":"had a 14 millimeter OCD, loose"},{"speaker":"Charles Goldfarb","startTime":1725.49,"endTime":1729.088,"body":"fragment floating in the joint"},{"speaker":"Charles Goldfarb","startTime":1729.147,"endTime":1732.862,"body":"it was actually hard to get in"},{"speaker":"Charles Goldfarb","startTime":1729.147,"endTime":1732.862,"body":"the posterior joint because this"},{"speaker":"Charles Goldfarb","startTime":1732.921,"endTime":1736.401,"body":"fragment is so big and it was a"},{"speaker":"Charles Goldfarb","startTime":1732.921,"endTime":1736.401,"body":"massive part of her capital"},{"speaker":"Charles Goldfarb","startTime":1736.46,"endTime":1739.822,"body":"because she was not that big."},{"speaker":"Charles Goldfarb","startTime":1736.46,"endTime":1739.822,"body":"And there was a really thin"},{"speaker":"Charles Goldfarb","startTime":1739.881,"endTime":1743.125,"body":"layer of bone. But because it"},{"speaker":"Charles Goldfarb","startTime":1739.881,"endTime":1743.125,"body":"was so massive, you know,"},{"speaker":"Charles Goldfarb","startTime":1743.184,"endTime":1746.604,"body":"ideally, these fragments they"},{"speaker":"Charles Goldfarb","startTime":1743.184,"endTime":1746.604,"body":"break off have bone on them,"},{"speaker":"Charles Goldfarb","startTime":1746.663,"endTime":1750.379,"body":"because if there's bone, there's"},{"speaker":"Charles Goldfarb","startTime":1746.663,"endTime":1750.379,"body":"hope for bone to bone healing."},{"speaker":"Charles Goldfarb","startTime":1750.438,"endTime":1754.036,"body":"Cartilage itself is not going to"},{"speaker":"Charles Goldfarb","startTime":1750.438,"endTime":1754.036,"body":"heal but there's bone on the"},{"speaker":"Charles Goldfarb","startTime":1754.095,"endTime":1757.692,"body":"fragment it might heal. There"},{"speaker":"Charles Goldfarb","startTime":1754.095,"endTime":1757.692,"body":"was a little bone in because it"},{"speaker":"Charles Goldfarb","startTime":1757.751,"endTime":1761.113,"body":"was massive. We went ahead and"},{"speaker":"Charles Goldfarb","startTime":1757.751,"endTime":1761.113,"body":"fixed it. Which was really"},{"speaker":"Charles Goldfarb","startTime":1761.172,"endTime":1764.77,"body":"satisfying. But I don't know if"},{"speaker":"Charles Goldfarb","startTime":1761.172,"endTime":1764.77,"body":"it's going to heal. But there"},{"speaker":"Charles Goldfarb","startTime":1764.829,"endTime":1768.485,"body":"are different tricks and tools"},{"speaker":"Charles Goldfarb","startTime":1764.829,"endTime":1768.485,"body":"out there. I used what's called"},{"speaker":"Charles Goldfarb","startTime":1768.544,"endTime":1772.201,"body":"a micro nails made by a company"},{"speaker":"Charles Goldfarb","startTime":1768.544,"endTime":1772.201,"body":"called Conmed. I've never used"},{"speaker":"Charles Goldfarb","startTime":1772.26,"endTime":1775.799,"body":"it before I really liked it. I"},{"speaker":"Charles Goldfarb","startTime":1772.26,"endTime":1775.799,"body":"think there's a lot of little"},{"speaker":"Charles Goldfarb","startTime":1775.858,"endTime":1779.278,"body":"things out there. They are"},{"speaker":"Charles Goldfarb","startTime":1775.858,"endTime":1779.278,"body":"bioabsorbable I put to a minute"},{"speaker":"Charles Goldfarb","startTime":1779.337,"endTime":1782.876,"body":"it was very slick. I could have"},{"speaker":"Charles Goldfarb","startTime":1779.337,"endTime":1782.876,"body":"used a headless screw. These"},{"speaker":"Charles Goldfarb","startTime":1782.935,"endTime":1786.12,"body":"things have a little bitty head"},{"speaker":"Charles Goldfarb","startTime":1782.935,"endTime":1786.12,"body":"on them. It was really"},{"speaker":"Charles Goldfarb","startTime":1786.179,"endTime":1789.6,"body":"satisfying. It'll be more"},{"speaker":"Charles Goldfarb","startTime":1786.179,"endTime":1789.6,"body":"satisfying if the fragment heels"},{"speaker":"Chris Dy","startTime":1789.9,"endTime":1792.333,"body":"Of course so in look"},{"speaker":"Chris Dy","startTime":1789.9,"endTime":1792.333,"body":"thinking about that case and"},{"speaker":"Chris Dy","startTime":1792.383,"endTime":1795.214,"body":"reflecting on her preoperative"},{"speaker":"Chris Dy","startTime":1792.383,"endTime":1795.214,"body":"exam. Why do you think she"},{"speaker":"Chris Dy","startTime":1795.264,"endTime":1798.294,"body":"couldn't extend her elbow all"},{"speaker":"Chris Dy","startTime":1795.264,"endTime":1798.294,"body":"the way it was that she was you"},{"speaker":"Chris Dy","startTime":1798.343,"endTime":1801.224,"body":"know the abnormal contact"},{"speaker":"Chris Dy","startTime":1798.343,"endTime":1801.224,"body":"pressures. at that area right on"},{"speaker":"Chris Dy","startTime":1801.274,"endTime":1803.46,"body":"her capital, every time she"},{"speaker":"Chris Dy","startTime":1801.274,"endTime":1803.46,"body":"tried to extend,"},{"speaker":"Charles Goldfarb","startTime":1803.73,"endTime":1805.863,"body":"it was a"},{"speaker":"Charles Goldfarb","startTime":1803.73,"endTime":1805.863,"body":"physical block because that"},{"speaker":"Charles Goldfarb","startTime":1805.923,"endTime":1809.598,"body":"fragment was loose. And so in"},{"speaker":"Charles Goldfarb","startTime":1805.923,"endTime":1809.598,"body":"the operating room, she had full"},{"speaker":"Charles Goldfarb","startTime":1809.657,"endTime":1813.273,"body":"motion, which is always also"},{"speaker":"Charles Goldfarb","startTime":1809.657,"endTime":1813.273,"body":"very satisfying. Now, this thing"},{"speaker":"Charles Goldfarb","startTime":1813.332,"endTime":1817.066,"body":"doesn't heal, we're gonna have"},{"speaker":"Charles Goldfarb","startTime":1813.332,"endTime":1817.066,"body":"to push the insurance company to"},{"speaker":"Charles Goldfarb","startTime":1817.125,"endTime":1820.86,"body":"approve an OATS procedure. But"},{"speaker":"Charles Goldfarb","startTime":1817.125,"endTime":1820.86,"body":"I'm hopeful, cautiously hopeful."},{"speaker":"Chris Dy","startTime":1821.2,"endTime":1824.121,"body":"So then to, to bring"},{"speaker":"Chris Dy","startTime":1821.2,"endTime":1824.121,"body":"in our therapy colleagues into"},{"speaker":"Chris Dy","startTime":1824.178,"endTime":1827.329,"body":"this What's your postdoc"},{"speaker":"Chris Dy","startTime":1824.178,"endTime":1827.329,"body":"protocol after? Maybe not this"},{"speaker":"Chris Dy","startTime":1827.387,"endTime":1830.709,"body":"case, for example, but maybe"},{"speaker":"Chris Dy","startTime":1827.387,"endTime":1830.709,"body":"after notes or microfracture?"},{"speaker":"Chris Dy","startTime":1830.767,"endTime":1834.204,"body":"Yeah, usually, you are just"},{"speaker":"Chris Dy","startTime":1830.767,"endTime":1834.204,"body":"trying  to get the elbow moving,"},{"speaker":"Chris Dy","startTime":1834.261,"endTime":1837.641,"body":"I don't splint these these"},{"speaker":"Chris Dy","startTime":1834.261,"endTime":1837.641,"body":"patients, bulky soft dressing to"},{"speaker":"Chris Dy","startTime":1837.699,"endTime":1841.25,"body":"start, I kind of tell them to"},{"speaker":"Chris Dy","startTime":1837.699,"endTime":1841.25,"body":"move at home. And then I see him"},{"speaker":"Chris Dy","startTime":1841.308,"endTime":1844.63,"body":"back at two weeks, these are"},{"speaker":"Chris Dy","startTime":1841.308,"endTime":1844.63,"body":"kids that you know, they they"},{"speaker":"Chris Dy","startTime":1844.688,"endTime":1848.182,"body":"don't tend to get stiff. And so"},{"speaker":"Chris Dy","startTime":1844.688,"endTime":1848.182,"body":"I check them at two weeks. If"},{"speaker":"Chris Dy","startTime":1848.24,"endTime":1851.734,"body":"they have their motion, then I"},{"speaker":"Chris Dy","startTime":1848.24,"endTime":1851.734,"body":"just tell them to wear a sling"},{"speaker":"Chris Dy","startTime":1851.791,"endTime":1855.458,"body":"as a reminder, at least for the"},{"speaker":"Chris Dy","startTime":1851.791,"endTime":1855.458,"body":"first six weeks, and try to keep"},{"speaker":"Chris Dy","startTime":1855.515,"endTime":1859.01,"body":"their activities limited. And"},{"speaker":"Chris Dy","startTime":1855.515,"endTime":1859.01,"body":"then at six or eight weeks, you"},{"speaker":"Chris Dy","startTime":1859.067,"endTime":1862.619,"body":"know, I often will start to do"},{"speaker":"Chris Dy","startTime":1859.067,"endTime":1862.619,"body":"some light strengthening, but I"},{"speaker":"Chris Dy","startTime":1862.676,"endTime":1866.171,"body":"protect these patients for a"},{"speaker":"Chris Dy","startTime":1862.676,"endTime":1866.171,"body":"while. So an OCD treated with an"},{"speaker":"Chris Dy","startTime":1866.228,"endTime":1869.608,"body":"OATS is usually healed about"},{"speaker":"Chris Dy","startTime":1866.228,"endTime":1869.608,"body":"three months and then they can"},{"speaker":"Chris Dy","startTime":1869.665,"endTime":1872.874,"body":"ramp up their activities"},{"speaker":"Chris Dy","startTime":1869.665,"endTime":1872.874,"body":"tolerated. And OCD treated with"},{"speaker":"Chris Dy","startTime":1872.931,"endTime":1876.368,"body":"a micro fracture. I actually"},{"speaker":"Chris Dy","startTime":1872.931,"endTime":1876.368,"body":"protect them for longer four to"},{"speaker":"Chris Dy","startTime":1876.425,"endTime":1879.92,"body":"six months and usually get an"},{"speaker":"Chris Dy","startTime":1876.425,"endTime":1879.92,"body":"MRI. Not everyone does a repeat"},{"speaker":"Chris Dy","startTime":1879.977,"endTime":1883.529,"body":"MRI, but I often get an MRI to"},{"speaker":"Chris Dy","startTime":1879.977,"endTime":1883.529,"body":"assess healing. And then if you"},{"speaker":"Chris Dy","startTime":1883.587,"endTime":1887.024,"body":"fix the fragment, which for me"},{"speaker":"Chris Dy","startTime":1883.587,"endTime":1887.024,"body":"is really uncommon, because I"},{"speaker":"Chris Dy","startTime":1887.081,"endTime":1890.461,"body":"can't usually find the indicated"},{"speaker":"Chris Dy","startTime":1887.081,"endTime":1890.461,"body":"you know, I can't find the"},{"speaker":"Chris Dy","startTime":1890.518,"endTime":1894.185,"body":"fragment, it needs to be fixed."},{"speaker":"Chris Dy","startTime":1890.518,"endTime":1894.185,"body":"But those I go slow on also need"},{"speaker":"Chris Dy","startTime":1894.242,"endTime":1897.565,"body":"to make sure we're healed before"},{"speaker":"Chris Dy","startTime":1894.242,"endTime":1897.565,"body":"we go back. So not a huge"},{"speaker":"Chris Dy","startTime":1897.622,"endTime":1901.346,"body":"therapy need for these kids. But"},{"speaker":"Chris Dy","startTime":1897.622,"endTime":1901.346,"body":"there can be I guess I would say"},{"speaker":"Chris Dy","startTime":1901.403,"endTime":1905.127,"body":"sports related rehab to get them"},{"speaker":"Chris Dy","startTime":1901.403,"endTime":1905.127,"body":"ready to go back to their sports"},{"speaker":"Chris Dy","startTime":1905.184,"endTime":1908.679,"body":"make sure their mechanics are"},{"speaker":"Chris Dy","startTime":1905.184,"endTime":1908.679,"body":"okay, as they kind of, you know"},{"speaker":"Chris Dy","startTime":1908.736,"endTime":1911.2,"body":"reincorporate into their"},{"speaker":"Chris Dy","startTime":1908.736,"endTime":1911.2,"body":"favorite activity."},{"speaker":"Chris Dy","startTime":1911.87,"endTime":1916.4,"body":"So when do patients aged out of"},{"speaker":"Chris Dy","startTime":1911.87,"endTime":1916.4,"body":"having OCDs? You know what,"},{"speaker":"Chris Dy","startTime":1916.43,"endTime":1919.67,"body":"getting older guy like me versus"},{"speaker":"Chris Dy","startTime":1916.43,"endTime":1919.67,"body":"an old guy like you? Are we"},{"speaker":"Chris Dy","startTime":1919.67,"endTime":1921.29,"body":"gonna get OCD in our elbow?"},{"speaker":"Charles Goldfarb","startTime":1921.65,"endTime":1924.11,"body":"I think I'm"},{"speaker":"Charles Goldfarb","startTime":1921.65,"endTime":1924.11,"body":"just gonna get plain old"},{"speaker":"Charles Goldfarb","startTime":1924.11,"endTime":1927.23,"body":"arthritis. I don't know about"},{"speaker":"Charles Goldfarb","startTime":1924.11,"endTime":1927.23,"body":"you. But see, I think what"},{"speaker":"Charles Goldfarb","startTime":1927.23,"endTime":1930.8,"body":"happens is, you know, usually if"},{"speaker":"Charles Goldfarb","startTime":1927.23,"endTime":1930.8,"body":"you once the growth plates"},{"speaker":"Charles Goldfarb","startTime":1930.83,"endTime":1936.59,"body":"close, I think it's pretty rare"},{"speaker":"Charles Goldfarb","startTime":1930.83,"endTime":1936.59,"body":"to see a new OCD. Now. I'll see"},{"speaker":"Charles Goldfarb","startTime":1936.62,"endTime":1941.09,"body":"OCD is with close growth plates."},{"speaker":"Charles Goldfarb","startTime":1936.62,"endTime":1941.09,"body":"But I think those develop before"},{"speaker":"Charles Goldfarb","startTime":1941.09,"endTime":1944.24,"body":"the growth plates close and just"},{"speaker":"Charles Goldfarb","startTime":1941.09,"endTime":1944.24,"body":"persist. But I think you don't"},{"speaker":"Charles Goldfarb","startTime":1944.24,"endTime":1947.42,"body":"really see him above the age of"},{"speaker":"Charles Goldfarb","startTime":1944.24,"endTime":1947.42,"body":"15 or 16. Or at least I don't."},{"speaker":"Chris Dy","startTime":1948.2,"endTime":1950.87,"body":"Okay, well, thank you"},{"speaker":"Chris Dy","startTime":1948.2,"endTime":1950.87,"body":"for educating me, I learned a"},{"speaker":"Chris Dy","startTime":1950.87,"endTime":1954.65,"body":"lot about OCDs more than I'm"},{"speaker":"Chris Dy","startTime":1950.87,"endTime":1954.65,"body":"ever going to want to remember"},{"speaker":"Chris Dy","startTime":1954.65,"endTime":1956.72,"body":"or ever need to know, because"},{"speaker":"Chris Dy","startTime":1954.65,"endTime":1956.72,"body":"I'm just going to send them to"},{"speaker":"Chris Dy","startTime":1956.72,"endTime":1960.08,"body":"you. But thank you, I think that"},{"speaker":"Chris Dy","startTime":1956.72,"endTime":1960.08,"body":"that's gonna be very educational"},{"speaker":"Chris Dy","startTime":1960.08,"endTime":1960.86,"body":"episode for many."},{"speaker":"Charles Goldfarb","startTime":1961.519,"endTime":1963.949,"body":"I think my I"},{"speaker":"Charles Goldfarb","startTime":1961.519,"endTime":1963.949,"body":"know, my penance is probably"},{"speaker":"Charles Goldfarb","startTime":1963.949,"endTime":1969.229,"body":"going to be two nerve topics."},{"speaker":"Charles Goldfarb","startTime":1963.949,"endTime":1969.229,"body":"And I don't know what else,"},{"speaker":"Charles Goldfarb","startTime":1969.319,"endTime":1969.889,"body":"that's okay."},{"speaker":"Chris Dy","startTime":1969.89,"endTime":1972.2,"body":"Well, we'll make sure"},{"speaker":"Chris Dy","startTime":1969.89,"endTime":1972.2,"body":"to give people what they want."},{"speaker":"Chris Dy","startTime":1972.2,"endTime":1974.21,"body":"And you know, that'll be part of"},{"speaker":"Chris Dy","startTime":1972.2,"endTime":1974.21,"body":"the new survey that's going to"},{"speaker":"Chris Dy","startTime":1974.21,"endTime":1977.3,"body":"come out. So those of us that"},{"speaker":"Chris Dy","startTime":1974.21,"endTime":1977.3,"body":"sign up, we're going to do it on"},{"speaker":"Chris Dy","startTime":1977.3,"endTime":1980.99,"body":"a survey, you'll enter to win"},{"speaker":"Chris Dy","startTime":1977.3,"endTime":1980.99,"body":"the books. Maybe get some extra"},{"speaker":"Chris Dy","startTime":1980.99,"endTime":1984.23,"body":"swag out there. And thank you,"},{"speaker":"Chris Dy","startTime":1980.99,"endTime":1984.23,"body":"everybody for for always"},{"speaker":"Chris Dy","startTime":1984.23,"endTime":1986.03,"body":"supporting the podcast. Really"},{"speaker":"Chris Dy","startTime":1984.23,"endTime":1986.03,"body":"appreciate it."},{"speaker":"Charles Goldfarb","startTime":1986.479,"endTime":1990.379,"body":"Absolutely. We"},{"speaker":"Charles Goldfarb","startTime":1986.479,"endTime":1990.379,"body":"are grateful beyond belief. Hey,"},{"speaker":"Charles Goldfarb","startTime":1990.379,"endTime":1991.429,"body":"Chris, this was fun."},{"speaker":"Chris Dy","startTime":1991.91,"endTime":1993.62,"body":"This was fun. We'll"},{"speaker":"Chris Dy","startTime":1991.91,"endTime":1993.62,"body":"see you next time,"},{"speaker":"Charles Goldfarb","startTime":1993.769,"endTime":1996.829,"body":"man. All"},{"speaker":"Charles Goldfarb","startTime":1993.769,"endTime":1996.829,"body":"right. Hey, Chris. That was fun."},{"speaker":"Charles Goldfarb","startTime":1996.859,"endTime":1998.029,"body":"Let's do it again real soon."},{"speaker":"Chris Dy","startTime":1998.3,"endTime":2000.82,"body":"Sounds good. Well, be"},{"speaker":"Chris Dy","startTime":1998.3,"endTime":2000.82,"body":"sure to check us out on Twitter"},{"speaker":"Chris Dy","startTime":2000.82,"endTime":2003.22,"body":"at hand podcast. Hey, Chuck,"},{"speaker":"Chris Dy","startTime":2000.82,"endTime":2003.22,"body":"what's your Twitter handle?"},{"speaker":"Charles Goldfarb","startTime":2003.55,"endTime":2006.4,"body":"Mine is at"},{"speaker":"Charles Goldfarb","startTime":2003.55,"endTime":2006.4,"body":"congenital hand. What about you?"},{"speaker":"Chris Dy","startTime":2006.58,"endTime":2010.06,"body":"Mine is at Chris de MD"},{"speaker":"Chris Dy","startTime":2006.58,"endTime":2010.06,"body":"spelled dy. And if you'd like to"},{"speaker":"Chris Dy","startTime":2010.06,"endTime":2013.81,"body":"email us, you can reach us at"},{"speaker":"Chris Dy","startTime":2010.06,"endTime":2013.81,"body":"hand podcast@gmail.com."},{"speaker":"Charles Goldfarb","startTime":2014.38,"endTime":2016.51,"body":"And remember,"},{"speaker":"Charles Goldfarb","startTime":2014.38,"endTime":2016.51,"body":"please subscribe wherever you"},{"speaker":"Charles Goldfarb","startTime":2016.51,"endTime":2017.62,"body":"get your podcast"},{"speaker":"Chris Dy","startTime":2017.65,"endTime":2019.87,"body":"and be sure to leave a"},{"speaker":"Chris Dy","startTime":2017.65,"endTime":2019.87,"body":"review that helps us get the"},{"speaker":"Chris Dy","startTime":2019.87,"endTime":2021.58,"body":"word out. Special thanks to"},{"speaker":"Charles Goldfarb","startTime":2021.58,"endTime":2023.86,"body":"Peter Martin"},{"speaker":"Charles Goldfarb","startTime":2021.58,"endTime":2023.86,"body":"for the amazing music. And"},{"speaker":"Charles Goldfarb","startTime":2023.86,"endTime":2026.92,"body":"remember, keep the upper hand."},{"speaker":"Charles Goldfarb","startTime":2023.86,"endTime":2026.92,"body":"Come back next time"}]}