{"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":7.44,"body":"and Chris talk Hansard."},{"speaker":"Chris Dy","startTime":7.9,"endTime":9.7,"body":"We are two hand"},{"speaker":"Chris Dy","startTime":7.9,"endTime":9.7,"body":"surgeons at Washington"},{"speaker":"Chris Dy","startTime":9.7,"endTime":12.34,"body":"University in St. Louis here to"},{"speaker":"Chris Dy","startTime":9.7,"endTime":12.34,"body":"talk about all things hand"},{"speaker":"Chris Dy","startTime":12.34,"endTime":14.62,"body":"surgery related from technical"},{"speaker":"Chris Dy","startTime":12.34,"endTime":14.62,"body":"to personal."},{"speaker":"Charles Goldfarb","startTime":15.34,"endTime":17.44,"body":"Please"},{"speaker":"Charles Goldfarb","startTime":15.34,"endTime":17.44,"body":"subscribe, wherever you get your"},{"speaker":"Charles Goldfarb","startTime":17.44,"endTime":17.98,"body":"podcasts."},{"speaker":"Chris Dy","startTime":18.94,"endTime":21.31,"body":"And thank you in"},{"speaker":"Chris Dy","startTime":18.94,"endTime":21.31,"body":"advance for leaving a review and"},{"speaker":"Chris Dy","startTime":21.31,"endTime":23.56,"body":"leaving a rating wherever you"},{"speaker":"Chris Dy","startTime":21.31,"endTime":23.56,"body":"get your podcasts."},{"speaker":"Charles Goldfarb","startTime":24.94,"endTime":25.93,"body":"Oh, hey,"},{"speaker":"Charles Goldfarb","startTime":24.94,"endTime":25.93,"body":"Chris."},{"speaker":"Chris Dy","startTime":26.44,"endTime":27.64,"body":"Hey, Chuck, how are"},{"speaker":"Chris Dy","startTime":26.44,"endTime":27.64,"body":"you?"},{"speaker":"Charles Goldfarb","startTime":28.12,"endTime":29.92,"body":"Oh, quite"},{"speaker":"Charles Goldfarb","startTime":28.12,"endTime":29.92,"body":"well, it feels like it's been a"},{"speaker":"Charles Goldfarb","startTime":29.92,"endTime":30.4,"body":"minute."},{"speaker":"Chris Dy","startTime":30.0,"endTime":32.92,"body":"It has been, well"},{"speaker":"Chris Dy","startTime":30.0,"endTime":32.92,"body":"welcome to 2023. I know that we"},{"speaker":"Chris Dy","startTime":30.0,"endTime":46.62,"body":"I don't know-  we have savvy"},{"speaker":"Chris Dy","startTime":30.0,"endTime":46.62,"body":"listeners. I don't think you"},{"speaker":"Chris Dy","startTime":32.98,"endTime":36.795,"body":"had a podcast and then we took a"},{"speaker":"Chris Dy","startTime":32.98,"endTime":36.795,"body":"week off last week. And then we"},{"speaker":"Chris Dy","startTime":36.855,"endTime":40.61,"body":"had an episode that we recorded"},{"speaker":"Chris Dy","startTime":36.855,"endTime":40.61,"body":"before. And love that listeners"},{"speaker":"Chris Dy","startTime":40.67,"endTime":43.83,"body":"picked up that that was recorded"},{"speaker":"Chris Dy","startTime":40.67,"endTime":43.83,"body":"before the New Year."},{"speaker":"Chris Dy","startTime":46.62,"endTime":48.39,"body":"give them enough credit. Dr. Dy."},{"speaker":"Chris Dy","startTime":48.54,"endTime":51.63,"body":"Yeah, we can't get one past"},{"speaker":"Chris Dy","startTime":48.54,"endTime":51.63,"body":"them. So. So yeah. Welcome to"},{"speaker":"Chris Dy","startTime":51.69,"endTime":52.74,"body":"2023."},{"speaker":"Charles Goldfarb","startTime":53.31,"endTime":55.47,"body":"Yeah, yeah,"},{"speaker":"Charles Goldfarb","startTime":53.31,"endTime":55.47,"body":"it's off to a good start. How"},{"speaker":"Charles Goldfarb","startTime":55.47,"endTime":57.48,"body":"was your holiday season?"},{"speaker":"Chris Dy","startTime":57.96,"endTime":61.05,"body":"Well, you know, we"},{"speaker":"Chris Dy","startTime":57.96,"endTime":61.05,"body":"were supposed to go to Estes"},{"speaker":"Chris Dy","startTime":61.05,"endTime":65.01,"body":"Park, Colorado for a little"},{"speaker":"Chris Dy","startTime":61.05,"endTime":65.01,"body":"family trip. And then I'm sure"},{"speaker":"Chris Dy","startTime":65.01,"endTime":68.22,"body":"many of our listeners also got"},{"speaker":"Chris Dy","startTime":65.01,"endTime":68.22,"body":"caught up in the whole Southwest"},{"speaker":"Chris Dy","startTime":68.22,"endTime":73.53,"body":"cancellation. snafu. More than a"},{"speaker":"Chris Dy","startTime":68.22,"endTime":73.53,"body":"snafu. It's our trip was"},{"speaker":"Chris Dy","startTime":73.53,"endTime":77.13,"body":"canceled and that we decided to"},{"speaker":"Chris Dy","startTime":73.53,"endTime":77.13,"body":"take it an alternate route. And"},{"speaker":"Chris Dy","startTime":77.13,"endTime":79.47,"body":"because we were supposed to"},{"speaker":"Chris Dy","startTime":77.13,"endTime":79.47,"body":"travel with my family from"},{"speaker":"Chris Dy","startTime":79.47,"endTime":84.3,"body":"Florida, and nobody was flying"},{"speaker":"Chris Dy","startTime":79.47,"endTime":84.3,"body":"anywhere. We drove and met them"},{"speaker":"Chris Dy","startTime":84.3,"endTime":89.76,"body":"halfway in your home former"},{"speaker":"Chris Dy","startTime":84.3,"endTime":89.76,"body":"hometown of Birmingham, Alabama."},{"speaker":"Charles Goldfarb","startTime":90.33,"endTime":93.36,"body":"I was so"},{"speaker":"Charles Goldfarb","startTime":90.33,"endTime":93.36,"body":"excited to hear that you went to"},{"speaker":"Charles Goldfarb","startTime":93.36,"endTime":97.29,"body":"see my birthplace. How was"},{"speaker":"Charles Goldfarb","startTime":93.36,"endTime":97.29,"body":"Birmingham?"},{"speaker":"Chris Dy","startTime":98.04,"endTime":101.22,"body":"You know what, we had"},{"speaker":"Chris Dy","startTime":98.04,"endTime":101.22,"body":"a fun time. You know, so we're"},{"speaker":"Chris Dy","startTime":101.22,"endTime":104.22,"body":"not skiers, so it's just gonna"},{"speaker":"Chris Dy","startTime":101.22,"endTime":104.22,"body":"be mainly like hanging out"},{"speaker":"Chris Dy","startTime":104.22,"endTime":107.13,"body":"inside anyway, to be honest with"},{"speaker":"Chris Dy","startTime":104.22,"endTime":107.13,"body":"you with some snow activities"},{"speaker":"Chris Dy","startTime":107.13,"endTime":110.97,"body":"for the kids. So we got to do"},{"speaker":"Chris Dy","startTime":107.13,"endTime":110.97,"body":"all those things, minus the snow"},{"speaker":"Chris Dy","startTime":110.97,"endTime":113.64,"body":"activities, but in warmer"},{"speaker":"Chris Dy","startTime":110.97,"endTime":113.64,"body":"weather. So you know, the kids"},{"speaker":"Chris Dy","startTime":113.64,"endTime":118.32,"body":"had a good time with their"},{"speaker":"Chris Dy","startTime":113.64,"endTime":118.32,"body":"cousins. And you know, me and my"},{"speaker":"Chris Dy","startTime":118.32,"endTime":120.93,"body":"wife and my sisters and my"},{"speaker":"Chris Dy","startTime":118.32,"endTime":120.93,"body":"brother in law, we had a good"},{"speaker":"Chris Dy","startTime":120.93,"endTime":126.0,"body":"time. So there was some cooking."},{"speaker":"Chris Dy","startTime":120.93,"endTime":126.0,"body":"There was a fair, we ate our way"},{"speaker":"Chris Dy","startTime":126.0,"endTime":129.24,"body":"through Birmingham. I've got a"},{"speaker":"Chris Dy","startTime":126.0,"endTime":129.24,"body":"bunch of spots, some of which"},{"speaker":"Chris Dy","startTime":129.24,"endTime":132.78,"body":"you recommended others in which"},{"speaker":"Chris Dy","startTime":129.24,"endTime":132.78,"body":"we branched out a bit from, and"},{"speaker":"Chris Dy","startTime":132.78,"endTime":133.5,"body":"we didn't really get time."},{"speaker":"Charles Goldfarb","startTime":134.67,"endTime":137.82,"body":"So you are not"},{"speaker":"Charles Goldfarb","startTime":134.67,"endTime":137.82,"body":"staying in Birmingham Central"},{"speaker":"Charles Goldfarb","startTime":137.82,"endTime":141.09,"body":"and is the Birmingham that I"},{"speaker":"Charles Goldfarb","startTime":137.82,"endTime":141.09,"body":"recall got rural pretty quick"},{"speaker":"Charles Goldfarb","startTime":141.27,"endTime":143.82,"body":"outside the city limits"},{"speaker":"Chris Dy","startTime":143.87,"endTime":147.23,"body":"we were in, Was it"},{"speaker":"Chris Dy","startTime":143.87,"endTime":147.23,"body":"Mountain Brook? Is that the"},{"speaker":"Chris Dy","startTime":147.26,"endTime":150.14,"body":"that's where you recommend. So"},{"speaker":"Chris Dy","startTime":147.26,"endTime":150.14,"body":"we were in Mountain Brook and I"},{"speaker":"Chris Dy","startTime":150.14,"endTime":152.39,"body":"was talking to somebody they"},{"speaker":"Chris Dy","startTime":150.14,"endTime":152.39,"body":"asked where we were staying. And"},{"speaker":"Chris Dy","startTime":152.39,"endTime":155.72,"body":"I told them and so when walk"},{"speaker":"Chris Dy","startTime":152.39,"endTime":155.72,"body":"around outside there."},{"speaker":"Charles Goldfarb","startTime":157.41,"endTime":159.15,"body":"That's why he"},{"speaker":"Charles Goldfarb","startTime":157.41,"endTime":159.15,"body":"got such a good deal on that."},{"speaker":"Chris Dy","startTime":159.9,"endTime":164.16,"body":"Well, it was a last"},{"speaker":"Chris Dy","startTime":159.9,"endTime":164.16,"body":"minute Airbnb. So. So yeah, we"},{"speaker":"Chris Dy","startTime":164.16,"endTime":169.05,"body":"had a really good time. It was a"},{"speaker":"Chris Dy","startTime":164.16,"endTime":169.05,"body":"wonderful place. The kids had a"},{"speaker":"Chris Dy","startTime":169.05,"endTime":173.13,"body":"good time. We had fun, all good."},{"speaker":"Chris Dy","startTime":169.05,"endTime":173.13,"body":"How was your holiday?"},{"speaker":"Charles Goldfarb","startTime":173.94,"endTime":178.56,"body":"We also were"},{"speaker":"Charles Goldfarb","startTime":173.94,"endTime":178.56,"body":"struck by Southwest. Although it"},{"speaker":"Charles Goldfarb","startTime":178.56,"endTime":181.2,"body":"all worked out, we lost we were"},{"speaker":"Charles Goldfarb","startTime":178.56,"endTime":181.2,"body":"gonna go to California for five"},{"speaker":"Charles Goldfarb","startTime":181.2,"endTime":184.29,"body":"days, just to you know, get out"},{"speaker":"Charles Goldfarb","startTime":181.2,"endTime":184.29,"body":"of town and get the kids"},{"speaker":"Charles Goldfarb","startTime":184.29,"endTime":188.07,"body":"together and have them a little"},{"speaker":"Charles Goldfarb","startTime":184.29,"endTime":188.07,"body":"bit captive. And Jake made it"},{"speaker":"Charles Goldfarb","startTime":188.07,"endTime":191.04,"body":"out. No problem flying from New"},{"speaker":"Charles Goldfarb","startTime":188.07,"endTime":191.04,"body":"York and the rest of us got our"},{"speaker":"Charles Goldfarb","startTime":191.04,"endTime":194.67,"body":"flight canceled. We lost two"},{"speaker":"Charles Goldfarb","startTime":191.04,"endTime":194.67,"body":"days. But we still weren't you"},{"speaker":"Charles Goldfarb","startTime":194.67,"endTime":197.1,"body":"know, we only ended up being"},{"speaker":"Charles Goldfarb","startTime":194.67,"endTime":197.1,"body":"there for two and a half days."},{"speaker":"Charles Goldfarb","startTime":197.1,"endTime":199.89,"body":"But we kind of had to go because"},{"speaker":"Charles Goldfarb","startTime":197.1,"endTime":199.89,"body":"Jake was there. It was fun. It"},{"speaker":"Charles Goldfarb","startTime":199.89,"endTime":203.73,"body":"was a great time highlighted by"},{"speaker":"Charles Goldfarb","startTime":199.89,"endTime":203.73,"body":"some time spent with our"},{"speaker":"Charles Goldfarb","startTime":203.73,"endTime":207.87,"body":"wonderful fellow David Wright"},{"speaker":"Charles Goldfarb","startTime":203.73,"endTime":207.87,"body":"and his family. And it's kind"},{"speaker":"Charles Goldfarb","startTime":207.87,"endTime":211.65,"body":"enough to take us out and a tour"},{"speaker":"Charles Goldfarb","startTime":207.87,"endTime":211.65,"body":"of San Diego Bay on his"},{"speaker":"Charles Goldfarb","startTime":211.65,"endTime":214.86,"body":"beautiful boat. So there was"},{"speaker":"Charles Goldfarb","startTime":211.65,"endTime":214.86,"body":"definitely a highlight. The kids"},{"speaker":"Charles Goldfarb","startTime":214.86,"endTime":215.25,"body":"loved it."},{"speaker":"Chris Dy","startTime":215.25,"endTime":217.5,"body":"Awesome. That sounds"},{"speaker":"Chris Dy","startTime":215.25,"endTime":217.5,"body":"great. Yeah, I saw the picture."},{"speaker":"Chris Dy","startTime":217.5,"endTime":221.64,"body":"And I also heard from a birdie"},{"speaker":"Chris Dy","startTime":217.5,"endTime":221.64,"body":"that David may have hosted Jake"},{"speaker":"Chris Dy","startTime":221.64,"endTime":223.08,"body":"for Christmas dinner."},{"speaker":"Charles Goldfarb","startTime":223.41,"endTime":226.23,"body":"Yeah, well,"},{"speaker":"Charles Goldfarb","startTime":223.41,"endTime":226.23,"body":"yes, we were. We had a call you"},{"speaker":"Charles Goldfarb","startTime":226.23,"endTime":229.95,"body":"had a great trip plan. And Jake"},{"speaker":"Charles Goldfarb","startTime":226.23,"endTime":229.95,"body":"got out there on Christmas Eve"},{"speaker":"Charles Goldfarb","startTime":229.95,"endTime":233.46,"body":"and we did not and David was"},{"speaker":"Charles Goldfarb","startTime":229.95,"endTime":233.46,"body":"kind enough to invite him over"},{"speaker":"Charles Goldfarb","startTime":233.49,"endTime":235.98,"body":"in the event. His family even"},{"speaker":"Charles Goldfarb","startTime":233.49,"endTime":235.98,"body":"gave him a nice gift."},{"speaker":"Chris Dy","startTime":236.62,"endTime":239.29,"body":"Wow, I thought it was"},{"speaker":"Chris Dy","startTime":236.62,"endTime":239.29,"body":"gonna be like the Plaza from"},{"speaker":"Chris Dy","startTime":239.29,"endTime":242.17,"body":"Home Alone where Jake was just"},{"speaker":"Chris Dy","startTime":239.29,"endTime":242.17,"body":"sitting there eating rooms,"},{"speaker":"Chris Dy","startTime":242.68,"endTime":245.17,"body":"watching movies, but I guess"},{"speaker":"Chris Dy","startTime":242.68,"endTime":245.17,"body":"he's a little older than that."},{"speaker":"Charles Goldfarb","startTime":245.64,"endTime":247.44,"body":"Well, we joked"},{"speaker":"Charles Goldfarb","startTime":245.64,"endTime":247.44,"body":"about that because he was in a"},{"speaker":"Charles Goldfarb","startTime":247.44,"endTime":251.46,"body":"nice spot. And he you know,"},{"speaker":"Charles Goldfarb","startTime":247.44,"endTime":251.46,"body":"there are worse places to be"},{"speaker":"Charles Goldfarb","startTime":251.46,"endTime":252.09,"body":"stuck alone."},{"speaker":"Chris Dy","startTime":252.6,"endTime":256.26,"body":"I'm sure I'm sure that"},{"speaker":"Chris Dy","startTime":252.6,"endTime":256.26,"body":"his accommodations were were"},{"speaker":"Chris Dy","startTime":256.26,"endTime":256.74,"body":"adequate."},{"speaker":"Charles Goldfarb","startTime":257.369,"endTime":260.939,"body":"Yes, for sure."},{"speaker":"Charles Goldfarb","startTime":257.369,"endTime":260.939,"body":"Sure your practice didn't slow"},{"speaker":"Charles Goldfarb","startTime":260.939,"endTime":264.389,"body":"down on the holidays at all,"},{"speaker":"Charles Goldfarb","startTime":260.939,"endTime":264.389,"body":"because mine was out of control."},{"speaker":"Charles Goldfarb","startTime":264.749,"endTime":265.139,"body":"Yeah,"},{"speaker":"Chris Dy","startTime":265.14,"endTime":267.9,"body":"it's I mean, our"},{"speaker":"Chris Dy","startTime":265.14,"endTime":267.9,"body":"friends from overseas are gonna"},{"speaker":"Chris Dy","startTime":267.9,"endTime":272.1,"body":"laugh at the American healthcare"},{"speaker":"Chris Dy","startTime":267.9,"endTime":272.1,"body":"system. But the end of the year,"},{"speaker":"Chris Dy","startTime":272.13,"endTime":276.15,"body":"I met my deductible, suddenly"},{"speaker":"Chris Dy","startTime":272.13,"endTime":276.15,"body":"urgent carpal tunnel situation"},{"speaker":"Chris Dy","startTime":276.15,"endTime":279.15,"body":"and many other chronic"},{"speaker":"Chris Dy","startTime":276.15,"endTime":279.15,"body":"conditions. You know, that"},{"speaker":"Chris Dy","startTime":279.15,"endTime":281.61,"body":"became real. I started hearing"},{"speaker":"Chris Dy","startTime":279.15,"endTime":281.61,"body":"that refrain in September as I'm"},{"speaker":"Chris Dy","startTime":281.61,"endTime":285.42,"body":"sure you did, too. And, you"},{"speaker":"Chris Dy","startTime":281.61,"endTime":285.42,"body":"know, like for many procedure"},{"speaker":"Chris Dy","startTime":285.42,"endTime":289.38,"body":"lists or surgeons in the US,"},{"speaker":"Chris Dy","startTime":285.42,"endTime":289.38,"body":"it's a very busy November,"},{"speaker":"Chris Dy","startTime":289.38,"endTime":291.78,"body":"December and maybe an exhale in"},{"speaker":"Chris Dy","startTime":289.38,"endTime":291.78,"body":"January."},{"speaker":"Charles Goldfarb","startTime":292.47,"endTime":295.68,"body":"Yeah, mine's"},{"speaker":"Charles Goldfarb","startTime":292.47,"endTime":295.68,"body":"carried over into January. I"},{"speaker":"Charles Goldfarb","startTime":295.68,"endTime":298.95,"body":"feel like I still haven't caught"},{"speaker":"Charles Goldfarb","startTime":295.68,"endTime":298.95,"body":"up but I mean, it's good. It's a"},{"speaker":"Charles Goldfarb","startTime":298.95,"endTime":302.58,"body":"nice way to end the year. But"},{"speaker":"Charles Goldfarb","startTime":298.95,"endTime":302.58,"body":"it's nice to take a few days off"},{"speaker":"Charles Goldfarb","startTime":302.58,"endTime":303.09,"body":"as well,"},{"speaker":"Chris Dy","startTime":303.36,"endTime":305.4,"body":"Well, you know, I've"},{"speaker":"Chris Dy","startTime":303.36,"endTime":305.4,"body":"got the Monday Friday clinic"},{"speaker":"Chris Dy","startTime":305.4,"endTime":307.98,"body":"schedule. And because of the way"},{"speaker":"Chris Dy","startTime":305.4,"endTime":307.98,"body":"the holidays fell this year, I"},{"speaker":"Chris Dy","startTime":307.98,"endTime":312.81,"body":"paid a substantial penalty. So"},{"speaker":"Chris Dy","startTime":307.98,"endTime":312.81,"body":"every clinic in January thus far"},{"speaker":"Chris Dy","startTime":312.81,"endTime":318.66,"body":"has been absolutely bonkers with"},{"speaker":"Chris Dy","startTime":312.81,"endTime":318.66,"body":"patients. You know, and it's,"},{"speaker":"Chris Dy","startTime":318.69,"endTime":323.4,"body":"it's been busy. But busy is"},{"speaker":"Chris Dy","startTime":318.69,"endTime":323.4,"body":"good. A lot of learning, as the"},{"speaker":"Chris Dy","startTime":323.4,"endTime":326.73,"body":"residents that I'm working with"},{"speaker":"Chris Dy","startTime":323.4,"endTime":326.73,"body":"now said, a lot of learning and"},{"speaker":"Chris Dy","startTime":326.73,"endTime":327.45,"body":"learning quickly."},{"speaker":"Charles Goldfarb","startTime":329.91,"endTime":331.98,"body":"So a little"},{"speaker":"Charles Goldfarb","startTime":329.91,"endTime":331.98,"body":"teaser, I think maybe next"},{"speaker":"Charles Goldfarb","startTime":331.98,"endTime":335.55,"body":"episode, I don't want to lock us"},{"speaker":"Charles Goldfarb","startTime":331.98,"endTime":335.55,"body":"in. 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As"},{"speaker":"Charles Goldfarb","startTime":338.01,"endTime":341.13,"body":"I've mentioned on this podcast,"},{"speaker":"Charles Goldfarb","startTime":341.58,"endTime":346.32,"body":"it's remarkable to me what I am"},{"speaker":"Charles Goldfarb","startTime":341.58,"endTime":346.32,"body":"seeing someone who- I don't even"},{"speaker":"Charles Goldfarb","startTime":346.32,"endTime":348.96,"body":"know if m name is out there as"},{"speaker":"Charles Goldfarb","startTime":346.32,"endTime":348.96,"body":"an adolescent elbow person- but"},{"speaker":"Charles Goldfarb","startTime":348.96,"endTime":353.31,"body":"I do a ton of it, and increasing"},{"speaker":"Charles Goldfarb","startTime":348.96,"endTime":353.31,"body":"complexity of challenges. So I'd"},{"speaker":"Charles Goldfarb","startTime":353.31,"endTime":356.58,"body":"love to share some thoughts and"},{"speaker":"Charles Goldfarb","startTime":353.31,"endTime":356.58,"body":"pick your brain just on kind of"},{"speaker":"Charles Goldfarb","startTime":356.58,"endTime":361.47,"body":"developing somewhat of a niche"},{"speaker":"Charles Goldfarb","startTime":356.58,"endTime":361.47,"body":"practices. I've always had an"},{"speaker":"Charles Goldfarb","startTime":361.47,"endTime":363.9,"body":"each practice and other areas,"},{"speaker":"Charles Goldfarb","startTime":361.47,"endTime":363.9,"body":"but not this. So could be an"},{"speaker":"Charles Goldfarb","startTime":363.9,"endTime":364.83,"body":"interesting conversation."},{"speaker":"Chris Dy","startTime":365.639,"endTime":367.889,"body":"Yeah, no, I think that"},{"speaker":"Chris Dy","startTime":365.639,"endTime":367.889,"body":"that's it's amazing. That's a"},{"speaker":"Chris Dy","startTime":367.889,"endTime":372.539,"body":"practice niche that did not"},{"speaker":"Chris Dy","startTime":367.889,"endTime":372.539,"body":"exist, even as recently ago when"},{"speaker":"Chris Dy","startTime":372.539,"endTime":374.849,"body":"I was in training, which was"},{"speaker":"Chris Dy","startTime":372.539,"endTime":374.849,"body":"probably just like two or three"},{"speaker":"Chris Dy","startTime":374.849,"endTime":380.579,"body":"years ago. But that that didn't"},{"speaker":"Chris Dy","startTime":374.849,"endTime":380.579,"body":"exist, and that was not, quote,"},{"speaker":"Chris Dy","startTime":380.609,"endTime":385.499,"body":"a thing. And I think that it'll"},{"speaker":"Chris Dy","startTime":380.609,"endTime":385.499,"body":"be interesting to hear you talk"},{"speaker":"Chris Dy","startTime":385.499,"endTime":388.469,"body":"through how that's developed for"},{"speaker":"Chris Dy","startTime":385.499,"endTime":388.469,"body":"you. And where you envision that"},{"speaker":"Chris Dy","startTime":388.469,"endTime":391.919,"body":"going. While you clearly I have"},{"speaker":"Chris Dy","startTime":388.469,"endTime":391.919,"body":"developed a niche in other"},{"speaker":"Chris Dy","startTime":391.919,"endTime":395.939,"body":"areas, including congenital and"},{"speaker":"Chris Dy","startTime":391.919,"endTime":395.939,"body":"pediatric hand, and as well as"},{"speaker":"Chris Dy","startTime":396.629,"endTime":399.689,"body":"the sports practice in general,"},{"speaker":"Chris Dy","startTime":396.629,"endTime":399.689,"body":"I think the landscape has"},{"speaker":"Chris Dy","startTime":399.689,"endTime":402.449,"body":"changed and something that's"},{"speaker":"Chris Dy","startTime":399.689,"endTime":402.449,"body":"even as hyper focused as"},{"speaker":"Chris Dy","startTime":402.479,"endTime":405.929,"body":"adolescent elbow, you know,"},{"speaker":"Chris Dy","startTime":402.479,"endTime":405.929,"body":"we'll be it'll be different to"},{"speaker":"Chris Dy","startTime":405.929,"endTime":408.299,"body":"try to develop that in 2023 and"},{"speaker":"Chris Dy","startTime":405.929,"endTime":408.299,"body":"beyond."},{"speaker":"Charles Goldfarb","startTime":408.72,"endTime":411.33,"body":"That's exactly"},{"speaker":"Charles Goldfarb","startTime":408.72,"endTime":411.33,"body":"right. Today, we have a great"},{"speaker":"Charles Goldfarb","startTime":411.33,"endTime":413.82,"body":"topic. But maybe before we jump"},{"speaker":"Charles Goldfarb","startTime":411.33,"endTime":413.82,"body":"in, we should thank our"},{"speaker":"Charles Goldfarb","startTime":413.82,"endTime":414.48,"body":"sponsors."},{"speaker":"Chris Dy","startTime":414.87,"endTime":417.81,"body":"Yes, the upper hand is"},{"speaker":"Chris Dy","startTime":414.87,"endTime":417.81,"body":"sponsored by Practicelink.com."},{"speaker":"Chris Dy","startTime":417.84,"endTime":420.75,"body":"And yes, they are still"},{"speaker":"Chris Dy","startTime":417.84,"endTime":420.75,"body":"sponsoring us. The most widely"},{"speaker":"Chris Dy","startTime":420.75,"endTime":423.54,"body":"used physician job search and"},{"speaker":"Chris Dy","startTime":420.75,"endTime":423.54,"body":"career advancement resource,"},{"speaker":"Chris Dy","startTime":423.57,"endTime":426.63,"body":"becoming a physician is hard."},{"speaker":"Chris Dy","startTime":423.57,"endTime":426.63,"body":"Finding the right job doesn't"},{"speaker":"Chris Dy","startTime":426.63,"endTime":427.14,"body":"have to be"},{"speaker":"Charles Goldfarb","startTime":427.51,"endTime":430.27,"body":"joined"},{"speaker":"Charles Goldfarb","startTime":427.51,"endTime":430.27,"body":"practice link for free today at"},{"speaker":"Charles Goldfarb","startTime":431.41,"endTime":436.84,"body":"www.practice.link.com/the"},{"speaker":"Charles Goldfarb","startTime":431.41,"endTime":436.84,"body":"upperhand. So it is a it is a"},{"speaker":"Charles Goldfarb","startTime":436.84,"endTime":440.29,"body":"service they provide, which is"},{"speaker":"Charles Goldfarb","startTime":436.84,"endTime":440.29,"body":"really interesting. And after"},{"speaker":"Charles Goldfarb","startTime":440.29,"endTime":442.96,"body":"speaking to some of our"},{"speaker":"Charles Goldfarb","startTime":440.29,"endTime":442.96,"body":"residents, it there's no easy"},{"speaker":"Charles Goldfarb","startTime":442.96,"endTime":446.05,"body":"resource. And so maybe maybe"},{"speaker":"Charles Goldfarb","startTime":442.96,"endTime":446.05,"body":"it's a it's an option for some"},{"speaker":"Charles Goldfarb","startTime":446.05,"endTime":448.57,"body":"hopefully, I'm not looking for a"},{"speaker":"Charles Goldfarb","startTime":446.05,"endTime":448.57,"body":"job anytime soon. But just in"},{"speaker":"Charles Goldfarb","startTime":448.57,"endTime":449.26,"body":"case."},{"speaker":"Chris Dy","startTime":450.54,"endTime":453.75,"body":"You never know. You"},{"speaker":"Chris Dy","startTime":450.54,"endTime":453.75,"body":"know, I think that at the very"},{"speaker":"Chris Dy","startTime":453.75,"endTime":456.09,"body":"least, it's somewhere to start"},{"speaker":"Chris Dy","startTime":453.75,"endTime":456.09,"body":"and how to start thinking about"},{"speaker":"Chris Dy","startTime":456.09,"endTime":459.99,"body":"the questions to ask as you look"},{"speaker":"Chris Dy","startTime":456.09,"endTime":459.99,"body":"at offers, and so much of the"},{"speaker":"Chris Dy","startTime":460.02,"endTime":466.59,"body":"that market is think it's still"},{"speaker":"Chris Dy","startTime":460.02,"endTime":466.59,"body":"highly, I guess, unregulated. So"},{"speaker":"Chris Dy","startTime":466.59,"endTime":468.75,"body":"putting some structure around it"},{"speaker":"Chris Dy","startTime":466.59,"endTime":468.75,"body":"and knowing how to approach a"},{"speaker":"Chris Dy","startTime":468.75,"endTime":471.72,"body":"process is good. And apparently"},{"speaker":"Chris Dy","startTime":468.75,"endTime":471.72,"body":"you have to use this link,"},{"speaker":"Chris Dy","startTime":471.72,"endTime":473.31,"body":"otherwise, we will not get"},{"speaker":"Chris Dy","startTime":471.72,"endTime":473.31,"body":"credit."},{"speaker":"Charles Goldfarb","startTime":474.18,"endTime":477.93,"body":"Please, please"},{"speaker":"Charles Goldfarb","startTime":474.18,"endTime":477.93,"body":"go often and time"},{"speaker":"Chris Dy","startTime":478.98,"endTime":483.78,"body":"And hit refresh. And"},{"speaker":"Chris Dy","startTime":478.98,"endTime":483.78,"body":"login to many VPN from different"},{"speaker":"Chris Dy","startTime":483.78,"endTime":484.35,"body":"countries."},{"speaker":"Charles Goldfarb","startTime":484.41,"endTime":485.67,"body":"It's actually"},{"speaker":"Charles Goldfarb","startTime":484.41,"endTime":485.67,"body":"interesting, we probably could"},{"speaker":"Charles Goldfarb","startTime":485.67,"endTime":488.34,"body":"have an interesting episode"},{"speaker":"Charles Goldfarb","startTime":485.67,"endTime":488.34,"body":"talking about job search,"},{"speaker":"Charles Goldfarb","startTime":488.34,"endTime":491.01,"body":"because I've learned a lot not"},{"speaker":"Charles Goldfarb","startTime":488.34,"endTime":491.01,"body":"necessarily because of this"},{"speaker":"Charles Goldfarb","startTime":491.01,"endTime":494.1,"body":"relationship. But just it's an"},{"speaker":"Charles Goldfarb","startTime":491.01,"endTime":494.1,"body":"it is a really interesting"},{"speaker":"Charles Goldfarb","startTime":494.1,"endTime":494.79,"body":"process for"},{"speaker":"Chris Dy","startTime":494.79,"endTime":497.58,"body":"sure. Hearing hearing"},{"speaker":"Chris Dy","startTime":494.79,"endTime":497.58,"body":"our residents and fellows go"},{"speaker":"Chris Dy","startTime":497.58,"endTime":500.58,"body":"through it. I think you pick up"},{"speaker":"Chris Dy","startTime":497.58,"endTime":500.58,"body":"pearls about how the process has"},{"speaker":"Chris Dy","startTime":500.58,"endTime":503.19,"body":"changed and honestly how"},{"speaker":"Chris Dy","startTime":500.58,"endTime":503.19,"body":"individual it is. But I think"},{"speaker":"Chris Dy","startTime":503.19,"endTime":507.6,"body":"that having having an"},{"speaker":"Chris Dy","startTime":503.19,"endTime":507.6,"body":"understanding of how to think"},{"speaker":"Chris Dy","startTime":507.6,"endTime":509.79,"body":"about it even know where to"},{"speaker":"Chris Dy","startTime":507.6,"endTime":509.79,"body":"start, I think can be very"},{"speaker":"Chris Dy","startTime":509.79,"endTime":510.75,"body":"useful. Yeah."},{"speaker":"Charles Goldfarb","startTime":510.75,"endTime":513.69,"body":"And when does"},{"speaker":"Charles Goldfarb","startTime":510.75,"endTime":513.69,"body":"it start? You had a good idea"},{"speaker":"Charles Goldfarb","startTime":513.69,"endTime":517.56,"body":"for a topic today, which may end"},{"speaker":"Charles Goldfarb","startTime":513.69,"endTime":517.56,"body":"up being a two parter, but we"},{"speaker":"Charles Goldfarb","startTime":517.56,"endTime":520.26,"body":"thought we would jump in and why"},{"speaker":"Charles Goldfarb","startTime":517.56,"endTime":520.26,"body":"don't you you want to start by"},{"speaker":"Charles Goldfarb","startTime":520.26,"endTime":521.34,"body":"telling us about a case?"},{"speaker":"Chris Dy","startTime":521.96,"endTime":525.62,"body":"Well, yeah, I mean, so"},{"speaker":"Chris Dy","startTime":521.96,"endTime":525.62,"body":"I saw, I saw a patient with"},{"speaker":"Chris Dy","startTime":525.92,"endTime":529.85,"body":"advanced ulnar neuropathy. And"},{"speaker":"Chris Dy","startTime":525.92,"endTime":529.85,"body":"this was, you know, the"},{"speaker":"Chris Dy","startTime":529.85,"endTime":533.63,"body":"completely burnt out and cold"},{"speaker":"Chris Dy","startTime":529.85,"endTime":533.63,"body":"all ulnar nerve. So no way of"},{"speaker":"Chris Dy","startTime":533.63,"endTime":537.59,"body":"salvaging that with any"},{"speaker":"Chris Dy","startTime":533.63,"endTime":537.59,"body":"transposition and supercharge."},{"speaker":"Chris Dy","startTime":537.59,"endTime":540.71,"body":"And you know, there was not a"},{"speaker":"Chris Dy","startTime":537.59,"endTime":540.71,"body":"substantial pink opponent. So"},{"speaker":"Chris Dy","startTime":540.71,"endTime":544.4,"body":"really, you really were left"},{"speaker":"Chris Dy","startTime":540.71,"endTime":544.4,"body":"with a functional issue of claw"},{"speaker":"Chris Dy","startTime":544.4,"endTime":548.72,"body":"head and the classic claw hand."},{"speaker":"Chris Dy","startTime":544.4,"endTime":548.72,"body":"And, you know, I think that"},{"speaker":"Chris Dy","startTime":550.04,"endTime":553.13,"body":"thinking about the claw hand was"},{"speaker":"Chris Dy","startTime":550.04,"endTime":553.13,"body":"always really challenging to me"},{"speaker":"Chris Dy","startTime":553.13,"endTime":556.55,"body":"because I didn't see that"},{"speaker":"Chris Dy","startTime":553.13,"endTime":556.55,"body":"patient as a resident very"},{"speaker":"Chris Dy","startTime":556.55,"endTime":562.1,"body":"often. And I saw some of it as a"},{"speaker":"Chris Dy","startTime":556.55,"endTime":562.1,"body":"fellow but I think that what you"},{"speaker":"Chris Dy","startTime":562.1,"endTime":567.23,"body":"see as a as a fellow in clinic"},{"speaker":"Chris Dy","startTime":562.1,"endTime":567.23,"body":"and an OR is very subject to"},{"speaker":"Chris Dy","startTime":567.26,"endTime":571.01,"body":"waves in practice and you know,"},{"speaker":"Chris Dy","startTime":567.26,"endTime":571.01,"body":"who's coming in on what they did"},{"speaker":"Chris Dy","startTime":571.01,"endTime":574.04,"body":"some of it's very random. So,"},{"speaker":"Chris Dy","startTime":571.01,"endTime":574.04,"body":"you know, I didn't get a lot of"},{"speaker":"Chris Dy","startTime":574.04,"endTime":579.17,"body":"exposure to thinking about the"},{"speaker":"Chris Dy","startTime":574.04,"endTime":579.17,"body":"claw hand you know, but then I"},{"speaker":"Chris Dy","startTime":579.17,"endTime":583.61,"body":"read this great article by a"},{"speaker":"Chris Dy","startTime":579.17,"endTime":583.61,"body":"young Dr. Goldfarb when he was"},{"speaker":"Chris Dy","startTime":583.61,"endTime":586.64,"body":"in training with Peter Stern"},{"speaker":"Chris Dy","startTime":583.61,"endTime":586.64,"body":"that was published in the now"},{"speaker":"Chris Dy","startTime":586.64,"endTime":590.09,"body":"defunct Journal of the American"},{"speaker":"Chris Dy","startTime":586.64,"endTime":590.09,"body":"Society for Surgery of the Hand."},{"speaker":"Charles Goldfarb","startTime":590.99,"endTime":594.17,"body":"I love that I"},{"speaker":"Charles Goldfarb","startTime":590.99,"endTime":594.17,"body":"feel some pride in having"},{"speaker":"Charles Goldfarb","startTime":594.17,"endTime":599.09,"body":"published in but not contributed"},{"speaker":"Charles Goldfarb","startTime":594.17,"endTime":599.09,"body":"to the end of a journal which"},{"speaker":"Charles Goldfarb","startTime":599.09,"endTime":602.45,"body":"was review Journal. Arnold Peter"},{"speaker":"Charles Goldfarb","startTime":599.09,"endTime":602.45,"body":"Weiss really led that effort. It"},{"speaker":"Charles Goldfarb","startTime":602.45,"endTime":605.75,"body":"was a very good journal, I'm not"},{"speaker":"Charles Goldfarb","startTime":602.45,"endTime":605.75,"body":"sure exactly why it's no longer"},{"speaker":"Charles Goldfarb","startTime":605.75,"endTime":608.93,"body":"present. But that was that"},{"speaker":"Charles Goldfarb","startTime":605.75,"endTime":608.93,"body":"review article on low nerve"},{"speaker":"Charles Goldfarb","startTime":608.93,"endTime":612.92,"body":"palsy really had a good deal of"},{"speaker":"Charles Goldfarb","startTime":608.93,"endTime":612.92,"body":"information on it. And there's"},{"speaker":"Charles Goldfarb","startTime":612.92,"endTime":617.39,"body":"not a lot new. So 20 years ago,"},{"speaker":"Charles Goldfarb","startTime":612.92,"endTime":617.39,"body":"we was about the same as it is"},{"speaker":"Charles Goldfarb","startTime":617.39,"endTime":619.64,"body":"today, actually, maybe even"},{"speaker":"Charles Goldfarb","startTime":617.39,"endTime":619.64,"body":"worse."},{"speaker":"Chris Dy","startTime":619.7,"endTime":622.01,"body":"I mean, I think that"},{"speaker":"Chris Dy","startTime":619.7,"endTime":622.01,"body":"that that review article,"},{"speaker":"Chris Dy","startTime":622.01,"endTime":626.99,"body":"somehow advanced the field. But"},{"speaker":"Chris Dy","startTime":622.01,"endTime":626.99,"body":"it's been disseminated as part"},{"speaker":"Chris Dy","startTime":626.99,"endTime":630.5,"body":"of the Stern classic readings in"},{"speaker":"Chris Dy","startTime":626.99,"endTime":630.5,"body":"the in the folder there. So I"},{"speaker":"Chris Dy","startTime":630.5,"endTime":632.6,"body":"think a lot of people have read"},{"speaker":"Chris Dy","startTime":630.5,"endTime":632.6,"body":"it. And for good reason, it's a"},{"speaker":"Chris Dy","startTime":632.6,"endTime":636.11,"body":"really good article. And what I"},{"speaker":"Chris Dy","startTime":632.6,"endTime":636.11,"body":"love about it is it very clearly"},{"speaker":"Chris Dy","startTime":636.11,"endTime":640.16,"body":"breaks down the reasons for a"},{"speaker":"Chris Dy","startTime":636.11,"endTime":640.16,"body":"claw. On top of that, it goes"},{"speaker":"Chris Dy","startTime":640.16,"endTime":644.18,"body":"into all of the physical"},{"speaker":"Chris Dy","startTime":640.16,"endTime":644.18,"body":"examination findings that that"},{"speaker":"Chris Dy","startTime":644.18,"endTime":647.42,"body":"are commonly discussed. So you"},{"speaker":"Chris Dy","startTime":644.18,"endTime":647.42,"body":"know, I think it is a really"},{"speaker":"Chris Dy","startTime":647.42,"endTime":651.71,"body":"solid read for any medical"},{"speaker":"Chris Dy","startTime":647.42,"endTime":651.71,"body":"student, resident, fellow Hand"},{"speaker":"Chris Dy","startTime":651.71,"endTime":654.95,"body":"therapist, who wants a"},{"speaker":"Chris Dy","startTime":651.71,"endTime":654.95,"body":"fundamental understanding,"},{"speaker":"Chris Dy","startTime":654.95,"endTime":656.99,"body":"because I think you can build a"},{"speaker":"Chris Dy","startTime":654.95,"endTime":656.99,"body":"lot of knowledge after you've"},{"speaker":"Chris Dy","startTime":656.99,"endTime":657.77,"body":"read that article,"},{"speaker":"Charles Goldfarb","startTime":658.34,"endTime":660.53,"body":"or attending"},{"speaker":"Charles Goldfarb","startTime":658.34,"endTime":660.53,"body":"who doesn't see this very often."},{"speaker":"Charles Goldfarb","startTime":660.53,"endTime":664.34,"body":"And I think that's most of us,"},{"speaker":"Charles Goldfarb","startTime":660.53,"endTime":664.34,"body":"you know, I, and I'd love to go"},{"speaker":"Charles Goldfarb","startTime":664.34,"endTime":667.34,"body":"into detail. I recently been"},{"speaker":"Charles Goldfarb","startTime":664.34,"endTime":667.34,"body":"treating a family with Charcot"},{"speaker":"Charles Goldfarb","startTime":667.34,"endTime":672.05,"body":"Marie Tooth, and they present"},{"speaker":"Charles Goldfarb","startTime":667.34,"endTime":672.05,"body":"like ulnar nerve, chronic ulnar"},{"speaker":"Charles Goldfarb","startTime":672.05,"endTime":675.83,"body":"nerve, and it's really"},{"speaker":"Charles Goldfarb","startTime":672.05,"endTime":675.83,"body":"fascinating to see them and"},{"speaker":"Charles Goldfarb","startTime":675.83,"endTime":677.54,"body":"think about, it's the same"},{"speaker":"Charles Goldfarb","startTime":675.83,"endTime":677.54,"body":"situation, how do you"},{"speaker":"Charles Goldfarb","startTime":677.54,"endTime":680.63,"body":"reconstruct them to improve"},{"speaker":"Charles Goldfarb","startTime":677.54,"endTime":680.63,"body":"their function, especially when"},{"speaker":"Charles Goldfarb","startTime":680.63,"endTime":683.21,"body":"you're not dealing with pain,"},{"speaker":"Charles Goldfarb","startTime":680.63,"endTime":683.21,"body":"and then you're not going to"},{"speaker":"Charles Goldfarb","startTime":683.21,"endTime":687.11,"body":"recover sensations intact for"},{"speaker":"Charles Goldfarb","startTime":683.21,"endTime":687.11,"body":"this group. So it's the same"},{"speaker":"Charles Goldfarb","startTime":687.11,"endTime":689.72,"body":"conversation just with a very"},{"speaker":"Charles Goldfarb","startTime":687.11,"endTime":689.72,"body":"specialized group."},{"speaker":"Chris Dy","startTime":690.5,"endTime":692.21,"body":"So I mean, I think"},{"speaker":"Chris Dy","startTime":690.5,"endTime":692.21,"body":"that one of the challenging"},{"speaker":"Chris Dy","startTime":692.21,"endTime":697.07,"body":"parts about just, you know,"},{"speaker":"Chris Dy","startTime":692.21,"endTime":697.07,"body":"these complex patients, and this"},{"speaker":"Chris Dy","startTime":697.07,"endTime":703.16,"body":"aspect nerve is just trying to"},{"speaker":"Chris Dy","startTime":697.07,"endTime":703.16,"body":"break down what's going on, and"},{"speaker":"Chris Dy","startTime":703.16,"endTime":705.77,"body":"what needs to be done. And I"},{"speaker":"Chris Dy","startTime":703.16,"endTime":705.77,"body":"think that, you know, I was"},{"speaker":"Chris Dy","startTime":705.77,"endTime":708.62,"body":"seeing a run of complex like,"},{"speaker":"Chris Dy","startTime":705.77,"endTime":708.62,"body":"kind of weird cervical"},{"speaker":"Chris Dy","startTime":708.62,"endTime":711.5,"body":"radiculopathy, double crush kind"},{"speaker":"Chris Dy","startTime":708.62,"endTime":711.5,"body":"of patients in clinic, do they?"},{"speaker":"Chris Dy","startTime":711.98,"endTime":715.22,"body":"And I was reminded of the quote,"},{"speaker":"Chris Dy","startTime":711.98,"endTime":715.22,"body":"you know, \"how do you eat an"},{"speaker":"Chris Dy","startTime":715.22,"endTime":720.47,"body":"elephant?\" One bite at a time."},{"speaker":"Chris Dy","startTime":715.22,"endTime":720.47,"body":"So you got to start somewhere,"},{"speaker":"Chris Dy","startTime":720.47,"endTime":724.01,"body":"right? So you know, this was not"},{"speaker":"Chris Dy","startTime":720.47,"endTime":724.01,"body":"going to be a cooking reference."},{"speaker":"Chris Dy","startTime":724.28,"endTime":728.09,"body":"But it's, I think that"},{"speaker":"Chris Dy","startTime":724.28,"endTime":728.09,"body":"understanding the lesion and"},{"speaker":"Chris Dy","startTime":728.09,"endTime":731.0,"body":"then understanding what drives"},{"speaker":"Chris Dy","startTime":728.09,"endTime":731.0,"body":"the lesion from a purely"},{"speaker":"Chris Dy","startTime":731.0,"endTime":733.4,"body":"anatomic or physiologic"},{"speaker":"Chris Dy","startTime":731.0,"endTime":733.4,"body":"perspective, and then figure out"},{"speaker":"Chris Dy","startTime":733.4,"endTime":736.88,"body":"what you can do to functionally"},{"speaker":"Chris Dy","startTime":733.4,"endTime":736.88,"body":"make a difference is the way to"},{"speaker":"Chris Dy","startTime":736.88,"endTime":737.12,"body":"go"},{"speaker":"Charles Goldfarb","startTime":737.84,"endTime":740.3,"body":"and"},{"speaker":"Charles Goldfarb","startTime":737.84,"endTime":740.3,"body":"understanding what each patient"},{"speaker":"Charles Goldfarb","startTime":740.3,"endTime":743.75,"body":"is bothered by. And that'll be"},{"speaker":"Charles Goldfarb","startTime":740.3,"endTime":743.75,"body":"interesting part of this"},{"speaker":"Charles Goldfarb","startTime":743.75,"endTime":746.3,"body":"conversation. So, so how do you"},{"speaker":"Charles Goldfarb","startTime":743.75,"endTime":746.3,"body":"want to start?"},{"speaker":"Chris Dy","startTime":747.83,"endTime":750.11,"body":"Well, I mean, I think"},{"speaker":"Chris Dy","startTime":747.83,"endTime":750.11,"body":"that maybe you could tell us a"},{"speaker":"Chris Dy","startTime":750.11,"endTime":754.04,"body":"bit about, you know, why if in"},{"speaker":"Chris Dy","startTime":750.11,"endTime":754.04,"body":"the classic isolated ulnar"},{"speaker":"Chris Dy","startTime":754.04,"endTime":758.66,"body":"neuropathy patient, why they get"},{"speaker":"Chris Dy","startTime":754.04,"endTime":758.66,"body":"a claw deformity, you know, so"},{"speaker":"Chris Dy","startTime":758.66,"endTime":762.14,"body":"what's going on at each of the"},{"speaker":"Chris Dy","startTime":758.66,"endTime":762.14,"body":"joints, because if you break it"},{"speaker":"Chris Dy","startTime":762.14,"endTime":765.83,"body":"down at that level, then I think"},{"speaker":"Chris Dy","startTime":762.14,"endTime":765.83,"body":"the rest of the process of"},{"speaker":"Chris Dy","startTime":765.83,"endTime":766.85,"body":"treating it follows."},{"speaker":"Charles Goldfarb","startTime":767.42,"endTime":773.87,"body":"Yeah, I think"},{"speaker":"Charles Goldfarb","startTime":767.42,"endTime":773.87,"body":"really simplistically, you lose"},{"speaker":"Charles Goldfarb","startTime":773.87,"endTime":777.83,"body":"the function of the intrinsic"},{"speaker":"Charles Goldfarb","startTime":773.87,"endTime":777.83,"body":"muscles of the hand. And that"},{"speaker":"Charles Goldfarb","startTime":777.83,"endTime":781.79,"body":"includes the interossei, and the"},{"speaker":"Charles Goldfarb","startTime":777.83,"endTime":781.79,"body":"lumbricals, especially ulnar"},{"speaker":"Charles Goldfarb","startTime":781.79,"endTime":784.76,"body":"sided interossei. But that"},{"speaker":"Charles Goldfarb","startTime":781.79,"endTime":784.76,"body":"varies from patient to patient."},{"speaker":"Charles Goldfarb","startTime":785.33,"endTime":789.38,"body":"And once you this, essentially"},{"speaker":"Charles Goldfarb","startTime":785.33,"endTime":789.38,"body":"what we're talking about is"},{"speaker":"Charles Goldfarb","startTime":789.38,"endTime":794.09,"body":"you're losing the extension of"},{"speaker":"Charles Goldfarb","startTime":789.38,"endTime":794.09,"body":"the PIP joints, the way I think"},{"speaker":"Charles Goldfarb","startTime":794.09,"endTime":796.58,"body":"about it, you may think about it"},{"speaker":"Charles Goldfarb","startTime":794.09,"endTime":796.58,"body":"differently. And this is just me"},{"speaker":"Charles Goldfarb","startTime":796.58,"endTime":800.75,"body":"processing the visual, is when"},{"speaker":"Charles Goldfarb","startTime":796.58,"endTime":800.75,"body":"you lose your ability to"},{"speaker":"Charles Goldfarb","startTime":800.93,"endTime":804.95,"body":"actively extend the IP joints."},{"speaker":"Charles Goldfarb","startTime":800.93,"endTime":804.95,"body":"And again, mainly the PIP joint,"},{"speaker":"Charles Goldfarb","startTime":805.22,"endTime":809.63,"body":"your body attempts to"},{"speaker":"Charles Goldfarb","startTime":805.22,"endTime":809.63,"body":"compensate. And you end up over"},{"speaker":"Charles Goldfarb","startTime":809.63,"endTime":814.16,"body":"firing your extrinsic extensors,"},{"speaker":"Charles Goldfarb","startTime":809.63,"endTime":814.16,"body":"your EDCs and your extensor"},{"speaker":"Charles Goldfarb","startTime":814.16,"endTime":818.27,"body":"digiti minimi. And over time,"},{"speaker":"Charles Goldfarb","startTime":814.16,"endTime":818.27,"body":"especially in some more lax"},{"speaker":"Charles Goldfarb","startTime":818.27,"endTime":822.53,"body":"individuals, you get marked"},{"speaker":"Charles Goldfarb","startTime":818.27,"endTime":822.53,"body":"hyperextension of the ring and"},{"speaker":"Charles Goldfarb","startTime":822.53,"endTime":826.19,"body":"little finger especially. And"},{"speaker":"Charles Goldfarb","startTime":822.53,"endTime":826.19,"body":"then you get a flexion posture"},{"speaker":"Charles Goldfarb","startTime":826.22,"endTime":829.64,"body":"of your ring and little and"},{"speaker":"Charles Goldfarb","startTime":826.22,"endTime":829.64,"body":"maybe your middle fingers. So"},{"speaker":"Charles Goldfarb","startTime":829.64,"endTime":832.61,"body":"that's the simplistic overview"},{"speaker":"Charles Goldfarb","startTime":829.64,"endTime":832.61,"body":"on the owner side of the hand."},{"speaker":"Charles Goldfarb","startTime":832.88,"endTime":833.75,"body":"What did I miss?"},{"speaker":"Chris Dy","startTime":834.2,"endTime":836.51,"body":"None of the I mean,"},{"speaker":"Chris Dy","startTime":834.2,"endTime":836.51,"body":"obviously, that's That's it"},{"speaker":"Chris Dy","startTime":836.54,"endTime":839.96,"body":"right? I mean, you wrote the"},{"speaker":"Chris Dy","startTime":836.54,"endTime":839.96,"body":"article, right. So, but I think"},{"speaker":"Chris Dy","startTime":839.96,"endTime":843.2,"body":"it is the absence of on their"},{"speaker":"Chris Dy","startTime":839.96,"endTime":843.2,"body":"intrinsic function in the"},{"speaker":"Chris Dy","startTime":843.2,"endTime":847.16,"body":"setting of maintained radial"},{"speaker":"Chris Dy","startTime":843.2,"endTime":847.16,"body":"(nerve) extrinsic extension of"},{"speaker":"Chris Dy","startTime":847.16,"endTime":850.58,"body":"the fingers. So you still have"},{"speaker":"Chris Dy","startTime":847.16,"endTime":850.58,"body":"something that is going to try"},{"speaker":"Chris Dy","startTime":850.58,"endTime":855.71,"body":"to pull on both the MP and PIP"},{"speaker":"Chris Dy","startTime":850.58,"endTime":855.71,"body":"joints into extension, the"},{"speaker":"Chris Dy","startTime":855.74,"endTime":861.65,"body":"radial nerve with the  EDC, the"},{"speaker":"Chris Dy","startTime":855.74,"endTime":861.65,"body":"EDM and the EIP. But you lack"},{"speaker":"Chris Dy","startTime":861.68,"endTime":865.79,"body":"the ulnar, the ulnar nerve"},{"speaker":"Chris Dy","startTime":861.68,"endTime":865.79,"body":"intrinsic function of flexing"},{"speaker":"Chris Dy","startTime":865.79,"endTime":870.02,"body":"the MP joints and extending the"},{"speaker":"Chris Dy","startTime":865.79,"endTime":870.02,"body":"PIP and DIP. So you have an"},{"speaker":"Chris Dy","startTime":870.02,"endTime":874.67,"body":"imbalance now, and you know, I"},{"speaker":"Chris Dy","startTime":870.02,"endTime":874.67,"body":"think one of the key so that's"},{"speaker":"Chris Dy","startTime":874.67,"endTime":877.34,"body":"the straightforward one where"},{"speaker":"Chris Dy","startTime":874.67,"endTime":877.34,"body":"you don't have any crazy radial"},{"speaker":"Chris Dy","startTime":877.34,"endTime":880.19,"body":"nerve involvement. And then the"},{"speaker":"Chris Dy","startTime":877.34,"endTime":880.19,"body":"thumb I want to leave for a"},{"speaker":"Chris Dy","startTime":880.19,"endTime":883.19,"body":"separate discussion because I"},{"speaker":"Chris Dy","startTime":880.19,"endTime":883.19,"body":"think that's a little bit harder"},{"speaker":"Chris Dy","startTime":883.19,"endTime":888.74,"body":"to tackle. So, if you have"},{"speaker":"Chris Dy","startTime":883.19,"endTime":888.74,"body":"somebody that's got clawing,"},{"speaker":"Chris Dy","startTime":888.86,"endTime":890.78,"body":"first off when you see the"},{"speaker":"Chris Dy","startTime":888.86,"endTime":890.78,"body":"patient, I think one of the"},{"speaker":"Chris Dy","startTime":890.87,"endTime":895.67,"body":"important things to check for is"},{"speaker":"Chris Dy","startTime":890.87,"endTime":895.67,"body":"maintenance of supple, supple"},{"speaker":"Chris Dy","startTime":895.67,"endTime":898.52,"body":"joints. So means making sure"},{"speaker":"Chris Dy","startTime":895.67,"endTime":898.52,"body":"that this is a passively"},{"speaker":"Chris Dy","startTime":898.52,"endTime":900.86,"body":"correctable claw deformity"},{"speaker":"Chris Dy","startTime":898.52,"endTime":900.86,"body":"because As I think it becomes a"},{"speaker":"Chris Dy","startTime":900.86,"endTime":904.1,"body":"much harder issue to deal with,"},{"speaker":"Chris Dy","startTime":900.86,"endTime":904.1,"body":"if things are not passively"},{"speaker":"Chris Dy","startTime":904.1,"endTime":904.73,"body":"correctable,"},{"speaker":"Charles Goldfarb","startTime":904.94,"endTime":908.21,"body":"and that's our"},{"speaker":"Charles Goldfarb","startTime":904.94,"endTime":908.21,"body":"job. And I'm sure Macy would,"},{"speaker":"Charles Goldfarb","startTime":908.24,"endTime":910.91,"body":"would educate us both. But"},{"speaker":"Charles Goldfarb","startTime":908.24,"endTime":910.91,"body":"that's our job as physicians and"},{"speaker":"Charles Goldfarb","startTime":910.91,"endTime":915.11,"body":"therapists, is early recognition"},{"speaker":"Charles Goldfarb","startTime":910.91,"endTime":915.11,"body":"in the setting of trauma. So if"},{"speaker":"Charles Goldfarb","startTime":915.11,"endTime":918.29,"body":"there's a gunshot wound to more"},{"speaker":"Charles Goldfarb","startTime":915.11,"endTime":918.29,"body":"proximal or nerve, for example,"},{"speaker":"Charles Goldfarb","startTime":918.77,"endTime":922.61,"body":"even if you supercharge"},{"speaker":"Charles Goldfarb","startTime":918.77,"endTime":922.61,"body":"reconstruction, I think you have"},{"speaker":"Charles Goldfarb","startTime":922.61,"endTime":928.67,"body":"to act as if you expect there to"},{"speaker":"Charles Goldfarb","startTime":922.61,"endTime":928.67,"body":"be a risk for claw. And I do two"},{"speaker":"Charles Goldfarb","startTime":928.67,"endTime":932.45,"body":"things in those patients. One, I"},{"speaker":"Charles Goldfarb","startTime":928.67,"endTime":932.45,"body":"asked therapy to educate on"},{"speaker":"Charles Goldfarb","startTime":932.45,"endTime":936.83,"body":"passive extension, to not lose"},{"speaker":"Charles Goldfarb","startTime":932.45,"endTime":936.83,"body":"it and to use some type of"},{"speaker":"Charles Goldfarb","startTime":936.83,"endTime":942.95,"body":"lumbrical bar to keep the MP"},{"speaker":"Charles Goldfarb","startTime":936.83,"endTime":942.95,"body":"joints flexed, which allows the"},{"speaker":"Charles Goldfarb","startTime":942.95,"endTime":945.83,"body":"patient to actively extend the"},{"speaker":"Charles Goldfarb","startTime":942.95,"endTime":945.83,"body":"IP joints. So those are my two"},{"speaker":"Charles Goldfarb","startTime":945.83,"endTime":947.45,"body":"early steps early intervention."},{"speaker":"Chris Dy","startTime":948.14,"endTime":950.48,"body":"Yeah, absolutely,"},{"speaker":"Chris Dy","startTime":948.14,"endTime":950.48,"body":"completely agree with that. And,"},{"speaker":"Chris Dy","startTime":950.75,"endTime":953.33,"body":"you know, that mentioned of the"},{"speaker":"Chris Dy","startTime":950.75,"endTime":953.33,"body":"lumbrical bar is very helpful,"},{"speaker":"Chris Dy","startTime":953.33,"endTime":957.2,"body":"because you know, that flexion"},{"speaker":"Chris Dy","startTime":953.33,"endTime":957.2,"body":"of the MP joints is an important"},{"speaker":"Chris Dy","startTime":957.2,"endTime":960.8,"body":"concept to understand in terms"},{"speaker":"Chris Dy","startTime":957.2,"endTime":960.8,"body":"of your options for correction"},{"speaker":"Chris Dy","startTime":960.89,"endTime":965.57,"body":"of a claw deformity. So in a"},{"speaker":"Chris Dy","startTime":960.89,"endTime":965.57,"body":"claw deformity, as you've"},{"speaker":"Chris Dy","startTime":965.57,"endTime":967.52,"body":"mentioned, I'm just going to say"},{"speaker":"Chris Dy","startTime":965.57,"endTime":967.52,"body":"it differently, just in case"},{"speaker":"Chris Dy","startTime":967.52,"endTime":970.55,"body":"people are going to hear it"},{"speaker":"Chris Dy","startTime":967.52,"endTime":970.55,"body":"differently to your MP joints"},{"speaker":"Chris Dy","startTime":970.55,"endTime":974.18,"body":"want to extend your and then"},{"speaker":"Chris Dy","startTime":970.55,"endTime":974.18,"body":"your PIP and DIP joints"},{"speaker":"Chris Dy","startTime":974.18,"endTime":976.55,"body":"essentially want to flex, and"},{"speaker":"Chris Dy","startTime":974.18,"endTime":976.55,"body":"especially for the ring and"},{"speaker":"Chris Dy","startTime":976.55,"endTime":981.26,"body":"small finger. So what you've got"},{"speaker":"Chris Dy","startTime":976.55,"endTime":981.26,"body":"to do to try to get those, those"},{"speaker":"Chris Dy","startTime":981.26,"endTime":983.75,"body":"ring and small fingers into"},{"speaker":"Chris Dy","startTime":981.26,"endTime":983.75,"body":"extension at the PIJ in"},{"speaker":"Chris Dy","startTime":983.75,"endTime":988.55,"body":"particular, is get those MP"},{"speaker":"Chris Dy","startTime":983.75,"endTime":988.55,"body":"joints into flexion. And I think"},{"speaker":"Chris Dy","startTime":988.55,"endTime":992.33,"body":"that's the biggest thing to"},{"speaker":"Chris Dy","startTime":988.55,"endTime":992.33,"body":"assess, you know, and the"},{"speaker":"Chris Dy","startTime":992.36,"endTime":995.0,"body":"physical exam maneuver that I"},{"speaker":"Chris Dy","startTime":992.36,"endTime":995.0,"body":"like the most is the Bouvier"},{"speaker":"Chris Dy","startTime":995.0,"endTime":1000.58,"body":"maneuver. And that's where you"},{"speaker":"Chris Dy","startTime":995.0,"endTime":1000.58,"body":"hold the MP joints in flexion."},{"speaker":"Chris Dy","startTime":1001.12,"endTime":1004.63,"body":"And then you ask the patient to"},{"speaker":"Chris Dy","startTime":1001.12,"endTime":1004.63,"body":"straighten their fingers. And to"},{"speaker":"Chris Dy","startTime":1004.63,"endTime":1007.6,"body":"me that's it's a big decision"},{"speaker":"Chris Dy","startTime":1004.63,"endTime":1007.6,"body":"node there, whether they can"},{"speaker":"Chris Dy","startTime":1007.6,"endTime":1013.18,"body":"straighten or extend their PIP"},{"speaker":"Chris Dy","startTime":1007.6,"endTime":1013.18,"body":"joint. If the MP joint is held"},{"speaker":"Chris Dy","startTime":1013.18,"endTime":1015.16,"body":"in flexion, did I summarize that"},{"speaker":"Chris Dy","startTime":1013.18,"endTime":1015.16,"body":"correctly?"},{"speaker":"Charles Goldfarb","startTime":1015.82,"endTime":1018.16,"body":"You did that I"},{"speaker":"Charles Goldfarb","startTime":1015.82,"endTime":1018.16,"body":"think that's important to"},{"speaker":"Charles Goldfarb","startTime":1018.19,"endTime":1022.0,"body":"understand as a clinician, not"},{"speaker":"Charles Goldfarb","startTime":1018.19,"endTime":1022.0,"body":"only because it helps you better"},{"speaker":"Charles Goldfarb","startTime":1022.54,"endTime":1026.08,"body":"process and discuss with the"},{"speaker":"Charles Goldfarb","startTime":1022.54,"endTime":1026.08,"body":"patient, but frankly, it drives"},{"speaker":"Charles Goldfarb","startTime":1026.26,"endTime":1028.33,"body":"the surgical decision making"},{"speaker":"Charles Goldfarb","startTime":1026.26,"endTime":1028.33,"body":"process as well."},{"speaker":"Chris Dy","startTime":1030.01,"endTime":1032.23,"body":"Right. So what's your"},{"speaker":"Chris Dy","startTime":1030.01,"endTime":1032.23,"body":"decision making process? I mean,"},{"speaker":"Chris Dy","startTime":1032.23,"endTime":1034.36,"body":"so you think about all the"},{"speaker":"Chris Dy","startTime":1032.23,"endTime":1034.36,"body":"different things that you could"},{"speaker":"Chris Dy","startTime":1034.36,"endTime":1039.22,"body":"do with the underlying principle"},{"speaker":"Chris Dy","startTime":1034.36,"endTime":1039.22,"body":"of wanting to get the MP joints"},{"speaker":"Chris Dy","startTime":1039.25,"endTime":1045.43,"body":"into flexion? With the goal of"},{"speaker":"Chris Dy","startTime":1039.25,"endTime":1045.43,"body":"using the extrinsic extensor,"},{"speaker":"Chris Dy","startTime":1045.46,"endTime":1050.8,"body":"extensors to then drive PIP"},{"speaker":"Chris Dy","startTime":1045.46,"endTime":1050.8,"body":"extension, how do you think"},{"speaker":"Chris Dy","startTime":1050.8,"endTime":1052.24,"body":"about different ways to get that"},{"speaker":"Chris Dy","startTime":1050.8,"endTime":1052.24,"body":"done?"},{"speaker":"Charles Goldfarb","startTime":1053.47,"endTime":1055.78,"body":"Well, the"},{"speaker":"Charles Goldfarb","startTime":1053.47,"endTime":1055.78,"body":"first in my mind, the first step"},{"speaker":"Charles Goldfarb","startTime":1055.78,"endTime":1059.5,"body":"is how do you control the MP"},{"speaker":"Charles Goldfarb","startTime":1055.78,"endTime":1059.5,"body":"joints? So there's two issues."},{"speaker":"Charles Goldfarb","startTime":1059.53,"endTime":1062.53,"body":"One control the MP joints and"},{"speaker":"Charles Goldfarb","startTime":1059.53,"endTime":1062.53,"body":"for some patients, that's"},{"speaker":"Charles Goldfarb","startTime":1062.53,"endTime":1067.93,"body":"sufficient. And then the second"},{"speaker":"Charles Goldfarb","startTime":1062.53,"endTime":1067.93,"body":"decision making is, do you want"},{"speaker":"Charles Goldfarb","startTime":1067.93,"endTime":1073.06,"body":"to try to power PRP extension?"},{"speaker":"Charles Goldfarb","startTime":1067.93,"endTime":1073.06,"body":"So if they the Bouvier test is"},{"speaker":"Charles Goldfarb","startTime":1073.06,"endTime":1076.15,"body":"positive, meaning they can't do"},{"speaker":"Charles Goldfarb","startTime":1073.06,"endTime":1076.15,"body":"that, then you have to decide?"},{"speaker":"Charles Goldfarb","startTime":1076.45,"endTime":1081.67,"body":"Do I want to try to power finger"},{"speaker":"Charles Goldfarb","startTime":1076.45,"endTime":1081.67,"body":"IP joint extension? And do I"},{"speaker":"Charles Goldfarb","startTime":1081.67,"endTime":1085.57,"body":"want to use a classic finger"},{"speaker":"Charles Goldfarb","startTime":1081.67,"endTime":1085.57,"body":"flexor to do that? Or do I want"},{"speaker":"Charles Goldfarb","startTime":1085.57,"endTime":1090.97,"body":"to use another muscle group"},{"speaker":"Charles Goldfarb","startTime":1085.57,"endTime":1090.97,"body":"altogether? Like the ecrb or"},{"speaker":"Charles Goldfarb","startTime":1090.97,"endTime":1094.54,"body":"ecrl, extended with a four tail"},{"speaker":"Charles Goldfarb","startTime":1090.97,"endTime":1094.54,"body":"graft? And so those are I think"},{"speaker":"Charles Goldfarb","startTime":1094.54,"endTime":1097.12,"body":"that's it really for the owner"},{"speaker":"Charles Goldfarb","startTime":1094.54,"endTime":1097.12,"body":"of the hand reconstruction?"},{"speaker":"Charles Goldfarb","startTime":1097.12,"endTime":1098.11,"body":"Those are the decisions."},{"speaker":"Chris Dy","startTime":1098.68,"endTime":1101.95,"body":"Right, exactly. So if"},{"speaker":"Chris Dy","startTime":1098.68,"endTime":1101.95,"body":"you if you do the Bouvier"},{"speaker":"Chris Dy","startTime":1101.95,"endTime":1105.88,"body":"maneuver, and the MP joints are"},{"speaker":"Chris Dy","startTime":1101.95,"endTime":1105.88,"body":"held in flexion, and you're able"},{"speaker":"Chris Dy","startTime":1105.88,"endTime":1110.35,"body":"to get active extension of the"},{"speaker":"Chris Dy","startTime":1105.88,"endTime":1110.35,"body":"PIP joint. Do you think that"},{"speaker":"Chris Dy","startTime":1110.35,"endTime":1114.94,"body":"that's enough to rely on holding"},{"speaker":"Chris Dy","startTime":1110.35,"endTime":1114.94,"body":"the MP joint and flexion and go"},{"speaker":"Chris Dy","startTime":1114.94,"endTime":1118.39,"body":"with what is called many would"},{"speaker":"Chris Dy","startTime":1114.94,"endTime":1118.39,"body":"call a static kind of transfer?"},{"speaker":"Chris Dy","startTime":1119.02,"endTime":1122.98,"body":"And do you think that the only"},{"speaker":"Chris Dy","startTime":1119.02,"endTime":1122.98,"body":"indication for a dynamic type"},{"speaker":"Chris Dy","startTime":1122.98,"endTime":1127.06,"body":"transfer is if you don't get"},{"speaker":"Chris Dy","startTime":1122.98,"endTime":1127.06,"body":"active extension of the PIP"},{"speaker":"Chris Dy","startTime":1127.06,"endTime":1130.48,"body":"joint with the Bouvier maneuver"},{"speaker":"Chris Dy","startTime":1127.06,"endTime":1130.48,"body":"MP joins held in flexion."},{"speaker":"Charles Goldfarb","startTime":1131.17,"endTime":1135.01,"body":"So I certainly"},{"speaker":"Charles Goldfarb","startTime":1131.17,"endTime":1135.01,"body":"am rapidly becoming one of the"},{"speaker":"Charles Goldfarb","startTime":1135.04,"endTime":1138.37,"body":"elderly senior statesman on the"},{"speaker":"Charles Goldfarb","startTime":1135.04,"endTime":1138.37,"body":"hand world in the sense that"},{"speaker":"Charles Goldfarb","startTime":1138.37,"endTime":1141.58,"body":"I've been doing this 20 years"},{"speaker":"Charles Goldfarb","startTime":1138.37,"endTime":1141.58,"body":"now. But and I'm at a you know,"},{"speaker":"Charles Goldfarb","startTime":1141.58,"endTime":1145.03,"body":"a big tertiary quarternary type"},{"speaker":"Charles Goldfarb","startTime":1141.58,"endTime":1145.03,"body":"referral center, but no one does"},{"speaker":"Charles Goldfarb","startTime":1145.03,"endTime":1149.71,"body":"a lot of this no one. And so,"},{"speaker":"Charles Goldfarb","startTime":1145.03,"endTime":1149.71,"body":"you know, leprosy taught us a"},{"speaker":"Charles Goldfarb","startTime":1149.71,"endTime":1152.89,"body":"great deal about this problem,"},{"speaker":"Charles Goldfarb","startTime":1149.71,"endTime":1152.89,"body":"but those surgeons are just not"},{"speaker":"Charles Goldfarb","startTime":1152.89,"endTime":1156.1,"body":"around anymore. So no one has a"},{"speaker":"Charles Goldfarb","startTime":1152.89,"endTime":1156.1,"body":"huge personal experience. My"},{"speaker":"Charles Goldfarb","startTime":1156.1,"endTime":1162.13,"body":"personal belief is that I really"},{"speaker":"Charles Goldfarb","startTime":1156.1,"endTime":1162.13,"body":"do still like a capsulodesis but"},{"speaker":"Charles Goldfarb","startTime":1162.13,"endTime":1166.27,"body":"I don't think it's sufficient"},{"speaker":"Charles Goldfarb","startTime":1162.13,"endTime":1166.27,"body":"because it will stretch out over"},{"speaker":"Charles Goldfarb","startTime":1166.27,"endTime":1169.63,"body":"time and most patients I don't"},{"speaker":"Charles Goldfarb","startTime":1166.27,"endTime":1169.63,"body":"believe in bony blocks are some"},{"speaker":"Charles Goldfarb","startTime":1169.63,"endTime":1173.89,"body":"of the other historical things."},{"speaker":"Charles Goldfarb","startTime":1169.63,"endTime":1173.89,"body":"To me, it's very simple. You"},{"speaker":"Charles Goldfarb","startTime":1173.95,"endTime":1177.94,"body":"Well, nothing's nothing simple,"},{"speaker":"Charles Goldfarb","startTime":1173.95,"endTime":1177.94,"body":"but you do I do a volar capsular"},{"speaker":"Charles Goldfarb","startTime":1177.97,"endTime":1181.93,"body":"thesis and essentially through"},{"speaker":"Charles Goldfarb","startTime":1177.97,"endTime":1181.93,"body":"the same incision, I add a"},{"speaker":"Charles Goldfarb","startTime":1182.02,"endTime":1184.21,"body":"Zancolli lasso. So how do you"},{"speaker":"Charles Goldfarb","startTime":1182.02,"endTime":1184.21,"body":"think about it?"},{"speaker":"Chris Dy","startTime":1185.26,"endTime":1187.45,"body":"So I mean, the"},{"speaker":"Chris Dy","startTime":1185.26,"endTime":1187.45,"body":"principle is to keep the MP"},{"speaker":"Chris Dy","startTime":1187.45,"endTime":1190.09,"body":"joint in flexion and there are a"},{"speaker":"Chris Dy","startTime":1187.45,"endTime":1190.09,"body":"number of different ways to do"},{"speaker":"Chris Dy","startTime":1190.09,"endTime":1193.75,"body":"that. And you've listed a couple"},{"speaker":"Chris Dy","startTime":1190.09,"endTime":1193.75,"body":"of them. You know, the first way"},{"speaker":"Chris Dy","startTime":1193.75,"endTime":1197.26,"body":"to get the MP join flex would be"},{"speaker":"Chris Dy","startTime":1193.75,"endTime":1197.26,"body":"to as you're talking about"},{"speaker":"Chris Dy","startTime":1197.5,"endTime":1201.37,"body":"advanced the MP joint volar"},{"speaker":"Chris Dy","startTime":1197.5,"endTime":1201.37,"body":"capsule and in an advancing"},{"speaker":"Chris Dy","startTime":1201.37,"endTime":1204.76,"body":"that, that's going to hold the"},{"speaker":"Chris Dy","startTime":1201.37,"endTime":1204.76,"body":"MP joint in flexion. Another way"},{"speaker":"Chris Dy","startTime":1204.76,"endTime":1209.77,"body":"to do that would be to"},{"speaker":"Chris Dy","startTime":1204.76,"endTime":1209.77,"body":"intentionally bowstring at and"},{"speaker":"Chris Dy","startTime":1209.77,"endTime":1214.21,"body":"essentially do a an aggressive"},{"speaker":"Chris Dy","startTime":1209.77,"endTime":1214.21,"body":"release of A1 and A2 in order to"},{"speaker":"Chris Dy","startTime":1214.21,"endTime":1218.74,"body":"get MP joint in flexion. And"},{"speaker":"Chris Dy","startTime":1214.21,"endTime":1218.74,"body":"that can be done in combination"},{"speaker":"Chris Dy","startTime":1218.74,"endTime":1222.13,"body":"with the capsulodesis. And then"},{"speaker":"Chris Dy","startTime":1218.74,"endTime":1222.13,"body":"you mentioned I might be missing"},{"speaker":"Chris Dy","startTime":1222.13,"endTime":1223.87,"body":"something else. But you"},{"speaker":"Chris Dy","startTime":1222.13,"endTime":1223.87,"body":"mentioned one of the other ones,"},{"speaker":"Chris Dy","startTime":1223.87,"endTime":1230.5,"body":"which is the Zancolli FDS lasso,"},{"speaker":"Chris Dy","startTime":1223.87,"endTime":1230.5,"body":"in which you find the FDS"},{"speaker":"Chris Dy","startTime":1230.65,"endTime":1234.55,"body":"tendons slips as they insert"},{"speaker":"Chris Dy","startTime":1230.65,"endTime":1234.55,"body":"distally, or wherever you choose"},{"speaker":"Chris Dy","startTime":1234.55,"endTime":1238.36,"body":"to take them, release them"},{"speaker":"Chris Dy","startTime":1234.55,"endTime":1238.36,"body":"distally, so they're no longer"},{"speaker":"Chris Dy","startTime":1238.36,"endTime":1243.19,"body":"flexing the PIP joint. And then"},{"speaker":"Chris Dy","startTime":1238.36,"endTime":1243.19,"body":"in there a number of different"},{"speaker":"Chris Dy","startTime":1243.19,"endTime":1247.0,"body":"ways to do this, but then loop"},{"speaker":"Chris Dy","startTime":1243.19,"endTime":1247.0,"body":"them back on top of themselves."},{"speaker":"Chris Dy","startTime":1247.0,"endTime":1250.81,"body":"So you've got them on top of the"},{"speaker":"Chris Dy","startTime":1247.0,"endTime":1250.81,"body":"A1 and A2 pulleys volar to the"},{"speaker":"Chris Dy","startTime":1250.81,"endTime":1255.19,"body":"A1 and A2 pulleys, and then"},{"speaker":"Chris Dy","startTime":1250.81,"endTime":1255.19,"body":"sutured back to itself proximal"},{"speaker":"Chris Dy","startTime":1255.19,"endTime":1259.06,"body":"to the A1 pulley. Can you think"},{"speaker":"Chris Dy","startTime":1255.19,"endTime":1259.06,"body":"of any other static kind of"},{"speaker":"Chris Dy","startTime":1259.09,"endTime":1261.22,"body":"procedures that would hold the"},{"speaker":"Chris Dy","startTime":1259.09,"endTime":1261.22,"body":"MP to an inflection?"},{"speaker":"Charles Goldfarb","startTime":1261.87,"endTime":1264.0,"body":"No, those are"},{"speaker":"Charles Goldfarb","startTime":1261.87,"endTime":1264.0,"body":"the main ones I like, again,"},{"speaker":"Charles Goldfarb","startTime":1264.0,"endTime":1267.75,"body":"historically, people put a bone"},{"speaker":"Charles Goldfarb","startTime":1264.0,"endTime":1267.75,"body":"block in the joint. I mean, you"},{"speaker":"Charles Goldfarb","startTime":1267.75,"endTime":1270.0,"body":"confuse the joint if you want."},{"speaker":"Charles Goldfarb","startTime":1267.75,"endTime":1270.0,"body":"But that doesn't make any sense"},{"speaker":"Charles Goldfarb","startTime":1270.0,"endTime":1273.69,"body":"to me. So I think in my mind,"},{"speaker":"Charles Goldfarb","startTime":1270.0,"endTime":1273.69,"body":"you've summarized it very"},{"speaker":"Charles Goldfarb","startTime":1273.69,"endTime":1276.0,"body":"nicely, including the technique."},{"speaker":"Charles Goldfarb","startTime":1273.69,"endTime":1276.0,"body":"And I think there are different"},{"speaker":"Charles Goldfarb","startTime":1276.0,"endTime":1279.48,"body":"ways to do Zancolli lasso. But"},{"speaker":"Charles Goldfarb","startTime":1276.0,"endTime":1279.48,"body":"they're all about the same in my"},{"speaker":"Charles Goldfarb","startTime":1279.48,"endTime":1283.32,"body":"mind, whether you go over A1 and"},{"speaker":"Charles Goldfarb","startTime":1279.48,"endTime":1283.32,"body":"A2 and there are different ways"},{"speaker":"Charles Goldfarb","startTime":1283.32,"endTime":1286.53,"body":"to do it, but accomplish the"},{"speaker":"Charles Goldfarb","startTime":1283.32,"endTime":1286.53,"body":"same goal, a dynamic transfer,"},{"speaker":"Charles Goldfarb","startTime":1286.71,"endTime":1290.37,"body":"that when the patient fires"},{"speaker":"Charles Goldfarb","startTime":1286.71,"endTime":1290.37,"body":"tends to flex the MP, and they"},{"speaker":"Charles Goldfarb","startTime":1290.37,"endTime":1292.74,"body":"may be able to extend the IP"},{"speaker":"Charles Goldfarb","startTime":1290.37,"endTime":1292.74,"body":"joint more easily."},{"speaker":"Chris Dy","startTime":1293.58,"endTime":1295.83,"body":"Wait a minute, this is"},{"speaker":"Chris Dy","startTime":1293.58,"endTime":1295.83,"body":"a static transfer this is"},{"speaker":"Chris Dy","startTime":1295.83,"endTime":1298.8,"body":"statically, holding the MP"},{"speaker":"Chris Dy","startTime":1295.83,"endTime":1298.8,"body":"joints in flexion. Right,"},{"speaker":"Charles Goldfarb","startTime":1298.86,"endTime":1301.11,"body":"the"},{"speaker":"Charles Goldfarb","startTime":1298.86,"endTime":1301.11,"body":"capsulodesis, but Zancolli adds"},{"speaker":"Charles Goldfarb","startTime":1301.11,"endTime":1304.32,"body":"a dynamic component when they're"},{"speaker":"Charles Goldfarb","startTime":1301.11,"endTime":1304.32,"body":"pulling on their FDS"},{"speaker":"Chris Dy","startTime":1304.68,"endTime":1306.66,"body":"Okay, gotcha. That's"},{"speaker":"Chris Dy","startTime":1304.68,"endTime":1306.66,"body":"okay. I see what you're saying."},{"speaker":"Chris Dy","startTime":1307.29,"endTime":1310.44,"body":"And then do you when do you"},{"speaker":"Chris Dy","startTime":1307.29,"endTime":1310.44,"body":"think that the volar"},{"speaker":"Chris Dy","startTime":1311.04,"endTime":1314.22,"body":"capsulodesis is enough? Because,"},{"speaker":"Chris Dy","startTime":1311.04,"endTime":1314.22,"body":"you know, when I've, whenever"},{"speaker":"Chris Dy","startTime":1314.22,"endTime":1317.58,"body":"I've done that I've been"},{"speaker":"Chris Dy","startTime":1314.22,"endTime":1317.58,"body":"unimpressed with the amount of"},{"speaker":"Chris Dy","startTime":1317.58,"endTime":1321.03,"body":"correction and the maintenance"},{"speaker":"Chris Dy","startTime":1317.58,"endTime":1321.03,"body":"of correction. And I don't know"},{"speaker":"Chris Dy","startTime":1321.03,"endTime":1325.35,"body":"whether I'm fooling myself."},{"speaker":"Chris Dy","startTime":1321.03,"endTime":1325.35,"body":"Yeah,"},{"speaker":"Charles Goldfarb","startTime":1325.0,"endTime":1327.55,"body":"it's hard. I"},{"speaker":"Charles Goldfarb","startTime":1325.0,"endTime":1327.55,"body":"don't know the perfect"},{"speaker":"Charles Goldfarb","startTime":1327.55,"endTime":1331.36,"body":"population, I would say a bit of"},{"speaker":"Charles Goldfarb","startTime":1327.55,"endTime":1331.36,"body":"an older patient, maybe with a"},{"speaker":"Charles Goldfarb","startTime":1331.36,"endTime":1333.97,"body":"more robust volar plate. Now"},{"speaker":"Charles Goldfarb","startTime":1331.36,"endTime":1333.97,"body":"those are the patients that may"},{"speaker":"Charles Goldfarb","startTime":1333.97,"endTime":1338.17,"body":"not get so much hyperextension"},{"speaker":"Charles Goldfarb","startTime":1333.97,"endTime":1338.17,"body":"the MP if they ever really, like"},{"speaker":"Charles Goldfarb","startTime":1338.17,"endTime":1342.91,"body":"a burly type worker may not get"},{"speaker":"Charles Goldfarb","startTime":1338.17,"endTime":1342.91,"body":"as much MP joint hyperextension."},{"speaker":"Charles Goldfarb","startTime":1342.97,"endTime":1345.46,"body":"But the flipside is, if they do"},{"speaker":"Charles Goldfarb","startTime":1342.97,"endTime":1345.46,"body":"get some they have a more"},{"speaker":"Charles Goldfarb","startTime":1345.46,"endTime":1348.22,"body":"substantial volar plate to work"},{"speaker":"Charles Goldfarb","startTime":1345.46,"endTime":1348.22,"body":"with. It's the same question we"},{"speaker":"Charles Goldfarb","startTime":1348.22,"endTime":1350.92,"body":"deal with when we're talking"},{"speaker":"Charles Goldfarb","startTime":1348.22,"endTime":1350.92,"body":"about the thumb CMC joint, like"},{"speaker":"Charles Goldfarb","startTime":1350.92,"endTime":1353.89,"body":"how do you control the MP joint"},{"speaker":"Charles Goldfarb","startTime":1350.92,"endTime":1353.89,"body":"of the thumb in a"},{"speaker":"Charles Goldfarb","startTime":1353.89,"endTime":1357.34,"body":"straightforward way in his"},{"speaker":"Charles Goldfarb","startTime":1353.89,"endTime":1357.34,"body":"capsulodesis enough? So I don't"},{"speaker":"Charles Goldfarb","startTime":1357.34,"endTime":1360.55,"body":"know the answer. But I do like"},{"speaker":"Charles Goldfarb","startTime":1357.34,"endTime":1360.55,"body":"it because it immediately places"},{"speaker":"Charles Goldfarb","startTime":1360.55,"endTime":1365.08,"body":"the MP joint in flexion. It's"},{"speaker":"Charles Goldfarb","startTime":1360.55,"endTime":1365.08,"body":"one more check. And I think, in"},{"speaker":"Charles Goldfarb","startTime":1365.08,"endTime":1368.74,"body":"general supplementing it with"},{"speaker":"Charles Goldfarb","startTime":1365.08,"endTime":1368.74,"body":"something else. Makes sense."},{"speaker":"Chris Dy","startTime":1369.77,"endTime":1371.84,"body":"First of all, I don't"},{"speaker":"Chris Dy","startTime":1369.77,"endTime":1371.84,"body":"want to gloss over a really good"},{"speaker":"Chris Dy","startTime":1371.84,"endTime":1378.05,"body":"point that you made. The big"},{"speaker":"Chris Dy","startTime":1371.84,"endTime":1378.05,"body":"working hand tends not to get a"},{"speaker":"Chris Dy","startTime":1378.05,"endTime":1380.78,"body":"claw, just because the MP joints"},{"speaker":"Chris Dy","startTime":1378.05,"endTime":1380.78,"body":"tend to be tight. And they tend"},{"speaker":"Chris Dy","startTime":1380.81,"endTime":1384.74,"body":"to have a bit of an MP joint"},{"speaker":"Chris Dy","startTime":1380.81,"endTime":1384.74,"body":"contraction which stops them"},{"speaker":"Chris Dy","startTime":1384.74,"endTime":1387.08,"body":"from going into this, you know,"},{"speaker":"Chris Dy","startTime":1384.74,"endTime":1387.08,"body":"if you have lakhs and if you"},{"speaker":"Chris Dy","startTime":1387.08,"endTime":1389.93,"body":"have more laxity, you're more"},{"speaker":"Chris Dy","startTime":1387.08,"endTime":1389.93,"body":"prone to get into this hyper"},{"speaker":"Chris Dy","startTime":1389.93,"endTime":1393.47,"body":"extended MP posture. And I"},{"speaker":"Chris Dy","startTime":1389.93,"endTime":1393.47,"body":"remember reading when I was a"},{"speaker":"Chris Dy","startTime":1393.47,"endTime":1396.56,"body":"resident reading the chapter on"},{"speaker":"Chris Dy","startTime":1393.47,"endTime":1396.56,"body":"older neuropathy and Green's"},{"speaker":"Chris Dy","startTime":1396.56,"endTime":1399.83,"body":"operative hand surgery, talking"},{"speaker":"Chris Dy","startTime":1396.56,"endTime":1399.83,"body":"about how the ulnar nerve is a"},{"speaker":"Chris Dy","startTime":1399.83,"endTime":1403.88,"body":"luxury to the laborer. And for a"},{"speaker":"Chris Dy","startTime":1399.83,"endTime":1403.88,"body":"number of reasons, but one of"},{"speaker":"Chris Dy","startTime":1403.88,"endTime":1406.61,"body":"them being that you know, the"},{"speaker":"Chris Dy","startTime":1403.88,"endTime":1406.61,"body":"cloth just doesn't happen as"},{"speaker":"Chris Dy","startTime":1406.61,"endTime":1409.25,"body":"much in that big burly hand."},{"speaker":"Chris Dy","startTime":1406.61,"endTime":1409.25,"body":"Now, that is clearly an"},{"speaker":"Chris Dy","startTime":1409.25,"endTime":1411.89,"body":"overgeneralization. But it's a"},{"speaker":"Chris Dy","startTime":1409.25,"endTime":1411.89,"body":"good concept to think about."},{"speaker":"Charles Goldfarb","startTime":1413.03,"endTime":1415.79,"body":"Absolutely."},{"speaker":"Charles Goldfarb","startTime":1413.03,"endTime":1415.79,"body":"And it's fact I mean, you'll see"},{"speaker":"Charles Goldfarb","startTime":1415.79,"endTime":1418.28,"body":"it in your clinic and you worry"},{"speaker":"Charles Goldfarb","startTime":1415.79,"endTime":1418.28,"body":"less about that worker with an"},{"speaker":"Charles Goldfarb","startTime":1418.28,"endTime":1423.29,"body":"older injury than you do with a,"},{"speaker":"Charles Goldfarb","startTime":1418.28,"endTime":1423.29,"body":"you know, a 15 year old"},{"speaker":"Charles Goldfarb","startTime":1423.29,"endTime":1425.63,"body":"adolescent female. It's just"},{"speaker":"Charles Goldfarb","startTime":1423.29,"endTime":1425.63,"body":"different population."},{"speaker":"Chris Dy","startTime":1426.32,"endTime":1429.5,"body":"So then I think we're"},{"speaker":"Chris Dy","startTime":1426.32,"endTime":1429.5,"body":"going to have to have another"},{"speaker":"Chris Dy","startTime":1429.5,"endTime":1432.68,"body":"episode on this because we're"},{"speaker":"Chris Dy","startTime":1429.5,"endTime":1432.68,"body":"probably running close to time."},{"speaker":"Chris Dy","startTime":1432.71,"endTime":1435.8,"body":"But you know, do you ever pin"},{"speaker":"Chris Dy","startTime":1432.71,"endTime":1435.8,"body":"the MP joins to keep them in the"},{"speaker":"Chris Dy","startTime":1435.8,"endTime":1437.21,"body":"flexed position temporarily?"},{"speaker":"Charles Goldfarb","startTime":1438.41,"endTime":1440.54,"body":"I am"},{"speaker":"Charles Goldfarb","startTime":1438.41,"endTime":1440.54,"body":"absolutely not against pinning-"},{"speaker":"Charles Goldfarb","startTime":1440.57,"endTime":1443.21,"body":"I've pinned less and less"},{"speaker":"Charles Goldfarb","startTime":1440.57,"endTime":1443.21,"body":"fingers in these situations"},{"speaker":"Charles Goldfarb","startTime":1443.21,"endTime":1447.11,"body":"whether it be the PIP joint"},{"speaker":"Charles Goldfarb","startTime":1443.21,"endTime":1447.11,"body":"after release or the MP joint"},{"speaker":"Charles Goldfarb","startTime":1447.11,"endTime":1452.96,"body":"the situation. I think again, if"},{"speaker":"Charles Goldfarb","startTime":1447.11,"endTime":1452.96,"body":"you have substantial volar plate"},{"speaker":"Charles Goldfarb","startTime":1452.96,"endTime":1454.79,"body":"to work with and you feel"},{"speaker":"Charles Goldfarb","startTime":1452.96,"endTime":1454.79,"body":"comfortable with your"},{"speaker":"Charles Goldfarb","startTime":1454.79,"endTime":1458.69,"body":"capsulodesis and you can capture"},{"speaker":"Charles Goldfarb","startTime":1454.79,"endTime":1458.69,"body":"a dorsal splint to block"},{"speaker":"Charles Goldfarb","startTime":1458.69,"endTime":1461.45,"body":"extension I am comfortable not"},{"speaker":"Charles Goldfarb","startTime":1458.69,"endTime":1461.45,"body":"pinning. But the flipside is"},{"speaker":"Charles Goldfarb","startTime":1461.45,"endTime":1464.15,"body":"also true if you need to pin"},{"speaker":"Charles Goldfarb","startTime":1461.45,"endTime":1464.15,"body":"your MP and you know what, you"},{"speaker":"Charles Goldfarb","startTime":1464.15,"endTime":1466.31,"body":"pin for six weeks and they're"},{"speaker":"Charles Goldfarb","startTime":1464.15,"endTime":1466.31,"body":"they're gonna get stiff."},{"speaker":"Chris Dy","startTime":1467.53,"endTime":1470.32,"body":"So we'll talk about"},{"speaker":"Chris Dy","startTime":1467.53,"endTime":1470.32,"body":"the technical aspects of the"},{"speaker":"Chris Dy","startTime":1470.35,"endTime":1474.1,"body":"Zancolli as well as other"},{"speaker":"Chris Dy","startTime":1470.35,"endTime":1474.1,"body":"dynamic transfers when we meet"},{"speaker":"Chris Dy","startTime":1474.1,"endTime":1477.37,"body":"again, but when you have"},{"speaker":"Chris Dy","startTime":1474.1,"endTime":1477.37,"body":"somebody who in whom you've done"},{"speaker":"Chris Dy","startTime":1477.37,"endTime":1481.39,"body":"a volar capsulodesis alone and"},{"speaker":"Chris Dy","startTime":1477.37,"endTime":1481.39,"body":"advanced it and you've gotten"},{"speaker":"Chris Dy","startTime":1481.39,"endTime":1484.42,"body":"them in good position, what's"},{"speaker":"Chris Dy","startTime":1481.39,"endTime":1484.42,"body":"your postop protocol for that?"},{"speaker":"Chris Dy","startTime":1484.42,"endTime":1486.82,"body":"And are you also intentionally"},{"speaker":"Chris Dy","startTime":1484.42,"endTime":1486.82,"body":"bowstringly  at the same time?"},{"speaker":"Charles Goldfarb","startTime":1488.05,"endTime":1491.2,"body":"I always"},{"speaker":"Charles Goldfarb","startTime":1488.05,"endTime":1491.2,"body":"release obviously A1 because"},{"speaker":"Charles Goldfarb","startTime":1491.2,"endTime":1494.5,"body":"that is your access point to the"},{"speaker":"Charles Goldfarb","startTime":1491.2,"endTime":1494.5,"body":"volar plate. I have not done"},{"speaker":"Charles Goldfarb","startTime":1494.5,"endTime":1498.7,"body":"that. It's a smart trick. I've"},{"speaker":"Charles Goldfarb","startTime":1494.5,"endTime":1498.7,"body":"not tried it. Meaning and I"},{"speaker":"Charles Goldfarb","startTime":1498.7,"endTime":1503.17,"body":"think what would be required"},{"speaker":"Charles Goldfarb","startTime":1498.7,"endTime":1503.17,"body":"would be to release A1 and A2. I"},{"speaker":"Charles Goldfarb","startTime":1503.17,"endTime":1505.9,"body":"haven't done that I might"},{"speaker":"Charles Goldfarb","startTime":1503.17,"endTime":1505.9,"body":"consider in the future. I think"},{"speaker":"Charles Goldfarb","startTime":1505.9,"endTime":1509.59,"body":"for me this volar plate"},{"speaker":"Charles Goldfarb","startTime":1505.9,"endTime":1509.59,"body":"capsulodesis would again be a,"},{"speaker":"Charles Goldfarb","startTime":1509.59,"endTime":1513.34,"body":"the right patient and b, the"},{"speaker":"Charles Goldfarb","startTime":1509.59,"endTime":1513.34,"body":"right injury. I wouldn't do that"},{"speaker":"Charles Goldfarb","startTime":1514.33,"endTime":1517.54,"body":"in a Charcot Marie Tooth patient"},{"speaker":"Charles Goldfarb","startTime":1514.33,"endTime":1517.54,"body":"or in a chronic ulnar nerve that"},{"speaker":"Charles Goldfarb","startTime":1517.81,"endTime":1521.47,"body":"we're not hoping recovers. But"},{"speaker":"Charles Goldfarb","startTime":1517.81,"endTime":1521.47,"body":"if it is a younger patient with"},{"speaker":"Charles Goldfarb","startTime":1521.47,"endTime":1525.43,"body":"an order of repair plus minus"},{"speaker":"Charles Goldfarb","startTime":1521.47,"endTime":1525.43,"body":"supercharge, that had been"},{"speaker":"Charles Goldfarb","startTime":1525.43,"endTime":1527.68,"body":"clawing prior to surgical"},{"speaker":"Charles Goldfarb","startTime":1525.43,"endTime":1527.68,"body":"intervention where you are"},{"speaker":"Charles Goldfarb","startTime":1527.68,"endTime":1531.46,"body":"hopeful for recovery. I think"},{"speaker":"Charles Goldfarb","startTime":1527.68,"endTime":1531.46,"body":"that's the perfect patient to do"},{"speaker":"Charles Goldfarb","startTime":1531.46,"endTime":1534.49,"body":"a capsulodesis alone, because if"},{"speaker":"Charles Goldfarb","startTime":1531.46,"endTime":1534.49,"body":"you recover if your nerve"},{"speaker":"Charles Goldfarb","startTime":1534.49,"endTime":1536.17,"body":"regeneration works, you're not"},{"speaker":"Charles Goldfarb","startTime":1534.49,"endTime":1536.17,"body":"going to need it."},{"speaker":"Chris Dy","startTime":1537.37,"endTime":1541.6,"body":"Do you think that down"},{"speaker":"Chris Dy","startTime":1537.37,"endTime":1541.6,"body":"the line that you having? I"},{"speaker":"Chris Dy","startTime":1541.6,"endTime":1545.5,"body":"think you think it'll stretch"},{"speaker":"Chris Dy","startTime":1541.6,"endTime":1545.5,"body":"out in with enough time that"},{"speaker":"Chris Dy","startTime":1545.5,"endTime":1548.29,"body":"it'll coincide with your"},{"speaker":"Chris Dy","startTime":1545.5,"endTime":1548.29,"body":"eventual recovery of intrinsic"},{"speaker":"Chris Dy","startTime":1548.29,"endTime":1549.67,"body":"function that you amazingly get?"},{"speaker":"Charles Goldfarb","startTime":1549.91,"endTime":1552.16,"body":"Absolutely,"},{"speaker":"Charles Goldfarb","startTime":1549.91,"endTime":1552.16,"body":"its always perfect timing."},{"speaker":"Chris Dy","startTime":1552.79,"endTime":1555.55,"body":"Well done. Well done."},{"speaker":"Chris Dy","startTime":1552.79,"endTime":1555.55,"body":"Um, that one, then I guess,"},{"speaker":"Chris Dy","startTime":1555.58,"endTime":1559.15,"body":"before I forget to ask"},{"speaker":"Chris Dy","startTime":1555.58,"endTime":1559.15,"body":"technically, how do you secure"},{"speaker":"Chris Dy","startTime":1559.15,"endTime":1561.13,"body":"your advancement of the capsule?"},{"speaker":"Charles Goldfarb","startTime":1562.0,"endTime":1565.33,"body":"Yeah, I tend"},{"speaker":"Charles Goldfarb","startTime":1562.0,"endTime":1565.33,"body":"to take a segment out of the"},{"speaker":"Charles Goldfarb","startTime":1565.33,"endTime":1568.96,"body":"volar plate. And I don't use"},{"speaker":"Charles Goldfarb","startTime":1565.33,"endTime":1568.96,"body":"suture anchors, although again,"},{"speaker":"Charles Goldfarb","startTime":1568.99,"endTime":1573.1,"body":"not against them. But I'd take a"},{"speaker":"Charles Goldfarb","startTime":1568.99,"endTime":1573.1,"body":"wedge segment out of the volar"},{"speaker":"Charles Goldfarb","startTime":1573.1,"endTime":1577.75,"body":"plate, flex the finger and use a"},{"speaker":"Charles Goldfarb","startTime":1573.1,"endTime":1577.75,"body":"pretty substantial like a 2-0,"},{"speaker":"Charles Goldfarb","startTime":1578.23,"endTime":1582.49,"body":"braided nonabsorbable suture to"},{"speaker":"Charles Goldfarb","startTime":1578.23,"endTime":1582.49,"body":"bring the edges of the boiler"},{"speaker":"Charles Goldfarb","startTime":1582.49,"endTime":1586.27,"body":"plate back together. That's part"},{"speaker":"Charles Goldfarb","startTime":1582.49,"endTime":1586.27,"body":"one. Part two is a mobilization"},{"speaker":"Charles Goldfarb","startTime":1586.27,"endTime":1586.99,"body":"for six weeks."},{"speaker":"Chris Dy","startTime":1587.68,"endTime":1590.29,"body":"Now, it was very hard"},{"speaker":"Chris Dy","startTime":1587.68,"endTime":1590.29,"body":"for you not to say the the brand"},{"speaker":"Chris Dy","startTime":1590.29,"endTime":1592.12,"body":"name of that feature he just"},{"speaker":"Chris Dy","startTime":1590.29,"endTime":1592.12,"body":"received"},{"speaker":"Charles Goldfarb","startTime":1592.18,"endTime":1594.22,"body":"a- I don't"},{"speaker":"Charles Goldfarb","startTime":1592.18,"endTime":1594.22,"body":"know why I didn't say the right"},{"speaker":"Charles Goldfarb","startTime":1594.25,"endTime":1597.49,"body":"brand name, you always need to"},{"speaker":"Charles Goldfarb","startTime":1594.25,"endTime":1597.49,"body":"correct me when I do. And b- it"},{"speaker":"Charles Goldfarb","startTime":1597.49,"endTime":1599.86,"body":"was very hard to say it that"},{"speaker":"Charles Goldfarb","startTime":1597.49,"endTime":1599.86,"body":"way."},{"speaker":"Chris Dy","startTime":1600.47,"endTime":1604.97,"body":"I like I like to use a"},{"speaker":"Chris Dy","startTime":1600.47,"endTime":1604.97,"body":"generic suture anchor. Because"},{"speaker":"Chris Dy","startTime":1604.97,"endTime":1608.21,"body":"that's, that's what I saw when"},{"speaker":"Chris Dy","startTime":1604.97,"endTime":1608.21,"body":"in the limited portions that I"},{"speaker":"Chris Dy","startTime":1608.21,"endTime":1611.75,"body":"saw in training. But I again, I"},{"speaker":"Chris Dy","startTime":1608.21,"endTime":1611.75,"body":"probably like to spend more"},{"speaker":"Chris Dy","startTime":1611.75,"endTime":1612.35,"body":"money than you."},{"speaker":"Charles Goldfarb","startTime":1613.44,"endTime":1615.75,"body":"Maybe you do,"},{"speaker":"Charles Goldfarb","startTime":1613.44,"endTime":1615.75,"body":"maybe. So when you do that you"},{"speaker":"Charles Goldfarb","startTime":1615.75,"endTime":1619.65,"body":"put the suture anchor in the"},{"speaker":"Charles Goldfarb","startTime":1615.75,"endTime":1619.65,"body":"base of the proximal phalanx? Do"},{"speaker":"Charles Goldfarb","startTime":1619.65,"endTime":1623.04,"body":"you excise any of the volar"},{"speaker":"Charles Goldfarb","startTime":1619.65,"endTime":1623.04,"body":"plate or you just use that"},{"speaker":"Charles Goldfarb","startTime":1623.04,"endTime":1625.5,"body":"suture anchor to grab some of"},{"speaker":"Charles Goldfarb","startTime":1623.04,"endTime":1625.5,"body":"the volar plate ?"},{"speaker":"Chris Dy","startTime":1625.5,"endTime":1629.67,"body":"I put the anchor in"},{"speaker":"Chris Dy","startTime":1625.5,"endTime":1629.67,"body":"the metacarpal. And use that at"},{"speaker":"Chris Dy","startTime":1629.67,"endTime":1631.8,"body":"the kind of the neck region"},{"speaker":"Chris Dy","startTime":1629.67,"endTime":1631.8,"body":"because I think you're getting"},{"speaker":"Chris Dy","startTime":1631.8,"endTime":1636.51,"body":"dicey, the further out you go"},{"speaker":"Chris Dy","startTime":1631.8,"endTime":1636.51,"body":"and then use the braided"},{"speaker":"Chris Dy","startTime":1636.54,"endTime":1640.89,"body":"nonabsorbable suture and"},{"speaker":"Chris Dy","startTime":1636.54,"endTime":1640.89,"body":"essentially crack out one limb"},{"speaker":"Chris Dy","startTime":1640.89,"endTime":1644.28,"body":"up and then bring that same limb"},{"speaker":"Chris Dy","startTime":1640.89,"endTime":1644.28,"body":"down and then hold the MP joint"},{"speaker":"Chris Dy","startTime":1644.28,"endTime":1647.16,"body":"down. And I think that if you're"},{"speaker":"Chris Dy","startTime":1644.28,"endTime":1647.16,"body":"limited in terms of the, if you"},{"speaker":"Chris Dy","startTime":1647.16,"endTime":1649.71,"body":"don't have anybody that can hold"},{"speaker":"Chris Dy","startTime":1647.16,"endTime":1649.71,"body":"it or you know, usually you're"},{"speaker":"Chris Dy","startTime":1649.71,"endTime":1652.11,"body":"the attending and you're flexing"},{"speaker":"Chris Dy","startTime":1649.71,"endTime":1652.11,"body":"the MP joint down and somebody"},{"speaker":"Chris Dy","startTime":1652.11,"endTime":1654.96,"body":"else is doing the stitch, that"},{"speaker":"Chris Dy","startTime":1652.11,"endTime":1654.96,"body":"can be very tight area to put a"},{"speaker":"Chris Dy","startTime":1654.96,"endTime":1658.11,"body":"stitch in, and also the slide"},{"speaker":"Chris Dy","startTime":1654.96,"endTime":1658.11,"body":"that not properly, which can"},{"speaker":"Chris Dy","startTime":1658.11,"endTime":1661.5,"body":"lead to some points of"},{"speaker":"Chris Dy","startTime":1658.11,"endTime":1661.5,"body":"frustration. So sometimes it is"},{"speaker":"Chris Dy","startTime":1661.5,"endTime":1664.11,"body":"more helpful just to at least"},{"speaker":"Chris Dy","startTime":1661.5,"endTime":1664.11,"body":"provisionally pin the joint,"},{"speaker":"Chris Dy","startTime":1665.25,"endTime":1667.89,"body":"which I try not to pin if I"},{"speaker":"Chris Dy","startTime":1665.25,"endTime":1667.89,"body":"don't have to. And then I also"},{"speaker":"Chris Dy","startTime":1667.89,"endTime":1671.31,"body":"think well if I've got it pinned"},{"speaker":"Chris Dy","startTime":1667.89,"endTime":1671.31,"body":"what not, leave it pinned. But"},{"speaker":"Chris Dy","startTime":1671.31,"endTime":1673.65,"body":"if I can avoid pinning it, I"},{"speaker":"Chris Dy","startTime":1671.31,"endTime":1673.65,"body":"avoid pinning it if I need to"},{"speaker":"Chris Dy","startTime":1673.65,"endTime":1676.65,"body":"just from a logistical"},{"speaker":"Chris Dy","startTime":1673.65,"endTime":1676.65,"body":"perspective I will. And then"},{"speaker":"Chris Dy","startTime":1676.65,"endTime":1679.62,"body":"just really this is the knot"},{"speaker":"Chris Dy","startTime":1676.65,"endTime":1679.62,"body":"where the knot tying skills"},{"speaker":"Chris Dy","startTime":1679.62,"endTime":1682.26,"body":"matter and sliding not not all"},{"speaker":"Chris Dy","startTime":1679.62,"endTime":1682.26,"body":"the all the way down and"},{"speaker":"Chris Dy","startTime":1682.26,"endTime":1686.73,"body":"securing it properly. It holds"},{"speaker":"Chris Dy","startTime":1682.26,"endTime":1686.73,"body":"really well I'm very happy with"},{"speaker":"Chris Dy","startTime":1686.73,"endTime":1689.43,"body":"that. It's just obviously like"},{"speaker":"Chris Dy","startTime":1686.73,"endTime":1689.43,"body":"anything will stretch over time,"},{"speaker":"Charles Goldfarb","startTime":1689.0,"endTime":1692.27,"body":"I think we"},{"speaker":"Charles Goldfarb","startTime":1689.0,"endTime":1692.27,"body":"need to create a new scale,"},{"speaker":"Charles Goldfarb","startTime":1692.3,"endTime":1696.29,"body":"we'll call it the \"F-bomb"},{"speaker":"Charles Goldfarb","startTime":1692.3,"endTime":1696.29,"body":"generating scale\" of procedures,"},{"speaker":"Charles Goldfarb","startTime":1696.29,"endTime":1699.86,"body":"this would be high on the list"},{"speaker":"Charles Goldfarb","startTime":1696.29,"endTime":1699.86,"body":"of generating F bombs. Because"},{"speaker":"Charles Goldfarb","startTime":1700.16,"endTime":1703.4,"body":"you have a relatively small area"},{"speaker":"Charles Goldfarb","startTime":1700.16,"endTime":1703.4,"body":"you're working in, you have the"},{"speaker":"Charles Goldfarb","startTime":1703.4,"endTime":1705.68,"body":"flexor tendons in your way"},{"speaker":"Charles Goldfarb","startTime":1703.4,"endTime":1705.68,"body":"you're trying to retract the"},{"speaker":"Charles Goldfarb","startTime":1705.68,"endTime":1709.49,"body":"flexor tendons, keep the MP"},{"speaker":"Charles Goldfarb","startTime":1705.68,"endTime":1709.49,"body":"flex, put some sutures in and"},{"speaker":"Charles Goldfarb","startTime":1709.49,"endTime":1714.32,"body":"look smooth doing it. And I'm"},{"speaker":"Charles Goldfarb","startTime":1709.49,"endTime":1714.32,"body":"sure you do Dr. Dy, but I let"},{"speaker":"Charles Goldfarb","startTime":1714.32,"endTime":1715.79,"body":"them fly during that case,"},{"speaker":"Chris Dy","startTime":1715.0,"endTime":1718.355,"body":"I'm just gonna say"},{"speaker":"Chris Dy","startTime":1715.0,"endTime":1718.355,"body":"that this is an excellent time"},{"speaker":"Charles Goldfarb","startTime":1715.0,"endTime":1727.57,"body":"I like that I"},{"speaker":"Charles Goldfarb","startTime":1715.0,"endTime":1727.57,"body":"would also for those of us who"},{"speaker":"Charles Goldfarb","startTime":1718.424,"endTime":1722.739,"body":"to reinforce knot tying skills."},{"speaker":"Charles Goldfarb","startTime":1718.424,"endTime":1722.739,"body":"So, so yes, we can go into more"},{"speaker":"Charles Goldfarb","startTime":1722.807,"endTime":1726.574,"body":"detail about other aspects. I"},{"speaker":"Charles Goldfarb","startTime":1722.807,"endTime":1726.574,"body":"think probably we need to"},{"speaker":"Charles Goldfarb","startTime":1726.642,"endTime":1730.615,"body":"alternate and you know, let you"},{"speaker":"Charles Goldfarb","startTime":1726.642,"endTime":1730.615,"body":"have your adolescent elbow"},{"speaker":"Charles Goldfarb","startTime":1729.1,"endTime":1737.26,"body":"have made it to the end of this"},{"speaker":"Charles Goldfarb","startTime":1729.1,"endTime":1737.26,"body":"episode, my request would be"},{"speaker":"Charles Goldfarb","startTime":1730.683,"endTime":1734.929,"body":"moment. Next and then we'll get"},{"speaker":"Charles Goldfarb","startTime":1730.683,"endTime":1734.929,"body":"back to two different types of"},{"speaker":"Charles Goldfarb","startTime":1734.998,"endTime":1739.45,"body":"tendon transfers for anti claw"},{"speaker":"Charles Goldfarb","startTime":1734.998,"endTime":1739.45,"body":"of alternate nerve ish and sports."},{"speaker":"Charles Goldfarb","startTime":1737.35,"endTime":1745.42,"body":"send us your F bomb generating"},{"speaker":"Charles Goldfarb","startTime":1737.35,"endTime":1745.42,"body":"cases, I think those will be of"},{"speaker":"Charles Goldfarb","startTime":1745.66,"endTime":1752.32,"body":"good fodder for discussion. I"},{"speaker":"Charles Goldfarb","startTime":1745.66,"endTime":1752.32,"body":"may even email the group to ask"},{"speaker":"Charles Goldfarb","startTime":1752.32,"endTime":1752.62,"body":"for those."},{"speaker":"Chris Dy","startTime":1753.37,"endTime":1756.88,"body":"This, look at this"},{"speaker":"Chris Dy","startTime":1753.37,"endTime":1756.88,"body":"2023 And a new lesson of"},{"speaker":"Chris Dy","startTime":1756.88,"endTime":1760.06,"body":"listener engagement. So thank"},{"speaker":"Chris Dy","startTime":1756.88,"endTime":1760.06,"body":"you to those of you who have"},{"speaker":"Chris Dy","startTime":1760.06,"endTime":1763.42,"body":"made it to the end. And now that"},{"speaker":"Chris Dy","startTime":1760.06,"endTime":1763.42,"body":"you you know, Chuck's pearls for"},{"speaker":"Chris Dy","startTime":1763.42,"endTime":1764.8,"body":"F bomb generating cases."},{"speaker":"Charles Goldfarb","startTime":1765.08,"endTime":1767.0,"body":"Perfect. I"},{"speaker":"Charles Goldfarb","startTime":1765.08,"endTime":1767.0,"body":"love it. Good to see you, Chris."},{"speaker":"Charles Goldfarb","startTime":1767.0,"endTime":1768.71,"body":"Have a good long weekend."},{"speaker":"Chris Dy","startTime":1769.04,"endTime":1770.39,"body":"You too. Hey, Chris,"},{"speaker":"Charles Goldfarb","startTime":1770.42,"endTime":1772.25,"body":"that was fun."},{"speaker":"Charles Goldfarb","startTime":1770.42,"endTime":1772.25,"body":"Let's do it again real soon."},{"speaker":"Chris Dy","startTime":1772.51,"endTime":1775.03,"body":"Sounds good. Well, be"},{"speaker":"Chris Dy","startTime":1772.51,"endTime":1775.03,"body":"sure to check us out on Twitter"},{"speaker":"Chris Dy","startTime":1775.18,"endTime":1777.46,"body":"@Handpodcast. Hey, Chuck, what's"},{"speaker":"Chris Dy","startTime":1775.18,"endTime":1777.46,"body":"your Twitter handle?"},{"speaker":"Charles Goldfarb","startTime":1777.79,"endTime":1780.64,"body":"Mine is"},{"speaker":"Charles Goldfarb","startTime":1777.79,"endTime":1780.64,"body":"@congenitalhand. What about you?"},{"speaker":"Chris Dy","startTime":1780.79,"endTime":1784.18,"body":"Mine is @ChrisDyMD"},{"speaker":"Chris Dy","startTime":1780.79,"endTime":1784.18,"body":"spelled d-y. And if you'd like"},{"speaker":"Chris Dy","startTime":1784.18,"endTime":1788.02,"body":"to email us, you can reach us at"},{"speaker":"Chris Dy","startTime":1784.18,"endTime":1788.02,"body":"handpodcast@gmail.com."},{"speaker":"Charles Goldfarb","startTime":1788.6,"endTime":1790.76,"body":"And remember,"},{"speaker":"Charles Goldfarb","startTime":1788.6,"endTime":1790.76,"body":"please subscribe wherever you"},{"speaker":"Charles Goldfarb","startTime":1790.76,"endTime":1791.84,"body":"get your podcast"},{"speaker":"Chris Dy","startTime":1791.87,"endTime":1794.09,"body":"and be sure to leave a"},{"speaker":"Chris Dy","startTime":1791.87,"endTime":1794.09,"body":"review that helps us get the"},{"speaker":"Chris Dy","startTime":1794.09,"endTime":1794.51,"body":"word out."},{"speaker":"Charles Goldfarb","startTime":1794.87,"endTime":1797.18,"body":"Special thanks"},{"speaker":"Charles Goldfarb","startTime":1794.87,"endTime":1797.18,"body":"to Peter Martin for the amazing"},{"speaker":"Charles Goldfarb","startTime":1797.18,"endTime":1801.14,"body":"music. And remember, keep the"},{"speaker":"Charles Goldfarb","startTime":1797.18,"endTime":1801.14,"body":"upper hand Come back next time"}]}