{"version":"1.0.0","segments":[{"speaker":"Charles Goldfarb","startTime":3.6,"endTime":5.97,"body":"Welcome to the"},{"speaker":"Charles Goldfarb","startTime":3.6,"endTime":5.97,"body":"upper hand podcast where Chuck"},{"speaker":"Charles Goldfarb","startTime":6.0,"endTime":7.53,"body":"and Chris talk Hand Surgery."},{"speaker":"Chris Dy","startTime":7.89,"endTime":9.69,"body":"We are two hand"},{"speaker":"Chris Dy","startTime":7.89,"endTime":9.69,"body":"surgeons at Washington"},{"speaker":"Chris Dy","startTime":9.69,"endTime":12.33,"body":"University in St. Louis here to"},{"speaker":"Chris Dy","startTime":9.69,"endTime":12.33,"body":"talk about all things hand"},{"speaker":"Chris Dy","startTime":12.33,"endTime":15.72,"body":"surgery related from technical"},{"speaker":"Chris Dy","startTime":12.33,"endTime":15.72,"body":"to personal. Please"},{"speaker":"Charles Goldfarb","startTime":15.72,"endTime":18.0,"body":"subscribe"},{"speaker":"Charles Goldfarb","startTime":15.72,"endTime":18.0,"body":"wherever you get your podcasts."},{"speaker":"Charles Goldfarb","startTime":18.93,"endTime":19.17,"body":"And"},{"speaker":"Chris Dy","startTime":19.17,"endTime":21.57,"body":"thank you in advance"},{"speaker":"Chris Dy","startTime":19.17,"endTime":21.57,"body":"for leaving a review and leaving"},{"speaker":"Chris Dy","startTime":21.57,"endTime":23.58,"body":"a rating wherever you get your"},{"speaker":"Chris Dy","startTime":21.57,"endTime":23.58,"body":"podcasts."},{"speaker":"Charles Goldfarb","startTime":24.6,"endTime":25.44,"body":"Oh hey, Chris."},{"speaker":"Chris Dy","startTime":25.8,"endTime":26.82,"body":"Hey, Chuck, how are"},{"speaker":"Chris Dy","startTime":25.8,"endTime":26.82,"body":"you?"},{"speaker":"Charles Goldfarb","startTime":27.03,"endTime":28.41,"body":"I'm great. How"},{"speaker":"Charles Goldfarb","startTime":27.03,"endTime":28.41,"body":"are you?"},{"speaker":"Chris Dy","startTime":28.71,"endTime":30.9,"body":"I'm great. It's a"},{"speaker":"Chris Dy","startTime":28.71,"endTime":30.9,"body":"festive time of the year and"},{"speaker":"Chris Dy","startTime":30.9,"endTime":33.36,"body":"honestly is one of my favorite"},{"speaker":"Chris Dy","startTime":30.9,"endTime":33.36,"body":"times of the year. I really do"},{"speaker":"Chris Dy","startTime":33.36,"endTime":36.81,"body":"enjoy it. So you know, it got"},{"speaker":"Chris Dy","startTime":33.36,"endTime":36.81,"body":"got a lot lined up for this"},{"speaker":"Chris Dy","startTime":36.81,"endTime":42.99,"body":"weekend. A little some youth"},{"speaker":"Chris Dy","startTime":36.81,"endTime":42.99,"body":"sports. Some kids outings,"},{"speaker":"Chris Dy","startTime":43.47,"endTime":46.98,"body":"another youth sports event."},{"speaker":"Chris Dy","startTime":43.47,"endTime":46.98,"body":"That's just Saturday. So how"},{"speaker":"Chris Dy","startTime":46.98,"endTime":48.03,"body":"about you? What do you got going"},{"speaker":"Chris Dy","startTime":46.98,"endTime":48.03,"body":"on?"},{"speaker":"Charles Goldfarb","startTime":48.06,"endTime":50.4,"body":"Well,"},{"speaker":"Charles Goldfarb","startTime":48.06,"endTime":50.4,"body":"sometimes this this, I don't"},{"speaker":"Charles Goldfarb","startTime":50.4,"endTime":55.86,"body":"know what the proper term is."},{"speaker":"Charles Goldfarb","startTime":50.4,"endTime":55.86,"body":"between seasons of sports can be"},{"speaker":"Charles Goldfarb","startTime":55.86,"endTime":58.11,"body":"nice. You can have a little"},{"speaker":"Charles Goldfarb","startTime":55.86,"endTime":58.11,"body":"shutdown. I was talking to one"},{"speaker":"Charles Goldfarb","startTime":58.11,"endTime":61.02,"body":"of our partners who said exactly"},{"speaker":"Charles Goldfarb","startTime":58.11,"endTime":61.02,"body":"that like there's a couple of"},{"speaker":"Charles Goldfarb","startTime":61.02,"endTime":64.26,"body":"weeks weekends here in a row"},{"speaker":"Charles Goldfarb","startTime":61.02,"endTime":64.26,"body":"where there's no youth sports,"},{"speaker":"Charles Goldfarb","startTime":64.26,"endTime":66.3,"body":"but you obviously didn't get"},{"speaker":"Charles Goldfarb","startTime":64.26,"endTime":66.3,"body":"that break."},{"speaker":"Chris Dy","startTime":67.29,"endTime":69.54,"body":"No, definitely not."},{"speaker":"Chris Dy","startTime":67.29,"endTime":69.54,"body":"I'm just happy to be in town."},{"speaker":"Chris Dy","startTime":69.54,"endTime":72.75,"body":"It's nice. You know, I've had"},{"speaker":"Chris Dy","startTime":69.54,"endTime":72.75,"body":"had to do a fair bit of work"},{"speaker":"Chris Dy","startTime":72.75,"endTime":76.65,"body":"related travel. You know, in"},{"speaker":"Chris Dy","startTime":72.75,"endTime":76.65,"body":"having a few weekends in a row"},{"speaker":"Chris Dy","startTime":76.65,"endTime":77.82,"body":"being home has been awesome."},{"speaker":"Charles Goldfarb","startTime":78.87,"endTime":81.84,"body":"Yeah, I I've"},{"speaker":"Charles Goldfarb","startTime":78.87,"endTime":81.84,"body":"cut back on my travel as you"},{"speaker":"Charles Goldfarb","startTime":81.84,"endTime":85.8,"body":"know, because of the MBA. We"},{"speaker":"Charles Goldfarb","startTime":81.84,"endTime":85.8,"body":"were I think my next trip"},{"speaker":"Charles Goldfarb","startTime":85.8,"endTime":88.59,"body":"actually, we're gonna do a quick"},{"speaker":"Charles Goldfarb","startTime":85.8,"endTime":88.59,"body":"trip around Christmas go to"},{"speaker":"Charles Goldfarb","startTime":88.59,"endTime":91.23,"body":"Charleston, South Carolina,"},{"speaker":"Charles Goldfarb","startTime":88.59,"endTime":91.23,"body":"which love to discuss at some"},{"speaker":"Charles Goldfarb","startTime":91.23,"endTime":98.04,"body":"point. But yeah, the the"},{"speaker":"Charles Goldfarb","startTime":91.23,"endTime":98.04,"body":"upcoming nonwork team building"},{"speaker":"Charles Goldfarb","startTime":98.04,"endTime":102.57,"body":"event is our group's going to"},{"speaker":"Charles Goldfarb","startTime":98.04,"endTime":102.57,"body":"play paintball. I'm sorry that"},{"speaker":"Charles Goldfarb","startTime":102.57,"endTime":106.11,"body":"you won't be able to make it but"},{"speaker":"Charles Goldfarb","startTime":102.57,"endTime":106.11,"body":"you know, it does hit my Alabama"},{"speaker":"Charles Goldfarb","startTime":106.11,"endTime":109.14,"body":"roots a little bit. My wife was"},{"speaker":"Charles Goldfarb","startTime":106.11,"endTime":109.14,"body":"invited and she looked at me"},{"speaker":"Charles Goldfarb","startTime":109.14,"endTime":110.19,"body":"like I was crazy."},{"speaker":"Chris Dy","startTime":111.57,"endTime":114.12,"body":"You know, I really I"},{"speaker":"Chris Dy","startTime":111.57,"endTime":114.12,"body":"have played paintball before."},{"speaker":"Chris Dy","startTime":114.15,"endTime":117.03,"body":"I'm sad to be missing out on it."},{"speaker":"Chris Dy","startTime":114.15,"endTime":117.03,"body":"I just I'm trying not to be over"},{"speaker":"Chris Dy","startTime":117.03,"endTime":119.91,"body":"scheduled, although I do love"},{"speaker":"Chris Dy","startTime":117.03,"endTime":119.91,"body":"team building morale type"},{"speaker":"Chris Dy","startTime":119.91,"endTime":123.57,"body":"events, and I'm quite"},{"speaker":"Chris Dy","startTime":119.91,"endTime":123.57,"body":"competitive. But I also asked"},{"speaker":"Chris Dy","startTime":123.57,"endTime":127.02,"body":"when so our partner David"},{"speaker":"Chris Dy","startTime":123.57,"endTime":127.02,"body":"Brogan. Medical Assistant Tracy"},{"speaker":"Chris Dy","startTime":127.02,"endTime":129.66,"body":"is organizing it saying it's"},{"speaker":"Chris Dy","startTime":127.02,"endTime":129.66,"body":"great. I did ask her if we were"},{"speaker":"Chris Dy","startTime":129.66,"endTime":132.48,"body":"going to be following Zoolander"},{"speaker":"Chris Dy","startTime":129.66,"endTime":132.48,"body":"rules because I clearly this is"},{"speaker":"Chris Dy","startTime":132.48,"endTime":136.71,"body":"my moneymaker up here. And I"},{"speaker":"Chris Dy","startTime":132.48,"endTime":136.71,"body":"said Zoolander but really its"},{"speaker":"Chris Dy","startTime":136.71,"endTime":140.13,"body":"Anchorman rules. Were no"},{"speaker":"Chris Dy","startTime":136.71,"endTime":140.13,"body":"touching the hair."},{"speaker":"Charles Goldfarb","startTime":141.33,"endTime":143.85,"body":"So funny."},{"speaker":"Charles Goldfarb","startTime":141.33,"endTime":143.85,"body":"Yeah, obviously don't worry"},{"speaker":"Charles Goldfarb","startTime":143.85,"endTime":147.54,"body":"about that quite as much. It's a"},{"speaker":"Charles Goldfarb","startTime":143.85,"endTime":147.54,"body":"good time of year because you"},{"speaker":"Charles Goldfarb","startTime":147.54,"endTime":150.09,"body":"have plenty of it's a little"},{"speaker":"Charles Goldfarb","startTime":147.54,"endTime":150.09,"body":"chilly and so I'll be wearing"},{"speaker":"Charles Goldfarb","startTime":150.09,"endTime":152.13,"body":"plenty clothes, so there"},{"speaker":"Charles Goldfarb","startTime":150.09,"endTime":152.13,"body":"shouldn't be any physical pain"},{"speaker":"Charles Goldfarb","startTime":152.49,"endTime":154.86,"body":"other than me trying to run"},{"speaker":"Charles Goldfarb","startTime":152.49,"endTime":154.86,"body":"that'll be the only physical"},{"speaker":"Charles Goldfarb","startTime":154.86,"endTime":156.96,"body":"thing there is. You"},{"speaker":"Chris Dy","startTime":156.96,"endTime":159.81,"body":"just need to be as a"},{"speaker":"Chris Dy","startTime":156.96,"endTime":159.81,"body":"sniper strategic positioning"},{"speaker":"Chris Dy","startTime":160.05,"endTime":162.12,"body":"because I don't think running is"},{"speaker":"Chris Dy","startTime":160.05,"endTime":162.12,"body":"in your best interests right"},{"speaker":"Chris Dy","startTime":162.12,"endTime":162.36,"body":"now."},{"speaker":"Charles Goldfarb","startTime":162.81,"endTime":165.27,"body":"Oh my god. No,"},{"speaker":"Charles Goldfarb","startTime":162.81,"endTime":165.27,"body":"it's not speaking of holiday"},{"speaker":"Charles Goldfarb","startTime":165.27,"endTime":170.58,"body":"season. I have do have a date"},{"speaker":"Charles Goldfarb","startTime":165.27,"endTime":170.58,"body":"for my uni computer navigated"},{"speaker":"Charles Goldfarb","startTime":170.61,"endTime":174.0,"body":"knee replacement. And I did skip"},{"speaker":"Charles Goldfarb","startTime":170.61,"endTime":174.0,"body":"around the holidays. My wife"},{"speaker":"Charles Goldfarb","startTime":174.0,"endTime":176.88,"body":"thinks I'm a lunatic. But I'm"},{"speaker":"Charles Goldfarb","startTime":174.0,"endTime":176.88,"body":"like I can't miss time in"},{"speaker":"Charles Goldfarb","startTime":176.88,"endTime":179.28,"body":"December. I gotta push this off"},{"speaker":"Charles Goldfarb","startTime":176.88,"endTime":179.28,"body":"in January but it can be busy"},{"speaker":"Charles Goldfarb","startTime":179.28,"endTime":179.64,"body":"too"},{"speaker":"Chris Dy","startTime":180.48,"endTime":183.15,"body":"You have met your"},{"speaker":"Chris Dy","startTime":180.48,"endTime":183.15,"body":"deductible. You're just like"},{"speaker":"Chris Dy","startTime":183.15,"endTime":186.66,"body":"every other American patient. So"},{"speaker":"Chris Dy","startTime":183.15,"endTime":186.66,"body":"are you gonna do the insane"},{"speaker":"Chris Dy","startTime":186.66,"endTime":189.45,"body":"thing of because I remember when"},{"speaker":"Chris Dy","startTime":186.66,"endTime":189.45,"body":"you were on the schedule for a"},{"speaker":"Chris Dy","startTime":189.45,"endTime":192.69,"body":"nice scope. You did it at the"},{"speaker":"Chris Dy","startTime":189.45,"endTime":192.69,"body":"end of your own or day. That's"},{"speaker":"Chris Dy","startTime":192.69,"endTime":195.96,"body":"insanity by the way, but I guess"},{"speaker":"Chris Dy","startTime":192.69,"endTime":195.96,"body":"you're probably NPO anyway jury"},{"speaker":"Chris Dy","startTime":195.96,"endTime":196.86,"body":"your day."},{"speaker":"Charles Goldfarb","startTime":197.52,"endTime":199.47,"body":"So funny. I"},{"speaker":"Charles Goldfarb","startTime":197.52,"endTime":199.47,"body":"actually have no regrets. I"},{"speaker":"Charles Goldfarb","startTime":199.47,"endTime":201.75,"body":"handled that one. I thought that"},{"speaker":"Charles Goldfarb","startTime":199.47,"endTime":201.75,"body":"was pretty proud of how it"},{"speaker":"Charles Goldfarb","startTime":201.75,"endTime":204.54,"body":"worked. And I think a knee"},{"speaker":"Charles Goldfarb","startTime":201.75,"endTime":204.54,"body":"replacements is a little"},{"speaker":"Charles Goldfarb","startTime":204.54,"endTime":208.5,"body":"different. Also had asked our"},{"speaker":"Charles Goldfarb","startTime":204.54,"endTime":208.5,"body":"Surgeon my surgeon to drive me"},{"speaker":"Charles Goldfarb","startTime":208.5,"endTime":210.48,"body":"home at the end of the day"},{"speaker":"Charles Goldfarb","startTime":208.5,"endTime":210.48,"body":"because my wife was out of town"},{"speaker":"Charles Goldfarb","startTime":210.48,"endTime":214.47,"body":"coming back that night. So yeah,"},{"speaker":"Charles Goldfarb","startTime":210.48,"endTime":214.47,"body":"I'm doing a knee replacement a"},{"speaker":"Charles Goldfarb","startTime":214.47,"endTime":217.29,"body":"little differently. Although my"},{"speaker":"Charles Goldfarb","startTime":214.47,"endTime":217.29,"body":"wife thinks I'm gonna work too"},{"speaker":"Charles Goldfarb","startTime":217.29,"endTime":220.47,"body":"quickly. But I got you got to be"},{"speaker":"Charles Goldfarb","startTime":217.29,"endTime":220.47,"body":"careful. I think I don't want to"},{"speaker":"Charles Goldfarb","startTime":220.47,"endTime":221.58,"body":"compromise results here."},{"speaker":"Chris Dy","startTime":221.97,"endTime":224.37,"body":"Yea absolutely. I"},{"speaker":"Chris Dy","startTime":221.97,"endTime":224.37,"body":"remember when you pulled off the"},{"speaker":"Chris Dy","startTime":224.4,"endTime":227.52,"body":"day of cases and then had your"},{"speaker":"Chris Dy","startTime":224.4,"endTime":227.52,"body":"own surgery. I thought that was"},{"speaker":"Chris Dy","startTime":227.52,"endTime":231.42,"body":"quintessential Goldfarb. Let me"},{"speaker":"Chris Dy","startTime":227.52,"endTime":231.42,"body":"that was the anybody that's"},{"speaker":"Chris Dy","startTime":231.42,"endTime":233.88,"body":"worked with you as a resident or"},{"speaker":"Chris Dy","startTime":231.42,"endTime":233.88,"body":"fellow knows that you have"},{"speaker":"Chris Dy","startTime":233.88,"endTime":236.94,"body":"threaded that needle so many"},{"speaker":"Chris Dy","startTime":233.88,"endTime":236.94,"body":"times. And when I think I'm"},{"speaker":"Chris Dy","startTime":236.94,"endTime":239.64,"body":"having a highly efficient day, I"},{"speaker":"Chris Dy","startTime":236.94,"endTime":239.64,"body":"realized that you probably had a"},{"speaker":"Chris Dy","startTime":239.64,"endTime":240.57,"body":"more efficient day."},{"speaker":"Charles Goldfarb","startTime":241.11,"endTime":243.63,"body":"You are kind"},{"speaker":"Charles Goldfarb","startTime":241.11,"endTime":243.63,"body":"that is music to my ears. But"},{"speaker":"Charles Goldfarb","startTime":243.63,"endTime":248.25,"body":"definitely I'm learning all the"},{"speaker":"Charles Goldfarb","startTime":243.63,"endTime":248.25,"body":"time in preview for sure. It's"},{"speaker":"Charles Goldfarb","startTime":248.28,"endTime":250.77,"body":"It's fascinating what's happened"},{"speaker":"Charles Goldfarb","startTime":248.28,"endTime":250.77,"body":"to my or schedule. And this is a"},{"speaker":"Charles Goldfarb","startTime":250.77,"endTime":255.18,"body":"brief tangent, I apologize. I"},{"speaker":"Charles Goldfarb","startTime":250.77,"endTime":255.18,"body":"used to start every day when"},{"speaker":"Charles Goldfarb","startTime":255.21,"endTime":259.2,"body":"when you way back when when you"},{"speaker":"Charles Goldfarb","startTime":255.21,"endTime":259.2,"body":"were a fellow, there would be a"},{"speaker":"Charles Goldfarb","startTime":259.2,"endTime":261.9,"body":"few carpal tunnels, a few"},{"speaker":"Charles Goldfarb","startTime":259.2,"endTime":261.9,"body":"triggers a few games that would"},{"speaker":"Charles Goldfarb","startTime":261.9,"endTime":265.29,"body":"have be how we warm up our day."},{"speaker":"Charles Goldfarb","startTime":261.9,"endTime":265.29,"body":"It doesn't work that way at all"},{"speaker":"Charles Goldfarb","startTime":265.29,"endTime":267.6,"body":"anymore. First of all, I don't"},{"speaker":"Charles Goldfarb","startTime":265.29,"endTime":267.6,"body":"do many of those cases anymore."},{"speaker":"Charles Goldfarb","startTime":267.81,"endTime":271.29,"body":"But they're all at the end of"},{"speaker":"Charles Goldfarb","startTime":267.81,"endTime":271.29,"body":"the day. And I become more and"},{"speaker":"Charles Goldfarb","startTime":271.29,"endTime":276.12,"body":"more that insistent because I'm"},{"speaker":"Charles Goldfarb","startTime":271.29,"endTime":276.12,"body":"not insistent, but more and more"},{"speaker":"Charles Goldfarb","startTime":276.12,"endTime":279.39,"body":"pushy for all the little cases"},{"speaker":"Charles Goldfarb","startTime":276.12,"endTime":279.39,"body":"to be at the end of the day"},{"speaker":"Charles Goldfarb","startTime":279.39,"endTime":284.43,"body":"local only. And so this week I"},{"speaker":"Charles Goldfarb","startTime":279.39,"endTime":284.43,"body":"had for at the end of the day,"},{"speaker":"Charles Goldfarb","startTime":284.49,"endTime":287.4,"body":"and it was great. I've had to"},{"speaker":"Charles Goldfarb","startTime":284.49,"endTime":287.4,"body":"shift how I think about things"},{"speaker":"Charles Goldfarb","startTime":287.4,"endTime":289.41,"body":"but it's been really nice."},{"speaker":"Chris Dy","startTime":290.22,"endTime":293.04,"body":"It's interesting"},{"speaker":"Chris Dy","startTime":290.22,"endTime":293.04,"body":"surgeon approaches to how they"},{"speaker":"Chris Dy","startTime":293.04,"endTime":295.68,"body":"schedule their days are"},{"speaker":"Chris Dy","startTime":293.04,"endTime":295.68,"body":"different because you know you"},{"speaker":"Chris Dy","startTime":295.68,"endTime":298.29,"body":"have how you used to do it in"},{"speaker":"Chris Dy","startTime":295.68,"endTime":298.29,"body":"terms of warmup cases and they"},{"speaker":"Chris Dy","startTime":298.29,"endTime":301.38,"body":"get into your bigger cases. And"},{"speaker":"Chris Dy","startTime":298.29,"endTime":301.38,"body":"then there's always the Rick"},{"speaker":"Chris Dy","startTime":301.38,"endTime":304.74,"body":"Wright model of downhill skiing,"},{"speaker":"Chris Dy","startTime":301.38,"endTime":304.74,"body":"knock out the big ones. My"},{"speaker":"Chris Dy","startTime":304.74,"endTime":307.14,"body":"problem with the downhill skiing"},{"speaker":"Chris Dy","startTime":304.74,"endTime":307.14,"body":"model is that sometimes there's"},{"speaker":"Chris Dy","startTime":307.14,"endTime":310.2,"body":"a lot of variability and how"},{"speaker":"Chris Dy","startTime":307.14,"endTime":310.2,"body":"long those cases will be, which"},{"speaker":"Chris Dy","startTime":310.2,"endTime":314.73,"body":"can throw off your entire day."},{"speaker":"Chris Dy","startTime":310.2,"endTime":314.73,"body":"And so I've moved my scheduling"},{"speaker":"Chris Dy","startTime":314.76,"endTime":319.98,"body":"model to when I run my two rooms"},{"speaker":"Chris Dy","startTime":314.76,"endTime":319.98,"body":"actually have a, I do one local"},{"speaker":"Chris Dy","startTime":319.98,"endTime":323.04,"body":"case at the very beginning of"},{"speaker":"Chris Dy","startTime":319.98,"endTime":323.04,"body":"the day, so that both rooms can"},{"speaker":"Chris Dy","startTime":323.04,"endTime":325.53,"body":"push back essentially, at the"},{"speaker":"Chris Dy","startTime":323.04,"endTime":325.53,"body":"same time the anesthesia room is"},{"speaker":"Chris Dy","startTime":325.53,"endTime":327.81,"body":"getting going, the general"},{"speaker":"Chris Dy","startTime":325.53,"endTime":327.81,"body":"anesthesia rooms getting going"},{"speaker":"Chris Dy","startTime":327.81,"endTime":330.36,"body":"while I'm doing a local case,"},{"speaker":"Chris Dy","startTime":327.81,"endTime":330.36,"body":"and I just flip and by the time"},{"speaker":"Chris Dy","startTime":330.36,"endTime":333.27,"body":"I'm in that other room,"},{"speaker":"Chris Dy","startTime":330.36,"endTime":333.27,"body":"everything's ready to go. But"},{"speaker":"Chris Dy","startTime":333.27,"endTime":337.77,"body":"now I've had to, to ensure that"},{"speaker":"Chris Dy","startTime":333.27,"endTime":337.77,"body":"I keep both rooms with two full"},{"speaker":"Chris Dy","startTime":338.25,"endTime":341.61,"body":"staffs, including the"},{"speaker":"Chris Dy","startTime":338.25,"endTime":341.61,"body":"anesthesiologist or the CRNA, I"},{"speaker":"Chris Dy","startTime":341.61,"endTime":343.98,"body":"now have to book I can't have"},{"speaker":"Chris Dy","startTime":341.61,"endTime":343.98,"body":"like a local in the room that"},{"speaker":"Chris Dy","startTime":343.98,"endTime":347.52,"body":"flips in quickly in and out of,"},{"speaker":"Chris Dy","startTime":343.98,"endTime":347.52,"body":"I have to book the right number"},{"speaker":"Chris Dy","startTime":347.52,"endTime":351.42,"body":"of cases for sequencing. And"},{"speaker":"Chris Dy","startTime":347.52,"endTime":351.42,"body":"I've gotten to know how you"},{"speaker":"Chris Dy","startTime":351.42,"endTime":354.15,"body":"would do like actually having to"},{"speaker":"Chris Dy","startTime":351.42,"endTime":354.15,"body":"set my own lineup personally, as"},{"speaker":"Chris Dy","startTime":354.15,"endTime":356.76,"body":"opposed to relying on somebody"},{"speaker":"Chris Dy","startTime":354.15,"endTime":356.76,"body":"else to do it. And it reminds me"},{"speaker":"Chris Dy","startTime":356.76,"endTime":359.85,"body":"of how you used to do that"},{"speaker":"Chris Dy","startTime":356.76,"endTime":359.85,"body":"painstaking process every Monday"},{"speaker":"Chris Dy","startTime":359.88,"endTime":361.5,"body":"of coordinating your Wednesday"},{"speaker":"Chris Dy","startTime":359.88,"endTime":361.5,"body":"schedule."},{"speaker":"Charles Goldfarb","startTime":362.22,"endTime":364.23,"body":"Yes, I still"},{"speaker":"Charles Goldfarb","startTime":362.22,"endTime":364.23,"body":"do. I don't, it's not that I"},{"speaker":"Charles Goldfarb","startTime":364.23,"endTime":366.66,"body":"don't trust anybody to do it. I"},{"speaker":"Charles Goldfarb","startTime":364.23,"endTime":366.66,"body":"mean, no one's volunteered"},{"speaker":"Charles Goldfarb","startTime":366.66,"endTime":370.44,"body":"really, because they know I it"},{"speaker":"Charles Goldfarb","startTime":366.66,"endTime":370.44,"body":"really matters a lot. And you"},{"speaker":"Charles Goldfarb","startTime":370.44,"endTime":372.87,"body":"not only have to know what the"},{"speaker":"Charles Goldfarb","startTime":370.44,"endTime":372.87,"body":"case is titled, but you have to"},{"speaker":"Charles Goldfarb","startTime":372.87,"endTime":376.77,"body":"know what is likely to happen."},{"speaker":"Charles Goldfarb","startTime":372.87,"endTime":376.77,"body":"And that's what drives me so"},{"speaker":"Charles Goldfarb","startTime":376.77,"endTime":379.92,"body":"crazy. If I come in and"},{"speaker":"Charles Goldfarb","startTime":376.77,"endTime":379.92,"body":"someone's messed with it, I sort"},{"speaker":"Charles Goldfarb","startTime":379.92,"endTime":384.12,"body":"of, you know, lose my mind. But"},{"speaker":"Charles Goldfarb","startTime":379.92,"endTime":384.12,"body":"hopefully not verbally or, or"},{"speaker":"Charles Goldfarb","startTime":384.63,"endTime":385.35,"body":"visually."},{"speaker":"Chris Dy","startTime":385.95,"endTime":388.02,"body":"I had a moment of bad"},{"speaker":"Chris Dy","startTime":385.95,"endTime":388.02,"body":"behavior one time a few years"},{"speaker":"Chris Dy","startTime":388.02,"endTime":391.56,"body":"ago that I did lose my mind, and"},{"speaker":"Chris Dy","startTime":388.02,"endTime":391.56,"body":"I verbalize it when somebody"},{"speaker":"Chris Dy","startTime":391.56,"endTime":395.37,"body":"mess with my schedule. And I"},{"speaker":"Chris Dy","startTime":391.56,"endTime":395.37,"body":"don't think I lost one heart one"},{"speaker":"Chris Dy","startTime":395.37,"endTime":396.03,"body":"mind that day."},{"speaker":"Charles Goldfarb","startTime":398.339,"endTime":401.099,"body":"Hey, it's what"},{"speaker":"Charles Goldfarb","startTime":398.339,"endTime":401.099,"body":"it takes to do what we do."},{"speaker":"Charles Goldfarb","startTime":401.399,"endTime":404.219,"body":"Because we as you said, we are"},{"speaker":"Charles Goldfarb","startTime":401.399,"endTime":404.219,"body":"threading a needle every day."},{"speaker":"Charles Goldfarb","startTime":404.219,"endTime":407.579,"body":"And obviously, we have to make"},{"speaker":"Charles Goldfarb","startTime":404.219,"endTime":407.579,"body":"sure that we take do the right"},{"speaker":"Charles Goldfarb","startTime":407.579,"endTime":410.609,"body":"thing and take great care of"},{"speaker":"Charles Goldfarb","startTime":407.579,"endTime":410.609,"body":"patients. But we need to do it"},{"speaker":"Charles Goldfarb","startTime":410.609,"endTime":412.319,"body":"in the most efficient way"},{"speaker":"Charles Goldfarb","startTime":410.609,"endTime":412.319,"body":"possible. It's just a"},{"speaker":"Charles Goldfarb","startTime":412.319,"endTime":415.709,"body":"requirement of medicine in the"},{"speaker":"Charles Goldfarb","startTime":412.319,"endTime":415.709,"body":"United States and 2023."},{"speaker":"Chris Dy","startTime":416.549,"endTime":418.529,"body":"I think so. And that"},{"speaker":"Chris Dy","startTime":416.549,"endTime":418.529,"body":"was you know, speaking recently"},{"speaker":"Chris Dy","startTime":418.529,"endTime":421.019,"body":"to somebody Yeah, and one of the"},{"speaker":"Chris Dy","startTime":418.529,"endTime":421.019,"body":"clinician scientists, forums"},{"speaker":"Chris Dy","startTime":421.019,"endTime":425.339,"body":"about you know, how to be, you"},{"speaker":"Chris Dy","startTime":421.019,"endTime":425.339,"body":"know, effective as a clinician"},{"speaker":"Chris Dy","startTime":425.339,"endTime":427.619,"body":"scientist, and I think you have"},{"speaker":"Chris Dy","startTime":425.339,"endTime":427.619,"body":"to be, you know, ruthlessly"},{"speaker":"Chris Dy","startTime":427.619,"endTime":431.099,"body":"efficient on your clinical days,"},{"speaker":"Chris Dy","startTime":427.619,"endTime":431.099,"body":"if you want to protect academic"},{"speaker":"Chris Dy","startTime":431.099,"endTime":434.339,"body":"time or for you, your admin,"},{"speaker":"Chris Dy","startTime":431.099,"endTime":434.339,"body":"your leadership, your MBA time,"},{"speaker":"Chris Dy","startTime":434.369,"endTime":437.789,"body":"you have to be very, very"},{"speaker":"Chris Dy","startTime":434.369,"endTime":437.789,"body":"efficient on all the other ones"},{"speaker":"Chris Dy","startTime":437.819,"endTime":440.969,"body":"and the other all the other"},{"speaker":"Chris Dy","startTime":437.819,"endTime":440.969,"body":"times, so that you can maintain"},{"speaker":"Chris Dy","startTime":441.029,"endTime":444.599,"body":"clinical excellence, clinical"},{"speaker":"Chris Dy","startTime":441.029,"endTime":444.599,"body":"volume, but then also, you know,"},{"speaker":"Chris Dy","startTime":444.629,"endTime":447.029,"body":"be present when you have your"},{"speaker":"Chris Dy","startTime":444.629,"endTime":447.029,"body":"protected time for whatever it"},{"speaker":"Chris Dy","startTime":447.029,"endTime":447.839,"body":"is that you're protecting."},{"speaker":"Charles Goldfarb","startTime":448.409,"endTime":451.199,"body":"Absolutely,"},{"speaker":"Charles Goldfarb","startTime":448.409,"endTime":451.199,"body":"yeah, it's interesting. I have"},{"speaker":"Charles Goldfarb","startTime":451.949,"endTime":454.769,"body":"am also still trying to find"},{"speaker":"Charles Goldfarb","startTime":451.949,"endTime":454.769,"body":"time, not to your degree, but"},{"speaker":"Charles Goldfarb","startTime":454.769,"endTime":458.189,"body":"for research, because this stuff"},{"speaker":"Charles Goldfarb","startTime":454.769,"endTime":458.189,"body":"continues, you know, my projects"},{"speaker":"Charles Goldfarb","startTime":458.189,"endTime":461.099,"body":"continue. And I've actually had"},{"speaker":"Charles Goldfarb","startTime":458.189,"endTime":461.099,"body":"a weird issue where there's a"},{"speaker":"Charles Goldfarb","startTime":461.099,"endTime":464.429,"body":"lot of people, whether they're"},{"speaker":"Charles Goldfarb","startTime":461.099,"endTime":464.429,"body":"actually some medical students,"},{"speaker":"Charles Goldfarb","startTime":464.789,"endTime":469.619,"body":"residents and fellows I'm trying"},{"speaker":"Charles Goldfarb","startTime":464.789,"endTime":469.619,"body":"to work with, it's just not"},{"speaker":"Charles Goldfarb","startTime":469.619,"endTime":473.069,"body":"enough hours in the day and some"},{"speaker":"Charles Goldfarb","startTime":469.619,"endTime":473.069,"body":"of the research concepts are"},{"speaker":"Charles Goldfarb","startTime":473.069,"endTime":473.549,"body":"great."},{"speaker":"Chris Dy","startTime":474.09,"endTime":476.46,"body":"Yeah, you turn you"},{"speaker":"Chris Dy","startTime":474.09,"endTime":476.46,"body":"turn to somebody I sent to you"},{"speaker":"Chris Dy","startTime":476.46,"endTime":480.57,"body":"down, you're gonna work with"},{"speaker":"Chris Dy","startTime":476.46,"endTime":480.57,"body":"this. But I understand year,"},{"speaker":"Chris Dy","startTime":480.57,"endTime":482.94,"body":"there's only so many hours in a"},{"speaker":"Chris Dy","startTime":480.57,"endTime":482.94,"body":"day. And I think that you, you"},{"speaker":"Chris Dy","startTime":482.94,"endTime":487.05,"body":"know, if you can't be if you"},{"speaker":"Chris Dy","startTime":482.94,"endTime":487.05,"body":"can't deliver at the level that"},{"speaker":"Chris Dy","startTime":487.05,"endTime":489.57,"body":"you're used to deliver it, then"},{"speaker":"Chris Dy","startTime":487.05,"endTime":489.57,"body":"you should say No, I mean,"},{"speaker":"Chris Dy","startTime":489.75,"endTime":492.81,"body":"you've earned your stripes"},{"speaker":"Chris Dy","startTime":489.75,"endTime":492.81,"body":"clearly. So Well,"},{"speaker":"Charles Goldfarb","startTime":492.839,"endTime":495.659,"body":"it's"},{"speaker":"Charles Goldfarb","startTime":492.839,"endTime":495.659,"body":"interesting, the department has"},{"speaker":"Charles Goldfarb","startTime":496.049,"endTime":500.819,"body":"established Diversity, Equity"},{"speaker":"Charles Goldfarb","startTime":496.049,"endTime":500.819,"body":"and Inclusion grant process. And"},{"speaker":"Charles Goldfarb","startTime":500.819,"endTime":505.469,"body":"I had a medical student who was"},{"speaker":"Charles Goldfarb","startTime":500.819,"endTime":505.469,"body":"sent to me to discuss a project"},{"speaker":"Charles Goldfarb","startTime":505.469,"endTime":508.199,"body":"and I, you know, on the one"},{"speaker":"Charles Goldfarb","startTime":505.469,"endTime":508.199,"body":"hand, I was kind of like, Oh, my"},{"speaker":"Charles Goldfarb","startTime":508.199,"endTime":510.629,"body":"God, I don't know that I can"},{"speaker":"Charles Goldfarb","startTime":508.199,"endTime":510.629,"body":"take this on and guide the"},{"speaker":"Charles Goldfarb","startTime":510.629,"endTime":514.289,"body":"medical student appropriately."},{"speaker":"Charles Goldfarb","startTime":510.629,"endTime":514.289,"body":"She was She knows she seems she"},{"speaker":"Charles Goldfarb","startTime":514.289,"endTime":517.979,"body":"she had things together. And so"},{"speaker":"Charles Goldfarb","startTime":514.289,"endTime":517.979,"body":"I agreed to do it, thinking it"},{"speaker":"Charles Goldfarb","startTime":517.979,"endTime":520.739,"body":"wouldn't be a lot of time. And"},{"speaker":"Charles Goldfarb","startTime":517.979,"endTime":520.739,"body":"you know, what's a lot? It's"},{"speaker":"Charles Goldfarb","startTime":520.739,"endTime":525.299,"body":"more time than I hoped. But it's"},{"speaker":"Charles Goldfarb","startTime":520.739,"endTime":525.299,"body":"also pretty cool. And so trying"},{"speaker":"Charles Goldfarb","startTime":525.299,"endTime":526.019,"body":"to find some time."},{"speaker":"Chris Dy","startTime":527.2,"endTime":529.33,"body":"Yeah, I was, I was"},{"speaker":"Chris Dy","startTime":527.2,"endTime":529.33,"body":"thinking about my wish list does"},{"speaker":"Chris Dy","startTime":529.33,"endTime":531.85,"body":"include another day in the week"},{"speaker":"Chris Dy","startTime":529.33,"endTime":531.85,"body":"and another couple of hours in"},{"speaker":"Chris Dy","startTime":531.85,"endTime":538.21,"body":"each day. So Santa is listening."},{"speaker":"Chris Dy","startTime":531.85,"endTime":538.21,"body":"Yeah, why don't we thank our"},{"speaker":"Chris Dy","startTime":538.21,"endTime":541.36,"body":"sponsors that Practice Link. The"},{"speaker":"Chris Dy","startTime":538.21,"endTime":541.36,"body":"upper hand is sponsored by"},{"speaker":"Chris Dy","startTime":541.39,"endTime":544.9,"body":"practicing.com. The most widely"},{"speaker":"Chris Dy","startTime":541.39,"endTime":544.9,"body":"used physician job search and"},{"speaker":"Chris Dy","startTime":544.9,"endTime":546.73,"body":"career advancement resource,"},{"speaker":"Charles Goldfarb","startTime":546.76,"endTime":548.77,"body":"Becoming a"},{"speaker":"Charles Goldfarb","startTime":546.76,"endTime":548.77,"body":"physician is hard finding the"},{"speaker":"Charles Goldfarb","startTime":548.77,"endTime":551.8,"body":"right job doesn't have to be"},{"speaker":"Charles Goldfarb","startTime":548.77,"endTime":551.8,"body":"joined practice link for free"},{"speaker":"Charles Goldfarb","startTime":551.86,"endTime":557.08,"body":"today"},{"speaker":"Charles Goldfarb","startTime":551.86,"endTime":557.08,"body":"www.practicelink.com/theupperhand."},{"speaker":"Chris Dy","startTime":558.64,"endTime":562.15,"body":"So exciting episode"},{"speaker":"Chris Dy","startTime":558.64,"endTime":562.15,"body":"today, it sounds like people"},{"speaker":"Chris Dy","startTime":562.15,"endTime":566.74,"body":"want episodes about details on"},{"speaker":"Chris Dy","startTime":562.15,"endTime":566.74,"body":"both clinical workup and"},{"speaker":"Chris Dy","startTime":566.74,"endTime":569.71,"body":"surgical technique. And it"},{"speaker":"Chris Dy","startTime":566.74,"endTime":569.71,"body":"sounds like you have a good"},{"speaker":"Chris Dy","startTime":569.74,"endTime":571.15,"body":"thing for us to discuss today."},{"speaker":"Charles Goldfarb","startTime":571.24,"endTime":573.97,"body":"Yes, on the"},{"speaker":"Charles Goldfarb","startTime":571.24,"endTime":573.97,"body":"surface, it may come across as"},{"speaker":"Charles Goldfarb","startTime":573.97,"endTime":577.9,"body":"too niche. I don't think it is."},{"speaker":"Charles Goldfarb","startTime":573.97,"endTime":577.9,"body":"And I think it'll bring up a lot"},{"speaker":"Charles Goldfarb","startTime":577.9,"endTime":581.62,"body":"of important points. And in"},{"speaker":"Charles Goldfarb","startTime":577.9,"endTime":581.62,"body":"fact, we could go too deep on"},{"speaker":"Charles Goldfarb","startTime":581.62,"endTime":583.78,"body":"this. So I think it'd be an"},{"speaker":"Charles Goldfarb","startTime":581.62,"endTime":583.78,"body":"interesting balance. Let me"},{"speaker":"Charles Goldfarb","startTime":583.78,"endTime":588.1,"body":"share a case scenario with you."},{"speaker":"Charles Goldfarb","startTime":583.78,"endTime":588.1,"body":"Which again, on the surface, I"},{"speaker":"Charles Goldfarb","startTime":588.1,"endTime":591.76,"body":"don't know may seem like"},{"speaker":"Charles Goldfarb","startTime":588.1,"endTime":591.76,"body":"nothing. So I have a 12 year old"},{"speaker":"Charles Goldfarb","startTime":591.76,"endTime":597.13,"body":"female who first presented to my"},{"speaker":"Charles Goldfarb","startTime":591.76,"endTime":597.13,"body":"office three months ago, with a"},{"speaker":"Charles Goldfarb","startTime":597.13,"endTime":600.85,"body":"minimally displaced medial"},{"speaker":"Charles Goldfarb","startTime":597.13,"endTime":600.85,"body":"epicondyle fracture at the"},{"speaker":"Charles Goldfarb","startTime":600.85,"endTime":606.64,"body":"elbow. And you know she came in"},{"speaker":"Charles Goldfarb","startTime":600.85,"endTime":606.64,"body":"one week after a gymnastics"},{"speaker":"Charles Goldfarb","startTime":606.64,"endTime":610.54,"body":"injury. So she was doing a"},{"speaker":"Charles Goldfarb","startTime":606.64,"endTime":610.54,"body":"triple back, lots handspring"},{"speaker":"Charles Goldfarb","startTime":610.84,"endTime":614.35,"body":"cartwheel something. And what"},{"speaker":"Chris Dy","startTime":614.35,"endTime":616.84,"body":"the hell's that? That"},{"speaker":"Chris Dy","startTime":614.35,"endTime":616.84,"body":"sounds like you incorporated"},{"speaker":"Chris Dy","startTime":616.84,"endTime":620.92,"body":"figure skating some some other"},{"speaker":"Chris Dy","startTime":616.84,"endTime":620.92,"body":"kind of tumbling maneuvers like"},{"speaker":"Chris Dy","startTime":620.92,"endTime":623.53,"body":"what are we talking about here"},{"speaker":"Chris Dy","startTime":620.92,"endTime":623.53,"body":"like just kind of turning over"},{"speaker":"Chris Dy","startTime":623.53,"endTime":626.5,"body":"like putting a lot of pressure"},{"speaker":"Chris Dy","startTime":623.53,"endTime":626.5,"body":"or axial loading and yes,"},{"speaker":"Chris Dy","startTime":626.53,"endTime":627.01,"body":"backflip?"},{"speaker":"Charles Goldfarb","startTime":627.43,"endTime":629.59,"body":"Yes, I'm sure"},{"speaker":"Charles Goldfarb","startTime":627.43,"endTime":629.59,"body":"everyone on the call who"},{"speaker":"Charles Goldfarb","startTime":629.59,"endTime":632.74,"body":"actually knows anything about"},{"speaker":"Charles Goldfarb","startTime":629.59,"endTime":632.74,"body":"gymnastics. But in all"},{"speaker":"Charles Goldfarb","startTime":632.74,"endTime":635.68,"body":"seriousness, she was doing some"},{"speaker":"Charles Goldfarb","startTime":632.74,"endTime":635.68,"body":"kind of back handspring round"},{"speaker":"Charles Goldfarb","startTime":635.68,"endTime":640.66,"body":"off immediate pain in your elbow"},{"speaker":"Charles Goldfarb","startTime":635.68,"endTime":640.66,"body":"and was seen through urgent care"},{"speaker":"Charles Goldfarb","startTime":641.11,"endTime":644.74,"body":"appropriately diagnosed with a"},{"speaker":"Charles Goldfarb","startTime":641.11,"endTime":644.74,"body":"medial epiocondyle fracture, I"},{"speaker":"Charles Goldfarb","startTime":644.74,"endTime":649.24,"body":"saw her the next week, minimally"},{"speaker":"Charles Goldfarb","startTime":644.74,"endTime":649.24,"body":"displaced fracture we discussed"},{"speaker":"Charles Goldfarb","startTime":649.24,"endTime":652.27,"body":"options which you and I can"},{"speaker":"Charles Goldfarb","startTime":649.24,"endTime":652.27,"body":"discuss and we elected for non"},{"speaker":"Charles Goldfarb","startTime":652.27,"endTime":653.86,"body":"operative care now"},{"speaker":"Chris Dy","startTime":653.89,"endTime":656.71,"body":"she feel pop when this"},{"speaker":"Chris Dy","startTime":653.89,"endTime":656.71,"body":"happened or is immediate pain"},{"speaker":"Chris Dy","startTime":656.71,"endTime":658.66,"body":"and what is the pop mean if"},{"speaker":"Chris Dy","startTime":656.71,"endTime":658.66,"body":"anything, and there's a lot of"},{"speaker":"Chris Dy","startTime":658.69,"endTime":661.87,"body":"bias recall bias with you know,"},{"speaker":"Chris Dy","startTime":658.69,"endTime":661.87,"body":"how patients describe things and"},{"speaker":"Chris Dy","startTime":661.87,"endTime":663.55,"body":"how we ask about them. Yeah,"},{"speaker":"Charles Goldfarb","startTime":663.58,"endTime":667.75,"body":"interesting. I"},{"speaker":"Charles Goldfarb","startTime":663.58,"endTime":667.75,"body":"hear the quote unquote pop more"},{"speaker":"Charles Goldfarb","startTime":667.75,"endTime":672.19,"body":"when this happens for baseball"},{"speaker":"Charles Goldfarb","startTime":667.75,"endTime":672.19,"body":"players actually throwing in"},{"speaker":"Charles Goldfarb","startTime":672.19,"endTime":675.19,"body":"this case she just felt pain in"},{"speaker":"Charles Goldfarb","startTime":672.19,"endTime":675.19,"body":"the medial elbow."},{"speaker":"Chris Dy","startTime":675.91,"endTime":680.44,"body":"Is this similar to the"},{"speaker":"Chris Dy","startTime":675.91,"endTime":680.44,"body":"gentleman and not a peds person?"},{"speaker":"Chris Dy","startTime":680.44,"endTime":682.99,"body":"But is this kind of like an"},{"speaker":"Chris Dy","startTime":680.44,"endTime":682.99,"body":"aphoitis type of deal where"},{"speaker":"Chris Dy","startTime":682.99,"endTime":686.11,"body":"there's a stress over repetitive"},{"speaker":"Chris Dy","startTime":682.99,"endTime":686.11,"body":"use, like in the throwers"},{"speaker":"Chris Dy","startTime":686.17,"endTime":689.44,"body":"adolescent throwers, or is this"},{"speaker":"Chris Dy","startTime":686.17,"endTime":689.44,"body":"different than that? Yeah, I"},{"speaker":"Chris Dy","startTime":689.44,"endTime":689.8,"body":"think"},{"speaker":"Charles Goldfarb","startTime":689.8,"endTime":692.47,"body":"in this case,"},{"speaker":"Charles Goldfarb","startTime":689.8,"endTime":692.47,"body":"it was different. But I do"},{"speaker":"Charles Goldfarb","startTime":692.5,"endTime":697.9,"body":"appreciate that line of inquiry,"},{"speaker":"Charles Goldfarb","startTime":692.5,"endTime":697.9,"body":"because a lot of these are, you"},{"speaker":"Charles Goldfarb","startTime":697.9,"endTime":702.07,"body":"know, a prophecy of"},{"speaker":"Charles Goldfarb","startTime":697.9,"endTime":702.07,"body":"inflammation, stress risers and"},{"speaker":"Charles Goldfarb","startTime":702.07,"endTime":706.06,"body":"eventual injury. Of course, that"},{"speaker":"Charles Goldfarb","startTime":702.07,"endTime":706.06,"body":"couldn't be the case here, but"},{"speaker":"Charles Goldfarb","startTime":706.09,"endTime":709.18,"body":"she denied any prodromal"},{"speaker":"Charles Goldfarb","startTime":706.09,"endTime":709.18,"body":"symptoms, just a one event."},{"speaker":"Chris Dy","startTime":710.44,"endTime":713.38,"body":"Got it. So she was"},{"speaker":"Chris Dy","startTime":710.44,"endTime":713.38,"body":"seen in urgent care was"},{"speaker":"Chris Dy","startTime":713.38,"endTime":716.17,"body":"diagnosed, got to you a week"},{"speaker":"Chris Dy","startTime":713.38,"endTime":716.17,"body":"later is at the appropriate"},{"speaker":"Chris Dy","startTime":716.2,"endTime":717.13,"body":"timing. For"},{"speaker":"Charles Goldfarb","startTime":717.13,"endTime":720.37,"body":"sure, for"},{"speaker":"Charles Goldfarb","startTime":717.13,"endTime":720.37,"body":"sure. And we had a good"},{"speaker":"Charles Goldfarb","startTime":720.4,"endTime":725.05,"body":"conversation, you know, the peds"},{"speaker":"Charles Goldfarb","startTime":720.4,"endTime":725.05,"body":"literature, you know, goes way"},{"speaker":"Charles Goldfarb","startTime":725.05,"endTime":729.01,"body":"in depth as it should regarding"},{"speaker":"Charles Goldfarb","startTime":725.05,"endTime":729.01,"body":"diagnosing and best"},{"speaker":"Charles Goldfarb","startTime":729.01,"endTime":732.79,"body":"understanding the amount of"},{"speaker":"Charles Goldfarb","startTime":729.01,"endTime":732.79,"body":"displacement of the medial"},{"speaker":"Charles Goldfarb","startTime":732.79,"endTime":735.16,"body":"epicondyle and according to"},{"speaker":"Charles Goldfarb","startTime":732.79,"endTime":735.16,"body":"literature, there's plenty of"},{"speaker":"Charles Goldfarb","startTime":735.16,"endTime":738.28,"body":"leeway, you know, up to a"},{"speaker":"Charles Goldfarb","startTime":735.16,"endTime":738.28,"body":"centimeter displacement is fine."},{"speaker":"Charles Goldfarb","startTime":738.28,"endTime":742.33,"body":"Some people say five"},{"speaker":"Charles Goldfarb","startTime":738.28,"endTime":742.33,"body":"millimeters. This was four"},{"speaker":"Charles Goldfarb","startTime":742.33,"endTime":747.55,"body":"millimeters. So it was, to me"},{"speaker":"Charles Goldfarb","startTime":742.33,"endTime":747.55,"body":"not even really great. And I,"},{"speaker":"Charles Goldfarb","startTime":747.82,"endTime":750.34,"body":"I've had some interesting"},{"speaker":"Charles Goldfarb","startTime":747.82,"endTime":750.34,"body":"experiences with me up a condo"},{"speaker":"Charles Goldfarb","startTime":750.34,"endTime":754.24,"body":"fracture. So I think this was a"},{"speaker":"Charles Goldfarb","startTime":750.34,"endTime":754.24,"body":"stoic kid as gymnast often are,"},{"speaker":"Charles Goldfarb","startTime":754.48,"endTime":758.38,"body":"and minimally displaced"},{"speaker":"Charles Goldfarb","startTime":754.48,"endTime":758.38,"body":"fracture, it wasn't hugely"},{"speaker":"Charles Goldfarb","startTime":758.38,"endTime":761.35,"body":"controversial to avoid surgery."},{"speaker":"Charles Goldfarb","startTime":758.38,"endTime":761.35,"body":"So"},{"speaker":"Chris Dy","startTime":761.35,"endTime":764.62,"body":"is this the kind of"},{"speaker":"Chris Dy","startTime":761.35,"endTime":764.62,"body":"case where is this a long arm"},{"speaker":"Chris Dy","startTime":764.62,"endTime":769.0,"body":"cast for however long? And then"},{"speaker":"Chris Dy","startTime":764.62,"endTime":769.0,"body":"typically, how does the non"},{"speaker":"Chris Dy","startTime":769.0,"endTime":770.68,"body":"operative treatment go from"},{"speaker":"Chris Dy","startTime":769.0,"endTime":770.68,"body":"there?"},{"speaker":"Charles Goldfarb","startTime":771.01,"endTime":773.56,"body":"Yeah, so for"},{"speaker":"Charles Goldfarb","startTime":771.01,"endTime":773.56,"body":"me, I usually start moving at"},{"speaker":"Charles Goldfarb","startTime":773.56,"endTime":777.04,"body":"three weeks. So if she was a"},{"speaker":"Charles Goldfarb","startTime":773.56,"endTime":777.04,"body":"week out, put her in a cast for"},{"speaker":"Charles Goldfarb","startTime":777.04,"endTime":779.89,"body":"two weeks, brought her back, let"},{"speaker":"Charles Goldfarb","startTime":777.04,"endTime":779.89,"body":"her started moving, let her"},{"speaker":"Charles Goldfarb","startTime":779.89,"endTime":786.01,"body":"start moving. And that was okay."},{"speaker":"Charles Goldfarb","startTime":779.89,"endTime":786.01,"body":"She didn't have a lot of"},{"speaker":"Charles Goldfarb","startTime":786.01,"endTime":789.28,"body":"specific medial epicondyle pain,"},{"speaker":"Charles Goldfarb","startTime":786.01,"endTime":789.28,"body":"but I asked her to come back in"},{"speaker":"Charles Goldfarb","startTime":789.31,"endTime":794.35,"body":"a month. We discussed the pros"},{"speaker":"Charles Goldfarb","startTime":789.31,"endTime":794.35,"body":"and cons of therapy. family"},{"speaker":"Charles Goldfarb","startTime":794.35,"endTime":796.42,"body":"wanted to go to therapy once and"},{"speaker":"Charles Goldfarb","startTime":794.35,"endTime":796.42,"body":"to do a home program."},{"speaker":"Chris Dy","startTime":797.8,"endTime":800.98,"body":"So this is your plan."},{"speaker":"Chris Dy","startTime":797.8,"endTime":800.98,"body":"You had her comeback. She'll be"},{"speaker":"Chris Dy","startTime":800.98,"endTime":804.04,"body":"six weeks out when she comes"},{"speaker":"Chris Dy","startTime":800.98,"endTime":804.04,"body":"back doing home stuff on her"},{"speaker":"Chris Dy","startTime":804.04,"endTime":806.95,"body":"own, I'm assuming and I have to"},{"speaker":"Chris Dy","startTime":804.04,"endTime":806.95,"body":"ask no nerve symptoms."},{"speaker":"Charles Goldfarb","startTime":807.75,"endTime":810.33,"body":"Okay, yeah,"},{"speaker":"Charles Goldfarb","startTime":807.75,"endTime":810.33,"body":"good point. So at this point, no"},{"speaker":"Charles Goldfarb","startTime":810.33,"endTime":816.54,"body":"nerve symptoms, minimal pain,"},{"speaker":"Charles Goldfarb","startTime":810.33,"endTime":816.54,"body":"reasonable family, and you know,"},{"speaker":"Charles Goldfarb","startTime":816.54,"endTime":819.3,"body":"in all regards, but yeah, she"},{"speaker":"Charles Goldfarb","startTime":816.54,"endTime":819.3,"body":"wasn't come back at six or seven"},{"speaker":"Charles Goldfarb","startTime":819.3,"endTime":823.26,"body":"weeks post injury. And I fully"},{"speaker":"Charles Goldfarb","startTime":819.3,"endTime":823.26,"body":"expected Now I understand that"},{"speaker":"Charles Goldfarb","startTime":823.29,"endTime":826.86,"body":"these can run the gamut. But I"},{"speaker":"Charles Goldfarb","startTime":823.29,"endTime":826.86,"body":"fully expected her to be near"},{"speaker":"Charles Goldfarb","startTime":826.86,"endTime":830.4,"body":"full motion. And I expect her X"},{"speaker":"Charles Goldfarb","startTime":826.86,"endTime":830.4,"body":"rays to look pretty good."},{"speaker":"Chris Dy","startTime":830.88,"endTime":833.31,"body":"So during that time,"},{"speaker":"Chris Dy","startTime":830.88,"endTime":833.31,"body":"where you're taking her out of"},{"speaker":"Chris Dy","startTime":833.31,"endTime":836.73,"body":"the cast, you're three weeks out"},{"speaker":"Chris Dy","startTime":833.31,"endTime":836.73,"body":"now from the injury itself, what"},{"speaker":"Chris Dy","startTime":836.73,"endTime":839.13,"body":"activity limitations were you"},{"speaker":"Chris Dy","startTime":836.73,"endTime":839.13,"body":"giving them as they were kind of"},{"speaker":"Chris Dy","startTime":839.13,"endTime":841.08,"body":"getting out of the cast doing"},{"speaker":"Chris Dy","startTime":839.13,"endTime":841.08,"body":"their home program for"},{"speaker":"Chris Dy","startTime":841.08,"endTime":842.46,"body":"exercises? Yeah,"},{"speaker":"Charles Goldfarb","startTime":842.46,"endTime":846.0,"body":"so she was not"},{"speaker":"Charles Goldfarb","startTime":842.46,"endTime":846.0,"body":"allowed to do any gymnastics,"},{"speaker":"Charles Goldfarb","startTime":846.03,"endTime":851.13,"body":"loading, no push ups, light"},{"speaker":"Charles Goldfarb","startTime":846.03,"endTime":851.13,"body":"activities, typing, Writing,"},{"speaker":"Charles Goldfarb","startTime":851.13,"endTime":855.42,"body":"Reading video games running. And"},{"speaker":"Charles Goldfarb","startTime":851.13,"endTime":855.42,"body":"the ultimate question which"},{"speaker":"Charles Goldfarb","startTime":855.42,"endTime":860.01,"body":"happens every single time, can I"},{"speaker":"Charles Goldfarb","startTime":855.42,"endTime":860.01,"body":"be in the gym, doing things"},{"speaker":"Charles Goldfarb","startTime":860.01,"endTime":865.71,"body":"where I don't use this elbow"},{"speaker":"Charles Goldfarb","startTime":860.01,"endTime":865.71,"body":"fitness and doing the no arm or"},{"speaker":"Charles Goldfarb","startTime":865.71,"endTime":870.03,"body":"one arm back handspring. And I"},{"speaker":"Charles Goldfarb","startTime":865.71,"endTime":870.03,"body":"usually look at the parents and"},{"speaker":"Charles Goldfarb","startTime":870.03,"endTime":872.13,"body":"say, if she can do it safely,"},{"speaker":"Charles Goldfarb","startTime":870.03,"endTime":872.13,"body":"she can do it."},{"speaker":"Chris Dy","startTime":873.36,"endTime":875.4,"body":"Yeah, and not to"},{"speaker":"Chris Dy","startTime":873.36,"endTime":875.4,"body":"distract too much from this"},{"speaker":"Chris Dy","startTime":875.4,"endTime":878.25,"body":"case. I did have a kid who"},{"speaker":"Chris Dy","startTime":875.4,"endTime":878.25,"body":"really wanted to play in his"},{"speaker":"Chris Dy","startTime":878.25,"endTime":881.22,"body":"hockey tournament with his"},{"speaker":"Chris Dy","startTime":878.25,"endTime":881.22,"body":"recently injured finger and I'm"},{"speaker":"Chris Dy","startTime":881.22,"endTime":885.63,"body":"like, I kind of get it now as a"},{"speaker":"Chris Dy","startTime":881.22,"endTime":885.63,"body":"dad, my kids not you know, at"},{"speaker":"Chris Dy","startTime":885.63,"endTime":890.37,"body":"that level, but it's probably"},{"speaker":"Chris Dy","startTime":885.63,"endTime":890.37,"body":"okay. But you obviously have to"},{"speaker":"Chris Dy","startTime":890.37,"endTime":893.31,"body":"catch it. So I think I look at"},{"speaker":"Chris Dy","startTime":890.37,"endTime":893.31,"body":"the parent and like, what do you"},{"speaker":"Chris Dy","startTime":893.31,"endTime":896.4,"body":"think this is up to you? You're"},{"speaker":"Chris Dy","startTime":893.31,"endTime":896.4,"body":"putting, you know, there's some"},{"speaker":"Chris Dy","startTime":896.4,"endTime":898.68,"body":"risk here and everybody's got"},{"speaker":"Chris Dy","startTime":896.4,"endTime":898.68,"body":"different appetite for risk."},{"speaker":"Charles Goldfarb","startTime":899.609,"endTime":902.789,"body":"Yeah, I deal"},{"speaker":"Charles Goldfarb","startTime":899.609,"endTime":902.789,"body":"with this every single day as"},{"speaker":"Charles Goldfarb","startTime":902.999,"endTime":907.019,"body":"you do as most and surgeons and"},{"speaker":"Charles Goldfarb","startTime":902.999,"endTime":907.019,"body":"orthopedic surgeons do, my"},{"speaker":"Charles Goldfarb","startTime":907.019,"endTime":909.659,"body":"philosophies evolved, I just had"},{"speaker":"Charles Goldfarb","startTime":907.019,"endTime":909.659,"body":"this conversation with one of"},{"speaker":"Charles Goldfarb","startTime":909.659,"endTime":912.179,"body":"our wonderful nurse"},{"speaker":"Charles Goldfarb","startTime":909.659,"endTime":912.179,"body":"practitioners. And more and"},{"speaker":"Charles Goldfarb","startTime":912.179,"endTime":915.959,"body":"more, I am willing to let first"},{"speaker":"Charles Goldfarb","startTime":912.179,"endTime":915.959,"body":"of all, I feel like I've always"},{"speaker":"Charles Goldfarb","startTime":915.959,"endTime":923.129,"body":"been lenient in encouraging of"},{"speaker":"Charles Goldfarb","startTime":915.959,"endTime":923.129,"body":"kids going back to sports. But I"},{"speaker":"Charles Goldfarb","startTime":923.129,"endTime":927.119,"body":"do get pushed where I'm not 100%"},{"speaker":"Charles Goldfarb","startTime":923.129,"endTime":927.119,"body":"comfortable. And I verbalize"},{"speaker":"Charles Goldfarb","startTime":927.119,"endTime":931.769,"body":"that. I try to do things to be"},{"speaker":"Charles Goldfarb","startTime":927.119,"endTime":931.769,"body":"protective. And I document that,"},{"speaker":"Charles Goldfarb","startTime":932.609,"endTime":936.119,"body":"that there that there's a risk"},{"speaker":"Charles Goldfarb","startTime":932.609,"endTime":936.119,"body":"of injury and not that I live in"},{"speaker":"Charles Goldfarb","startTime":936.119,"endTime":939.089,"body":"the fear of being sued, because"},{"speaker":"Charles Goldfarb","startTime":936.119,"endTime":939.089,"body":"that's not my word had that I"},{"speaker":"Charles Goldfarb","startTime":939.089,"endTime":941.669,"body":"hadn't had that happen,"},{"speaker":"Charles Goldfarb","startTime":939.089,"endTime":941.669,"body":"especially in these situations,"},{"speaker":"Charles Goldfarb","startTime":941.669,"endTime":943.919,"body":"but I think it is about the"},{"speaker":"Charles Goldfarb","startTime":941.669,"endTime":943.919,"body":"conversation."},{"speaker":"Chris Dy","startTime":945.09,"endTime":946.95,"body":"Absolutely. So tell me"},{"speaker":"Chris Dy","startTime":945.09,"endTime":946.95,"body":"more about how this case"},{"speaker":"Chris Dy","startTime":946.95,"endTime":947.43,"body":"unfolded."},{"speaker":"Charles Goldfarb","startTime":948.119,"endTime":950.279,"body":"So she comes"},{"speaker":"Charles Goldfarb","startTime":948.119,"endTime":950.279,"body":"back in six weeks, and her"},{"speaker":"Charles Goldfarb","startTime":950.279,"endTime":957.689,"body":"motions terrible. Her range is"},{"speaker":"Charles Goldfarb","startTime":950.279,"endTime":957.689,"body":"45 to 120. She had full"},{"speaker":"Charles Goldfarb","startTime":957.689,"endTime":962.549,"body":"rotation. And what was"},{"speaker":"Charles Goldfarb","startTime":957.689,"endTime":962.549,"body":"interesting, whether it was this"},{"speaker":"Charles Goldfarb","startTime":962.999,"endTime":968.069,"body":"visit or the next share we did"},{"speaker":"Charles Goldfarb","startTime":962.999,"endTime":968.069,"body":"in the meanwhile, there are a"},{"speaker":"Charles Goldfarb","startTime":968.069,"endTime":971.249,"body":"couple of things that were"},{"speaker":"Charles Goldfarb","startTime":968.069,"endTime":971.249,"body":"interesting. One as we started,"},{"speaker":"Charles Goldfarb","startTime":971.549,"endTime":974.279,"body":"you know, it's hard to figure"},{"speaker":"Charles Goldfarb","startTime":971.549,"endTime":974.279,"body":"out why is your motion so bad,"},{"speaker":"Charles Goldfarb","startTime":974.279,"endTime":977.429,"body":"you know, there's no x rays look"},{"speaker":"Charles Goldfarb","startTime":974.279,"endTime":977.429,"body":"fine. It's always hard to see"},{"speaker":"Charles Goldfarb","startTime":977.429,"endTime":980.819,"body":"healing at the hypothesis with"},{"speaker":"Charles Goldfarb","startTime":977.429,"endTime":980.819,"body":"minimal displacement. But x rays"},{"speaker":"Charles Goldfarb","startTime":980.819,"endTime":986.159,"body":"look like things were"},{"speaker":"Charles Goldfarb","startTime":980.819,"endTime":986.159,"body":"progressing. And she just seemed"},{"speaker":"Charles Goldfarb","startTime":986.159,"endTime":988.499,"body":"to develop discomfort at the end"},{"speaker":"Charles Goldfarb","startTime":986.159,"endTime":988.499,"body":"range."},{"speaker":"Chris Dy","startTime":989.88,"endTime":994.29,"body":"So you're lacking 45"},{"speaker":"Chris Dy","startTime":989.88,"endTime":994.29,"body":"degrees of extension? And"},{"speaker":"Chris Dy","startTime":994.29,"endTime":996.54,"body":"assuming is your active arc same"},{"speaker":"Chris Dy","startTime":994.29,"endTime":996.54,"body":"as a passive arc?"},{"speaker":"Charles Goldfarb","startTime":996.899,"endTime":1000.169,"body":"Yeah, so"},{"speaker":"Charles Goldfarb","startTime":996.899,"endTime":1000.169,"body":"sorry, let me clarify. I do like"},{"speaker":"Charles Goldfarb","startTime":1000.169,"endTime":1003.799,"body":"the elbow, I do a lot of elbow,"},{"speaker":"Charles Goldfarb","startTime":1000.169,"endTime":1003.799,"body":"I was taught how to measure"},{"speaker":"Charles Goldfarb","startTime":1003.829,"endTime":1008.449,"body":"elbows and shit and verbalize"},{"speaker":"Charles Goldfarb","startTime":1003.829,"endTime":1008.449,"body":"the measurements back in"},{"speaker":"Charles Goldfarb","startTime":1008.449,"endTime":1011.269,"body":"fellowship, but not everyone"},{"speaker":"Charles Goldfarb","startTime":1008.449,"endTime":1011.269,"body":"does it the same way. So when I"},{"speaker":"Charles Goldfarb","startTime":1011.269,"endTime":1015.589,"body":"say motion was 45 to 110. So"},{"speaker":"Charles Goldfarb","startTime":1011.269,"endTime":1015.589,"body":"that means full motion will be"},{"speaker":"Charles Goldfarb","startTime":1015.589,"endTime":1021.079,"body":"zero. So full extension to 145."},{"speaker":"Charles Goldfarb","startTime":1015.589,"endTime":1021.079,"body":"Typically, that's full flexion."},{"speaker":"Charles Goldfarb","startTime":1021.949,"endTime":1026.089,"body":"And in this case, it was 45. So"},{"speaker":"Charles Goldfarb","startTime":1021.949,"endTime":1026.089,"body":"she lacked 45 degrees of"},{"speaker":"Charles Goldfarb","startTime":1026.089,"endTime":1030.529,"body":"extension, and she flex to 110."},{"speaker":"Charles Goldfarb","startTime":1026.089,"endTime":1030.529,"body":"And yes, active equalled"},{"speaker":"Charles Goldfarb","startTime":1030.529,"endTime":1034.579,"body":"passive. And so that raises a"},{"speaker":"Charles Goldfarb","startTime":1030.529,"endTime":1034.579,"body":"super interesting question, does"},{"speaker":"Charles Goldfarb","startTime":1034.579,"endTime":1038.689,"body":"active equal passive because"},{"speaker":"Charles Goldfarb","startTime":1034.579,"endTime":1038.689,"body":"she's developed a contracture of"},{"speaker":"Charles Goldfarb","startTime":1038.689,"endTime":1043.549,"body":"the joint, which has been quick,"},{"speaker":"Charles Goldfarb","startTime":1038.689,"endTime":1043.549,"body":"but not not impossible? Or is"},{"speaker":"Charles Goldfarb","startTime":1043.639,"endTime":1044.989,"body":"there something else going on?"},{"speaker":"Chris Dy","startTime":1045.98,"endTime":1047.06,"body":"Yeah, it's"},{"speaker":"Chris Dy","startTime":1045.98,"endTime":1047.06,"body":"interesting, because it could"},{"speaker":"Chris Dy","startTime":1047.06,"endTime":1051.11,"body":"just be kind of her gardening"},{"speaker":"Chris Dy","startTime":1047.06,"endTime":1051.11,"body":"for lack of a better term. And"},{"speaker":"Chris Dy","startTime":1051.11,"endTime":1054.44,"body":"then it would be really quick to"},{"speaker":"Chris Dy","startTime":1051.11,"endTime":1054.44,"body":"develop an actual contractor."},{"speaker":"Chris Dy","startTime":1054.86,"endTime":1058.43,"body":"But like you said, Not"},{"speaker":"Chris Dy","startTime":1054.86,"endTime":1058.43,"body":"impossible. So how do you first"},{"speaker":"Chris Dy","startTime":1058.43,"endTime":1061.52,"body":"so how do you address this with"},{"speaker":"Chris Dy","startTime":1058.43,"endTime":1061.52,"body":"the family? You know, and the"},{"speaker":"Chris Dy","startTime":1061.52,"endTime":1064.13,"body":"patient? And then what do you"},{"speaker":"Chris Dy","startTime":1061.52,"endTime":1064.13,"body":"do? Yeah."},{"speaker":"Charles Goldfarb","startTime":1067.04,"endTime":1069.62,"body":"The family,"},{"speaker":"Charles Goldfarb","startTime":1067.04,"endTime":1069.62,"body":"you know, was frustrated,"},{"speaker":"Charles Goldfarb","startTime":1069.62,"endTime":1073.49,"body":"honestly, and and I shared that"},{"speaker":"Charles Goldfarb","startTime":1069.62,"endTime":1073.49,"body":"I'm frustrated as well, but also"},{"speaker":"Charles Goldfarb","startTime":1073.49,"endTime":1076.31,"body":"share that I've, unfortunately"},{"speaker":"Charles Goldfarb","startTime":1073.49,"endTime":1076.31,"body":"had experience with this. It"},{"speaker":"Charles Goldfarb","startTime":1076.31,"endTime":1080.81,"body":"doesn't happen very often. It"},{"speaker":"Charles Goldfarb","startTime":1076.31,"endTime":1080.81,"body":"always happens in 10 to 12 year"},{"speaker":"Charles Goldfarb","startTime":1080.81,"endTime":1085.22,"body":"old girls, with some rare"},{"speaker":"Charles Goldfarb","startTime":1080.81,"endTime":1085.22,"body":"exceptions, but literally, every"},{"speaker":"Charles Goldfarb","startTime":1085.22,"endTime":1088.16,"body":"time it's incredible. And"},{"speaker":"Chris Dy","startTime":1088.43,"endTime":1090.44,"body":"is this like a well"},{"speaker":"Chris Dy","startTime":1088.43,"endTime":1090.44,"body":"known entity, or this is we're"},{"speaker":"Chris Dy","startTime":1090.44,"endTime":1093.35,"body":"getting into Chuck Goldfarb"},{"speaker":"Chris Dy","startTime":1090.44,"endTime":1093.35,"body":"level five, like, you know,"},{"speaker":"Chris Dy","startTime":1093.59,"endTime":1096.08,"body":"everybody gather around the"},{"speaker":"Chris Dy","startTime":1093.59,"endTime":1096.08,"body":"fireplace. Let's learn something"},{"speaker":"Chris Dy","startTime":1096.08,"endTime":1097.67,"body":"from the guy that hasn't"},{"speaker":"Chris Dy","startTime":1096.08,"endTime":1097.67,"body":"published it yet."},{"speaker":"Charles Goldfarb","startTime":1098.45,"endTime":1100.37,"body":"Well, a couple"},{"speaker":"Charles Goldfarb","startTime":1098.45,"endTime":1100.37,"body":"of interesting things. Thank you"},{"speaker":"Charles Goldfarb","startTime":1100.37,"endTime":1103.97,"body":"for that very fair comment."},{"speaker":"Charles Goldfarb","startTime":1100.37,"endTime":1103.97,"body":"Lindley. And I did just"},{"speaker":"Charles Goldfarb","startTime":1104.0,"endTime":1106.73,"body":"published this, and I don't know"},{"speaker":"Charles Goldfarb","startTime":1104.0,"endTime":1106.73,"body":"if it's out yet, it was a small"},{"speaker":"Charles Goldfarb","startTime":1106.73,"endTime":1109.82,"body":"series as it might be expected,"},{"speaker":"Charles Goldfarb","startTime":1106.73,"endTime":1109.82,"body":"but it's one of those situations"},{"speaker":"Charles Goldfarb","startTime":1109.82,"endTime":1112.43,"body":"where once you have thought"},{"speaker":"Charles Goldfarb","startTime":1109.82,"endTime":1112.43,"body":"about something and written"},{"speaker":"Charles Goldfarb","startTime":1112.43,"endTime":1116.75,"body":"about something, you start to"},{"speaker":"Charles Goldfarb","startTime":1112.43,"endTime":1116.75,"body":"see it more and more. And so we,"},{"speaker":"Charles Goldfarb","startTime":1116.84,"endTime":1119.81,"body":"and I think it's in general a"},{"speaker":"Charles Goldfarb","startTime":1116.84,"endTime":1119.81,"body":"hand surgery go or will be"},{"speaker":"Charles Goldfarb","startTime":1119.81,"endTime":1124.58,"body":"shortly, but 10 to 12 year old"},{"speaker":"Charles Goldfarb","startTime":1119.81,"endTime":1124.58,"body":"females, medial epicondyle"},{"speaker":"Charles Goldfarb","startTime":1124.58,"endTime":1127.73,"body":"fractures, something happens,"},{"speaker":"Charles Goldfarb","startTime":1124.58,"endTime":1127.73,"body":"and you're gonna like what we"},{"speaker":"Charles Goldfarb","startTime":1127.73,"endTime":1132.8,"body":"think that something is. But"},{"speaker":"Charles Goldfarb","startTime":1127.73,"endTime":1132.8,"body":"what happens is, these patients"},{"speaker":"Charles Goldfarb","startTime":1132.8,"endTime":1136.55,"body":"start to develop co"},{"speaker":"Charles Goldfarb","startTime":1132.8,"endTime":1136.55,"body":"contractions, which is a term"},{"speaker":"Charles Goldfarb","startTime":1136.55,"endTime":1139.49,"body":"that we discussed at length with"},{"speaker":"Charles Goldfarb","startTime":1136.55,"endTime":1139.49,"body":"our wonderful therapy"},{"speaker":"Charles Goldfarb","startTime":1139.49,"endTime":1143.99,"body":"colleagues. And so it's in now I"},{"speaker":"Charles Goldfarb","startTime":1139.49,"endTime":1143.99,"body":"look for that every time so"},{"speaker":"Charles Goldfarb","startTime":1143.99,"endTime":1148.52,"body":"essentially, when she goes to"},{"speaker":"Charles Goldfarb","startTime":1143.99,"endTime":1148.52,"body":"extend, she's not only firing"},{"speaker":"Charles Goldfarb","startTime":1148.52,"endTime":1151.52,"body":"her triceps, she's firing her"},{"speaker":"Charles Goldfarb","startTime":1148.52,"endTime":1151.52,"body":"biceps, and when she goes to"},{"speaker":"Charles Goldfarb","startTime":1151.52,"endTime":1154.76,"body":"flex, she's also firing her"},{"speaker":"Charles Goldfarb","startTime":1151.52,"endTime":1154.76,"body":"triceps. So she's fighting"},{"speaker":"Charles Goldfarb","startTime":1154.76,"endTime":1158.63,"body":"against herself because"},{"speaker":"Charles Goldfarb","startTime":1154.76,"endTime":1158.63,"body":"something's going on with the"},{"speaker":"Charles Goldfarb","startTime":1158.63,"endTime":1160.94,"body":"ulnar nerve, even though she"},{"speaker":"Charles Goldfarb","startTime":1158.63,"endTime":1160.94,"body":"doesn't complain about her nerve"},{"speaker":"Charles Goldfarb","startTime":1160.94,"endTime":1162.32,"body":"symptoms. That"},{"speaker":"Chris Dy","startTime":1162.32,"endTime":1164.42,"body":"is super interesting."},{"speaker":"Chris Dy","startTime":1162.32,"endTime":1164.42,"body":"And now you have piqued my"},{"speaker":"Chris Dy","startTime":1164.42,"endTime":1167.42,"body":"interest. First off,"},{"speaker":"Chris Dy","startTime":1164.42,"endTime":1167.42,"body":"congratulations on publishing"},{"speaker":"Chris Dy","startTime":1167.42,"endTime":1170.3,"body":"that as a listener pointed out a"},{"speaker":"Chris Dy","startTime":1167.42,"endTime":1170.3,"body":"couple of years ago Chuck"},{"speaker":"Chris Dy","startTime":1170.3,"endTime":1173.0,"body":"Goldfarb, just a workman"},{"speaker":"Chris Dy","startTime":1170.3,"endTime":1173.0,"body":"hammering nails, just finding"},{"speaker":"Chris Dy","startTime":1173.0,"endTime":1176.15,"body":"all the nails and hammering"},{"speaker":"Chris Dy","startTime":1173.0,"endTime":1176.15,"body":"them. And I applaud you for"},{"speaker":"Chris Dy","startTime":1176.15,"endTime":1178.25,"body":"getting it out. Because a lot of"},{"speaker":"Chris Dy","startTime":1176.15,"endTime":1178.25,"body":"people don't take that extra"},{"speaker":"Chris Dy","startTime":1178.25,"endTime":1181.97,"body":"step. And you know, they think"},{"speaker":"Chris Dy","startTime":1178.25,"endTime":1181.97,"body":"about something they put it as"},{"speaker":"Chris Dy","startTime":1181.97,"endTime":1183.98,"body":"part of their practice they tell"},{"speaker":"Chris Dy","startTime":1181.97,"endTime":1183.98,"body":"their colleagues but they don't"},{"speaker":"Chris Dy","startTime":1183.98,"endTime":1186.47,"body":"necessarily get it out there"},{"speaker":"Chris Dy","startTime":1183.98,"endTime":1186.47,"body":"literature so congrats on that."},{"speaker":"Chris Dy","startTime":1186.53,"endTime":1189.38,"body":"Now before we dive into the"},{"speaker":"Chris Dy","startTime":1186.53,"endTime":1189.38,"body":"nerve part, which I'm super"},{"speaker":"Chris Dy","startTime":1189.38,"endTime":1192.44,"body":"excited about, we should thank"},{"speaker":"Chris Dy","startTime":1189.38,"endTime":1192.44,"body":"our next sponsor. So the upper"},{"speaker":"Chris Dy","startTime":1192.44,"endTime":1194.51,"body":"hand is sponsored by checkpoint"},{"speaker":"Chris Dy","startTime":1192.44,"endTime":1194.51,"body":"surgical, a provider of"},{"speaker":"Chris Dy","startTime":1194.51,"endTime":1197.3,"body":"innovative solutions for"},{"speaker":"Chris Dy","startTime":1194.51,"endTime":1197.3,"body":"peripheral nerve surgery. As a"},{"speaker":"Chris Dy","startTime":1197.3,"endTime":1199.85,"body":"hand surgeon and as a hand"},{"speaker":"Chris Dy","startTime":1197.3,"endTime":1199.85,"body":"therapist or an orthopedic"},{"speaker":"Chris Dy","startTime":1199.85,"endTime":1202.34,"body":"surgeon genio that nerves"},{"speaker":"Chris Dy","startTime":1199.85,"endTime":1202.34,"body":"matter. It's why checkpoint"},{"speaker":"Chris Dy","startTime":1202.34,"endTime":1205.43,"body":"surgical is singularly focused"},{"speaker":"Chris Dy","startTime":1202.34,"endTime":1205.43,"body":"on elevating the clinical"},{"speaker":"Chris Dy","startTime":1205.43,"endTime":1207.53,"body":"practice of peripheral nerve"},{"speaker":"Chris Dy","startTime":1205.43,"endTime":1207.53,"body":"surgery with innovative"},{"speaker":"Chris Dy","startTime":1207.53,"endTime":1211.13,"body":"technologies that help improve"},{"speaker":"Chris Dy","startTime":1207.53,"endTime":1211.13,"body":"patient outcomes. Checkpoint"},{"speaker":"Charles Goldfarb","startTime":1211.13,"endTime":1213.77,"body":"surgicals"},{"speaker":"Charles Goldfarb","startTime":1211.13,"endTime":1213.77,"body":"portfolio includes a range of"},{"speaker":"Charles Goldfarb","startTime":1213.77,"endTime":1217.73,"body":"handheld intra operative nerve"},{"speaker":"Charles Goldfarb","startTime":1213.77,"endTime":1217.73,"body":"stimulators, nerve cutting"},{"speaker":"Charles Goldfarb","startTime":1217.73,"endTime":1221.66,"body":"instruments and biomaterials To"},{"speaker":"Charles Goldfarb","startTime":1217.73,"endTime":1221.66,"body":"learn more visit www dot"},{"speaker":"Charles Goldfarb","startTime":1221.66,"endTime":1225.32,"body":"checkpoint surgical.com"},{"speaker":"Charles Goldfarb","startTime":1221.66,"endTime":1225.32,"body":"Checkpoint, surgical driving"},{"speaker":"Charles Goldfarb","startTime":1225.35,"endTime":1227.21,"body":"innovation, enhancer,"},{"speaker":"Chris Dy","startTime":1228.32,"endTime":1230.72,"body":"nerve surgery hand"},{"speaker":"Chris Dy","startTime":1228.32,"endTime":1230.72,"body":"surgery, you will get you just"},{"speaker":"Chris Dy","startTime":1231.02,"endTime":1235.64,"body":"mixing up the copy there. Sorry,"},{"speaker":"Chris Dy","startTime":1231.02,"endTime":1235.64,"body":"Becca, both of us riffs on the"},{"speaker":"Chris Dy","startTime":1235.64,"endTime":1239.72,"body":"coffee. So tell me how this how"},{"speaker":"Chris Dy","startTime":1235.64,"endTime":1239.72,"body":"this evolved in terms of the"},{"speaker":"Chris Dy","startTime":1239.72,"endTime":1242.99,"body":"nerve stuff and tell me more"},{"speaker":"Chris Dy","startTime":1239.72,"endTime":1242.99,"body":"about this patient and also what"},{"speaker":"Chris Dy","startTime":1242.99,"endTime":1245.36,"body":"you found in your series. Yeah,"},{"speaker":"Charles Goldfarb","startTime":1245.39,"endTime":1247.91,"body":"I think let's"},{"speaker":"Charles Goldfarb","startTime":1245.39,"endTime":1247.91,"body":"you and I have discussed"},{"speaker":"Charles Goldfarb","startTime":1247.91,"endTime":1254.42,"body":"previously, the concept of the"},{"speaker":"Charles Goldfarb","startTime":1247.91,"endTime":1254.42,"body":"ulnar nerve and throwers with"},{"speaker":"Charles Goldfarb","startTime":1254.42,"endTime":1258.95,"body":"UCL injuries. And what we share"},{"speaker":"Charles Goldfarb","startTime":1254.42,"endTime":1258.95,"body":"then in case the listeners don't"},{"speaker":"Charles Goldfarb","startTime":1258.95,"endTime":1262.37,"body":"recall is that, you know, both"},{"speaker":"Charles Goldfarb","startTime":1258.95,"endTime":1262.37,"body":"you and I, I think me a little"},{"speaker":"Charles Goldfarb","startTime":1262.37,"endTime":1266.18,"body":"more frequently work closely"},{"speaker":"Charles Goldfarb","startTime":1262.37,"endTime":1266.18,"body":"with our sports partners. And"},{"speaker":"Charles Goldfarb","startTime":1266.18,"endTime":1269.99,"body":"one of our partners, Matt Smith"},{"speaker":"Charles Goldfarb","startTime":1266.18,"endTime":1269.99,"body":"is amazing and particularly"},{"speaker":"Charles Goldfarb","startTime":1269.99,"endTime":1274.97,"body":"focused on the UCL does a lot of"},{"speaker":"Charles Goldfarb","startTime":1269.99,"endTime":1274.97,"body":"reconstructions. And we team up"},{"speaker":"Charles Goldfarb","startTime":1274.97,"endTime":1278.63,"body":"regularly because it is quite"},{"speaker":"Charles Goldfarb","startTime":1274.97,"endTime":1278.63,"body":"frequent that the owner nerve is"},{"speaker":"Charles Goldfarb","startTime":1278.63,"endTime":1281.6,"body":"irritated as well. Now, if the"},{"speaker":"Charles Goldfarb","startTime":1278.63,"endTime":1281.6,"body":"owner is not irritated, I'm not"},{"speaker":"Charles Goldfarb","startTime":1281.6,"endTime":1287.06,"body":"involved. But if it is at all,"},{"speaker":"Charles Goldfarb","startTime":1281.6,"endTime":1287.06,"body":"or if the nerve is subluxated,"},{"speaker":"Charles Goldfarb","startTime":1287.09,"endTime":1290.3,"body":"then I go ahead and transpose"},{"speaker":"Charles Goldfarb","startTime":1287.09,"endTime":1290.3,"body":"the nerve. But what we find in"},{"speaker":"Charles Goldfarb","startTime":1290.3,"endTime":1294.05,"body":"those surgeries, it's"},{"speaker":"Charles Goldfarb","startTime":1290.3,"endTime":1294.05,"body":"fascinating. The medial elbow"},{"speaker":"Charles Goldfarb","startTime":1294.05,"endTime":1300.02,"body":"soft tissues are not normal."},{"speaker":"Charles Goldfarb","startTime":1294.05,"endTime":1300.02,"body":"There's scar, there's hyperemia."},{"speaker":"Charles Goldfarb","startTime":1300.02,"endTime":1306.5,"body":"And the vasculature is really"},{"speaker":"Charles Goldfarb","startTime":1300.02,"endTime":1306.5,"body":"robust. And it's just it's very,"},{"speaker":"Charles Goldfarb","startTime":1306.53,"endTime":1309.8,"body":"very different from the"},{"speaker":"Charles Goldfarb","startTime":1306.53,"endTime":1309.8,"body":"idiopathic X. And these are the"},{"speaker":"Charles Goldfarb","startTime":1309.8,"endTime":1313.13,"body":"throwers or your these are the"},{"speaker":"Charles Goldfarb","startTime":1309.8,"endTime":1313.13,"body":"throwers. And then sortition."},{"speaker":"Chris Dy","startTime":1313.76,"endTime":1316.01,"body":"Let me let me ask you"},{"speaker":"Chris Dy","startTime":1313.76,"endTime":1316.01,"body":"one question on that first. So"},{"speaker":"Chris Dy","startTime":1316.01,"endTime":1319.13,"body":"you mentioned that the ulnar"},{"speaker":"Chris Dy","startTime":1316.01,"endTime":1319.13,"body":"nerve if it's irritable Now,"},{"speaker":"Chris Dy","startTime":1319.52,"endTime":1322.07,"body":"typically my experience with"},{"speaker":"Chris Dy","startTime":1319.52,"endTime":1322.07,"body":"these younger patients that"},{"speaker":"Chris Dy","startTime":1322.07,"endTime":1324.92,"body":"their nerve studies come back as"},{"speaker":"Chris Dy","startTime":1322.07,"endTime":1324.92,"body":"quote normal, because those"},{"speaker":"Chris Dy","startTime":1324.92,"endTime":1329.15,"body":"normal values on nerve study are"},{"speaker":"Chris Dy","startTime":1324.92,"endTime":1329.15,"body":"based on an older population. So"},{"speaker":"Chris Dy","startTime":1330.32,"endTime":1333.17,"body":"is it something on examination"},{"speaker":"Chris Dy","startTime":1330.32,"endTime":1333.17,"body":"that clues you into that the"},{"speaker":"Chris Dy","startTime":1333.17,"endTime":1336.41,"body":"nerve is irritated? Yeah, it's"},{"speaker":"Chris Dy","startTime":1333.17,"endTime":1336.41,"body":"not subluxated Yeah,"},{"speaker":"Charles Goldfarb","startTime":1336.41,"endTime":1339.62,"body":"and if the"},{"speaker":"Charles Goldfarb","startTime":1336.41,"endTime":1339.62,"body":"patient is seen and has UCL"},{"speaker":"Charles Goldfarb","startTime":1339.62,"endTime":1343.43,"body":"problem, I don't order nerve"},{"speaker":"Charles Goldfarb","startTime":1339.62,"endTime":1343.43,"body":"studies. It's a clinical exam by"},{"speaker":"Charles Goldfarb","startTime":1343.43,"endTime":1347.36,"body":"Dr. Smith and myself. And that"},{"speaker":"Charles Goldfarb","startTime":1343.43,"endTime":1347.36,"body":"exam evaluates for you know,"},{"speaker":"Charles Goldfarb","startTime":1347.36,"endTime":1351.68,"body":"certainly 10 nails or elbow"},{"speaker":"Charles Goldfarb","startTime":1347.36,"endTime":1351.68,"body":"flesh compression test, nerve"},{"speaker":"Charles Goldfarb","startTime":1351.68,"endTime":1355.85,"body":"stability, and patient"},{"speaker":"Charles Goldfarb","startTime":1351.68,"endTime":1355.85,"body":"complaints in the thrower, they"},{"speaker":"Charles Goldfarb","startTime":1355.85,"endTime":1359.42,"body":"often complain of medial elbow"},{"speaker":"Charles Goldfarb","startTime":1355.85,"endTime":1359.42,"body":"pain, and sometimes they"},{"speaker":"Charles Goldfarb","startTime":1359.45,"endTime":1362.33,"body":"complain at the distal radiation"},{"speaker":"Charles Goldfarb","startTime":1359.45,"endTime":1362.33,"body":"and occasional numbness and"},{"speaker":"Charles Goldfarb","startTime":1362.33,"endTime":1367.52,"body":"tingling. But as it seems to be"},{"speaker":"Charles Goldfarb","startTime":1362.33,"endTime":1367.52,"body":"not only the ligament causing"},{"speaker":"Charles Goldfarb","startTime":1367.52,"endTime":1369.41,"body":"pain, but also the nerve. So"},{"speaker":"Chris Dy","startTime":1369.41,"endTime":1371.45,"body":"what's your go to"},{"speaker":"Chris Dy","startTime":1369.41,"endTime":1371.45,"body":"treatment for the thrower who's"},{"speaker":"Chris Dy","startTime":1371.45,"endTime":1374.24,"body":"having UCL surgery of some sort?"},{"speaker":"Chris Dy","startTime":1371.45,"endTime":1374.24,"body":"Yeah,"},{"speaker":"Charles Goldfarb","startTime":1374.24,"endTime":1376.52,"body":"and again,"},{"speaker":"Charles Goldfarb","startTime":1374.24,"endTime":1376.52,"body":"this is adolescent young adult"},{"speaker":"Charles Goldfarb","startTime":1376.52,"endTime":1380.21,"body":"population. I don't believe in"},{"speaker":"Charles Goldfarb","startTime":1376.52,"endTime":1380.21,"body":"decompression in those patients."},{"speaker":"Charles Goldfarb","startTime":1380.27,"endTime":1384.89,"body":"So these are transpositions,"},{"speaker":"Charles Goldfarb","startTime":1380.27,"endTime":1384.89,"body":"subcutaneous fascia, cutaneous"},{"speaker":"Charles Goldfarb","startTime":1384.89,"endTime":1388.85,"body":"flap, early motion, and we you"},{"speaker":"Charles Goldfarb","startTime":1384.89,"endTime":1388.85,"body":"know, usually what happens is"},{"speaker":"Charles Goldfarb","startTime":1388.85,"endTime":1392.69,"body":"we're protecting them because of"},{"speaker":"Charles Goldfarb","startTime":1388.85,"endTime":1392.69,"body":"the UCL whether it's a repair,"},{"speaker":"Charles Goldfarb","startTime":1392.69,"endTime":1395.12,"body":"whether it's an internal brace,"},{"speaker":"Charles Goldfarb","startTime":1392.69,"endTime":1395.12,"body":"whether it's a true"},{"speaker":"Charles Goldfarb","startTime":1395.12,"endTime":1400.91,"body":"reconstruction, so Matt likes"},{"speaker":"Charles Goldfarb","startTime":1395.12,"endTime":1400.91,"body":"hinged elbow braces. And we get"},{"speaker":"Charles Goldfarb","startTime":1400.91,"endTime":1405.14,"body":"a moving pretty early, but"},{"speaker":"Charles Goldfarb","startTime":1400.91,"endTime":1405.14,"body":"fascinating is flat, I do not go"},{"speaker":"Charles Goldfarb","startTime":1405.14,"endTime":1407.27,"body":"so muscular. It's I think that"},{"speaker":"Charles Goldfarb","startTime":1405.14,"endTime":1407.27,"body":"comes with a cost."},{"speaker":"Chris Dy","startTime":1408.56,"endTime":1410.96,"body":"Definitely a cost in"},{"speaker":"Chris Dy","startTime":1408.56,"endTime":1410.96,"body":"that throwing athlete for sure."},{"speaker":"Chris Dy","startTime":1411.41,"endTime":1413.42,"body":"Um, so tell me about the"},{"speaker":"Chris Dy","startTime":1411.41,"endTime":1413.42,"body":"gymnasts. Yeah,"},{"speaker":"Charles Goldfarb","startTime":1413.42,"endTime":1417.71,"body":"so we"},{"speaker":"Charles Goldfarb","startTime":1413.42,"endTime":1417.71,"body":"recognized and discuss this"},{"speaker":"Charles Goldfarb","startTime":1417.71,"endTime":1422.87,"body":"concept of how it's likely her"},{"speaker":"Charles Goldfarb","startTime":1417.71,"endTime":1422.87,"body":"owner nerve is contributing to"},{"speaker":"Charles Goldfarb","startTime":1422.87,"endTime":1426.2,"body":"these co contractions and her"},{"speaker":"Charles Goldfarb","startTime":1422.87,"endTime":1426.2,"body":"failure to regain motion. I"},{"speaker":"Charles Goldfarb","startTime":1426.2,"endTime":1429.02,"body":"stressed the importance of"},{"speaker":"Charles Goldfarb","startTime":1426.2,"endTime":1429.02,"body":"therapy and got our therapy"},{"speaker":"Charles Goldfarb","startTime":1429.02,"endTime":1432.86,"body":"colleagues more involved to try"},{"speaker":"Charles Goldfarb","startTime":1429.02,"endTime":1432.86,"body":"to work with that. Clinically,"},{"speaker":"Charles Goldfarb","startTime":1432.86,"endTime":1437.03,"body":"she did not have clear evidence"},{"speaker":"Charles Goldfarb","startTime":1432.86,"endTime":1437.03,"body":"of an owner at that moment,"},{"speaker":"Charles Goldfarb","startTime":1437.78,"endTime":1439.1,"body":"meaning nowhere to build it."},{"speaker":"Chris Dy","startTime":1439.73,"endTime":1442.04,"body":"Can you tell me more"},{"speaker":"Chris Dy","startTime":1439.73,"endTime":1442.04,"body":"about why the ulnar nerve might"},{"speaker":"Chris Dy","startTime":1442.04,"endTime":1446.57,"body":"be causing contractions just"},{"speaker":"Chris Dy","startTime":1442.04,"endTime":1446.57,"body":"because I don't typically think"},{"speaker":"Chris Dy","startTime":1446.57,"endTime":1448.94,"body":"that the ulnar nerve is"},{"speaker":"Chris Dy","startTime":1446.57,"endTime":1448.94,"body":"providing any innervation to the"},{"speaker":"Chris Dy","startTime":1448.94,"endTime":1453.2,"body":"biceps or to the triceps or the"},{"speaker":"Chris Dy","startTime":1448.94,"endTime":1453.2,"body":"brachialis. Yes,"},{"speaker":"Charles Goldfarb","startTime":1453.26,"endTime":1459.35,"body":"I don't"},{"speaker":"Charles Goldfarb","startTime":1453.26,"endTime":1459.35,"body":"either. I is a pain reaction of"},{"speaker":"Charles Goldfarb","startTime":1459.35,"endTime":1463.61,"body":"some sort is a subclinical pain"},{"speaker":"Charles Goldfarb","startTime":1459.35,"endTime":1463.61,"body":"reaction, and the patient is"},{"speaker":"Charles Goldfarb","startTime":1463.64,"endTime":1467.39,"body":"somehow another guarding against"},{"speaker":"Charles Goldfarb","startTime":1463.64,"endTime":1467.39,"body":"motions that stress the nerve"},{"speaker":"Charles Goldfarb","startTime":1467.39,"endTime":1471.2,"body":"you would think especially"},{"speaker":"Charles Goldfarb","startTime":1467.39,"endTime":1471.2,"body":"flexion. But it's extension as"},{"speaker":"Charles Goldfarb","startTime":1471.2,"endTime":1475.28,"body":"well. I don't understand and"},{"speaker":"Charles Goldfarb","startTime":1471.2,"endTime":1475.28,"body":"there is some literature out"},{"speaker":"Charles Goldfarb","startTime":1475.28,"endTime":1479.48,"body":"there on on the concept of"},{"speaker":"Charles Goldfarb","startTime":1475.28,"endTime":1479.48,"body":"contractions. Because we looked"},{"speaker":"Charles Goldfarb","startTime":1479.48,"endTime":1482.42,"body":"into it for this paper we use"},{"speaker":"Charles Goldfarb","startTime":1479.48,"endTime":1482.42,"body":"wrote, but the literature"},{"speaker":"Charles Goldfarb","startTime":1482.42,"endTime":1485.63,"body":"doesn't fully explain it to me"},{"speaker":"Charles Goldfarb","startTime":1482.42,"endTime":1485.63,"body":"so I don't know the answer to"},{"speaker":"Charles Goldfarb","startTime":1485.63,"endTime":1488.63,"body":"that question. But there's no"},{"speaker":"Charles Goldfarb","startTime":1485.63,"endTime":1488.63,"body":"doubt in my mind that it's an"},{"speaker":"Charles Goldfarb","startTime":1488.63,"endTime":1490.28,"body":"angry older nervous the culprit."},{"speaker":"Chris Dy","startTime":1494.3,"endTime":1496.37,"body":"So for any residents"},{"speaker":"Chris Dy","startTime":1494.3,"endTime":1496.37,"body":"or fellows listening if you want"},{"speaker":"Chris Dy","startTime":1496.37,"endTime":1500.54,"body":"an easy research project, you"},{"speaker":"Chris Dy","startTime":1496.37,"endTime":1500.54,"body":"can definitely build on Chuck's"},{"speaker":"Chris Dy","startTime":1500.54,"endTime":1503.57,"body":"work here, and put some needles"},{"speaker":"Chris Dy","startTime":1500.54,"endTime":1503.57,"body":"in there and try to figure out"},{"speaker":"Chris Dy","startTime":1503.57,"endTime":1504.14,"body":"what's going on."},{"speaker":"Charles Goldfarb","startTime":1504.38,"endTime":1506.69,"body":"It is it is an"},{"speaker":"Charles Goldfarb","startTime":1504.38,"endTime":1506.69,"body":"interesting topic, right? You do"},{"speaker":"Charles Goldfarb","startTime":1506.69,"endTime":1512.18,"body":"some niche work. This, you know,"},{"speaker":"Charles Goldfarb","startTime":1506.69,"endTime":1512.18,"body":"when Lindley and I were talking"},{"speaker":"Charles Goldfarb","startTime":1512.18,"endTime":1514.4,"body":"about this and recognize the"},{"speaker":"Charles Goldfarb","startTime":1512.18,"endTime":1514.4,"body":"problem, and our therapist"},{"speaker":"Charles Goldfarb","startTime":1514.4,"endTime":1517.55,"body":"recognized the problem, you kind"},{"speaker":"Charles Goldfarb","startTime":1514.4,"endTime":1517.55,"body":"of like, Well, should we publish"},{"speaker":"Charles Goldfarb","startTime":1517.55,"endTime":1521.66,"body":"this? Is it? Is it a big enough"},{"speaker":"Charles Goldfarb","startTime":1517.55,"endTime":1521.66,"body":"deal? And I think the reality is"},{"speaker":"Charles Goldfarb","startTime":1521.66,"endTime":1525.2,"body":"that we've seen in I think our"},{"speaker":"Charles Goldfarb","startTime":1521.66,"endTime":1525.2,"body":"case series was 12. But since"},{"speaker":"Charles Goldfarb","startTime":1525.2,"endTime":1529.19,"body":"then, in the last year, I've"},{"speaker":"Charles Goldfarb","startTime":1525.2,"endTime":1529.19,"body":"probably seen 10 more kids. It's"},{"speaker":"Charles Goldfarb","startTime":1529.22,"endTime":1533.21,"body":"out there, and you just wonder"},{"speaker":"Charles Goldfarb","startTime":1529.22,"endTime":1533.21,"body":"whether people will find this"},{"speaker":"Charles Goldfarb","startTime":1533.21,"endTime":1537.17,"body":"work. But if you don't publish"},{"speaker":"Charles Goldfarb","startTime":1533.21,"endTime":1537.17,"body":"it, then one thing is for sure,"},{"speaker":"Charles Goldfarb","startTime":1537.2,"endTime":1540.23,"body":"no one no one will, you know,"},{"speaker":"Charles Goldfarb","startTime":1537.2,"endTime":1540.23,"body":"everyone will be reinventing the"},{"speaker":"Charles Goldfarb","startTime":1540.23,"endTime":1541.37,"body":"wheel there"},{"speaker":"Chris Dy","startTime":1541.1,"endTime":1543.804,"body":"and say what you will"},{"speaker":"Chris Dy","startTime":1541.1,"endTime":1543.804,"body":"about, you know, I think the"},{"speaker":"Chris Dy","startTime":1543.858,"endTime":1546.941,"body":"traditional academic model is"},{"speaker":"Chris Dy","startTime":1543.858,"endTime":1546.941,"body":"that something that is open"},{"speaker":"Chris Dy","startTime":1546.995,"endTime":1550.403,"body":"access is not considered as high"},{"speaker":"Chris Dy","startTime":1546.995,"endTime":1550.403,"body":"prestige factor, but it's when"},{"speaker":"Chris Dy","startTime":1550.457,"endTime":1553.594,"body":"people read it, people can get"},{"speaker":"Chris Dy","startTime":1550.457,"endTime":1553.594,"body":"that around the world, both"},{"speaker":"Chris Dy","startTime":1553.648,"endTime":1556.569,"body":"people who are patients,"},{"speaker":"Chris Dy","startTime":1553.648,"endTime":1556.569,"body":"families, etc, but also other"},{"speaker":"Chris Dy","startTime":1556.623,"endTime":1559.652,"body":"practicing surgeons and"},{"speaker":"Chris Dy","startTime":1556.623,"endTime":1559.652,"body":"therapists. I've had people come"},{"speaker":"Chris Dy","startTime":1559.706,"endTime":1563.005,"body":"in and print out articles that"},{"speaker":"Chris Dy","startTime":1559.706,"endTime":1563.005,"body":"are open access in their mind,"},{"speaker":"Chris Dy","startTime":1563.06,"endTime":1566.088,"body":"and they print out the Open"},{"speaker":"Chris Dy","startTime":1563.06,"endTime":1566.088,"body":"Access ones and not the ones"},{"speaker":"Chris Dy","startTime":1566.143,"endTime":1569.55,"body":"that are brought in to paywall."},{"speaker":"Chris Dy","startTime":1566.143,"endTime":1569.55,"body":"So there's definitely something"},{"speaker":"Chris Dy","startTime":1569.604,"endTime":1572.795,"body":"there about the scholarship part"},{"speaker":"Chris Dy","startTime":1569.604,"endTime":1572.795,"body":"of it. So kudos to you for"},{"speaker":"Chris Dy","startTime":1572.85,"endTime":1574.04,"body":"getting it out there.,"},{"speaker":"Charles Goldfarb","startTime":1574.04,"endTime":1576.819,"body":"Yea for sure."},{"speaker":"Charles Goldfarb","startTime":1574.04,"endTime":1576.819,"body":"I don't think we've talked about"},{"speaker":"Charles Goldfarb","startTime":1576.88,"endTime":1580.808,"body":"this, but it definitely relates-"},{"speaker":"Charles Goldfarb","startTime":1576.88,"endTime":1580.808,"body":"10 years ago, more than 10 years"},{"speaker":"Charles Goldfarb","startTime":1580.868,"endTime":1584.434,"body":"ago, when Nate Van Zeeland was a"},{"speaker":"Charles Goldfarb","startTime":1580.868,"endTime":1584.434,"body":"fellow. Nate was the first"},{"speaker":"Charles Goldfarb","startTime":1584.494,"endTime":1588.301,"body":"author in a paper I wrote with"},{"speaker":"Charles Goldfarb","startTime":1584.494,"endTime":1588.301,"body":"Don Bae from Boston, sharing our"},{"speaker":"Charles Goldfarb","startTime":1588.362,"endTime":1591.927,"body":"experience with intra articular"},{"speaker":"Charles Goldfarb","startTime":1588.362,"endTime":1591.927,"body":"radial head fractures. very"},{"speaker":"Charles Goldfarb","startTime":1591.988,"endTime":1595.614,"body":"uncommon. But we had noticed a"},{"speaker":"Charles Goldfarb","startTime":1591.988,"endTime":1595.614,"body":"trend of catastrophic results"},{"speaker":"Charles Goldfarb","startTime":1595.674,"endTime":1599.421,"body":"when those radial head fractures"},{"speaker":"Charles Goldfarb","startTime":1595.674,"endTime":1599.421,"body":"were underestimated. So wrote"},{"speaker":"Charles Goldfarb","startTime":1599.481,"endTime":1603.289,"body":"about it. And I really think it"},{"speaker":"Charles Goldfarb","startTime":1599.481,"endTime":1603.289,"body":"was 2012. It was published. And"},{"speaker":"Charles Goldfarb","startTime":1603.349,"endTime":1607.096,"body":"it was one of those deals saying"},{"speaker":"Charles Goldfarb","startTime":1603.349,"endTime":1607.096,"body":"exactly the thing is this, it"},{"speaker":"Charles Goldfarb","startTime":1607.156,"endTime":1611.024,"body":"didn't feel that impactful, rare"},{"speaker":"Charles Goldfarb","startTime":1607.156,"endTime":1611.024,"body":"situation. But what's happened,"},{"speaker":"Charles Goldfarb","startTime":1611.084,"endTime":1614.771,"body":"and I reviewed the literature,"},{"speaker":"Charles Goldfarb","startTime":1611.084,"endTime":1614.771,"body":"because I had to present on it"},{"speaker":"Charles Goldfarb","startTime":1614.831,"endTime":1618.638,"body":"recently is there's been a lot"},{"speaker":"Charles Goldfarb","startTime":1614.831,"endTime":1618.638,"body":"more work done in that area, and"},{"speaker":"Charles Goldfarb","startTime":1618.699,"endTime":1622.446,"body":"an increased recognition of the"},{"speaker":"Charles Goldfarb","startTime":1618.699,"endTime":1622.446,"body":"danger of that fracture, which"},{"speaker":"Charles Goldfarb","startTime":1622.506,"endTime":1626.253,"body":"felt really good. It felt really"},{"speaker":"Charles Goldfarb","startTime":1622.506,"endTime":1626.253,"body":"good. And maybe this, this is"},{"speaker":"Charles Goldfarb","startTime":1626.313,"endTime":1629.697,"body":"something similar. But the"},{"speaker":"Charles Goldfarb","startTime":1626.313,"endTime":1629.697,"body":"message here is, if you see a"},{"speaker":"Charles Goldfarb","startTime":1629.758,"endTime":1632.78,"body":"clinical problem, others are"},{"speaker":"Charles Goldfarb","startTime":1629.758,"endTime":1632.78,"body":"seeing it too, right?"},{"speaker":"Chris Dy","startTime":1633.14,"endTime":1634.7,"body":"I mean, because you've"},{"speaker":"Chris Dy","startTime":1633.14,"endTime":1634.7,"body":"seen 12 of them in your case"},{"speaker":"Chris Dy","startTime":1634.7,"endTime":1637.64,"body":"series, you've seen 10 More,"},{"speaker":"Chris Dy","startTime":1634.7,"endTime":1637.64,"body":"multiply that by the number of"},{"speaker":"Chris Dy","startTime":1637.64,"endTime":1641.09,"body":"people that are out there, and"},{"speaker":"Chris Dy","startTime":1637.64,"endTime":1641.09,"body":"you know, so I'm glad that I'm"},{"speaker":"Chris Dy","startTime":1641.09,"endTime":1644.63,"body":"sure this has seen me, but I"},{"speaker":"Chris Dy","startTime":1641.09,"endTime":1644.63,"body":"have not seen it. And it's"},{"speaker":"Chris Dy","startTime":1644.63,"endTime":1646.19,"body":"probably seen a lot of other"},{"speaker":"Chris Dy","startTime":1644.63,"endTime":1646.19,"body":"people in practice"},{"speaker":"Charles Goldfarb","startTime":1646.19,"endTime":1649.079,"body":"Yeah, I assume"},{"speaker":"Charles Goldfarb","startTime":1646.19,"endTime":1649.079,"body":"so. So our approach with this"},{"speaker":"Charles Goldfarb","startTime":1649.144,"endTime":1653.215,"body":"patient was more therapy under"},{"speaker":"Charles Goldfarb","startTime":1649.144,"endTime":1653.215,"body":"more close therapy guidance. So"},{"speaker":"Charles Goldfarb","startTime":1653.281,"endTime":1657.286,"body":"go into therapy twice a week,"},{"speaker":"Charles Goldfarb","startTime":1653.281,"endTime":1657.286,"body":"which is no easy thing. I mean,"},{"speaker":"Charles Goldfarb","startTime":1657.352,"endTime":1661.554,"body":"the more I when I when I talk to"},{"speaker":"Charles Goldfarb","startTime":1657.352,"endTime":1661.554,"body":"families about copays, and it's"},{"speaker":"Charles Goldfarb","startTime":1661.62,"endTime":1665.428,"body":"unbelievable. I mean, there's"},{"speaker":"Charles Goldfarb","startTime":1661.62,"endTime":1665.428,"body":"some patients who have 75 to"},{"speaker":"Charles Goldfarb","startTime":1665.494,"endTime":1669.565,"body":"$100 copay is to see me and 50"},{"speaker":"Charles Goldfarb","startTime":1665.494,"endTime":1669.565,"body":"to $75 copay see the therapist,"},{"speaker":"Charles Goldfarb","startTime":1669.63,"endTime":1673.373,"body":"and you're asking him to go"},{"speaker":"Charles Goldfarb","startTime":1669.63,"endTime":1673.373,"body":"twice a week. No one everyone"},{"speaker":"Charles Goldfarb","startTime":1673.439,"endTime":1677.51,"body":"flinches at that. But I still"},{"speaker":"Charles Goldfarb","startTime":1673.439,"endTime":1677.51,"body":"think in this situation with the"},{"speaker":"Charles Goldfarb","startTime":1677.575,"endTime":1680.99,"body":"hope to avoid surgery, it was"},{"speaker":"Charles Goldfarb","startTime":1677.575,"endTime":1680.99,"body":"the right thing to do."},{"speaker":"Chris Dy","startTime":1681.44,"endTime":1684.53,"body":"Yeah, absolutely. I,"},{"speaker":"Chris Dy","startTime":1681.44,"endTime":1684.53,"body":"when I'm debating whether to"},{"speaker":"Chris Dy","startTime":1684.53,"endTime":1687.05,"body":"continue therapy, I ask them, Is"},{"speaker":"Chris Dy","startTime":1684.53,"endTime":1687.05,"body":"it convenient? Does it cost a"},{"speaker":"Chris Dy","startTime":1687.05,"endTime":1689.87,"body":"lot? And it's, you can tell the"},{"speaker":"Chris Dy","startTime":1687.05,"endTime":1689.87,"body":"people that don't mind going"},{"speaker":"Chris Dy","startTime":1689.87,"endTime":1692.87,"body":"because it's close to home, and"},{"speaker":"Chris Dy","startTime":1689.87,"endTime":1692.87,"body":"there's no out of pocket? But"},{"speaker":"Chris Dy","startTime":1692.9,"endTime":1694.79,"body":"you know, for other people,"},{"speaker":"Chris Dy","startTime":1692.9,"endTime":1694.79,"body":"clearly, it's something that we"},{"speaker":"Chris Dy","startTime":1694.79,"endTime":1697.49,"body":"need to consider. Well, is there"},{"speaker":"Chris Dy","startTime":1694.79,"endTime":1697.49,"body":"any thought to Botox in the"},{"speaker":"Chris Dy","startTime":1697.49,"endTime":1697.97,"body":"biceps"},{"speaker":"Charles Goldfarb","startTime":1697.49,"endTime":1700.236,"body":"Yeah, great"},{"speaker":"Charles Goldfarb","startTime":1697.49,"endTime":1700.236,"body":"question. There was thought I"},{"speaker":"Charles Goldfarb","startTime":1700.303,"endTime":1704.524,"body":"haven't done that yet. I think"},{"speaker":"Charles Goldfarb","startTime":1700.303,"endTime":1704.524,"body":"it's it's in play. Obviously, in"},{"speaker":"Charles Goldfarb","startTime":1704.591,"endTime":1708.275,"body":"an active kid, where you might"},{"speaker":"Charles Goldfarb","startTime":1704.591,"endTime":1708.275,"body":"get six months of biceps"},{"speaker":"Charles Goldfarb","startTime":1708.342,"endTime":1712.094,"body":"dysfunction might not be the"},{"speaker":"Charles Goldfarb","startTime":1708.342,"endTime":1712.094,"body":"ideal approach. But it's in"},{"speaker":"Charles Goldfarb","startTime":1712.161,"endTime":1715.845,"body":"play. Because if you ended up"},{"speaker":"Charles Goldfarb","startTime":1712.161,"endTime":1715.845,"body":"doing if you end up doing"},{"speaker":"Charles Goldfarb","startTime":1715.912,"endTime":1720.065,"body":"therapy for a couple of months,"},{"speaker":"Charles Goldfarb","startTime":1715.912,"endTime":1720.065,"body":"and then surgery and recovery,"},{"speaker":"Charles Goldfarb","startTime":1720.132,"endTime":1724.286,"body":"you're at six months anyways."},{"speaker":"Charles Goldfarb","startTime":1720.132,"endTime":1724.286,"body":"And so it's a really interesting"},{"speaker":"Charles Goldfarb","startTime":1724.353,"endTime":1727.1,"body":"thought. And I think it's a fair"},{"speaker":"Charles Goldfarb","startTime":1724.353,"endTime":1727.1,"body":"thought."},{"speaker":"Chris Dy","startTime":1727.1,"endTime":1729.718,"body":"I mean, you still have"},{"speaker":"Chris Dy","startTime":1727.1,"endTime":1729.718,"body":"your brachialis and your BR that"},{"speaker":"Chris Dy","startTime":1729.766,"endTime":1732.479,"body":"are going to help flex the"},{"speaker":"Chris Dy","startTime":1729.766,"endTime":1732.479,"body":"elbow. So I mean, I don't know"},{"speaker":"Chris Dy","startTime":1732.527,"endTime":1735.431,"body":"if it'd be a complete loss of"},{"speaker":"Chris Dy","startTime":1732.527,"endTime":1735.431,"body":"elbow flexion. But it certainly"},{"speaker":"Chris Dy","startTime":1735.479,"endTime":1738.05,"body":"would help the home team in"},{"speaker":"Chris Dy","startTime":1735.479,"endTime":1738.05,"body":"terms of your goals. Yeah,"},{"speaker":"Charles Goldfarb","startTime":1738.35,"endTime":1741.26,"body":"it's just it"},{"speaker":"Charles Goldfarb","startTime":1738.35,"endTime":1741.26,"body":"to your point. Yeah, I don't"},{"speaker":"Charles Goldfarb","startTime":1741.26,"endTime":1743.57,"body":"think she could could get back"},{"speaker":"Charles Goldfarb","startTime":1741.26,"endTime":1743.57,"body":"to gymnastics without her"},{"speaker":"Charles Goldfarb","startTime":1743.57,"endTime":1748.73,"body":"biceps. But if it allowed you to"},{"speaker":"Charles Goldfarb","startTime":1743.57,"endTime":1748.73,"body":"kind of stop this process, then"},{"speaker":"Charles Goldfarb","startTime":1748.76,"endTime":1750.02,"body":"it would be a huge win."},{"speaker":"Chris Dy","startTime":1750.89,"endTime":1753.32,"body":"So what do you what do"},{"speaker":"Chris Dy","startTime":1750.89,"endTime":1753.32,"body":"you do? You've tried to therapy?"},{"speaker":"Chris Dy","startTime":1754.1,"endTime":1756.74,"body":"I'm guessing this is leading"},{"speaker":"Chris Dy","startTime":1754.1,"endTime":1756.74,"body":"towards a surgical case, but"},{"speaker":"Chris Dy","startTime":1756.74,"endTime":1759.08,"body":"were you able to salvage it with"},{"speaker":"Chris Dy","startTime":1756.74,"endTime":1759.08,"body":"all of your non operative"},{"speaker":"Chris Dy","startTime":1759.08,"endTime":1760.91,"body":"efforts? No,"},{"speaker":"Charles Goldfarb","startTime":1760.97,"endTime":1762.95,"body":"and I don't"},{"speaker":"Charles Goldfarb","startTime":1760.97,"endTime":1762.95,"body":"know how successful in general"},{"speaker":"Charles Goldfarb","startTime":1762.95,"endTime":1768.41,"body":"we've been with therapy. So we"},{"speaker":"Charles Goldfarb","startTime":1762.95,"endTime":1768.41,"body":"ended up we did go the operating"},{"speaker":"Charles Goldfarb","startTime":1768.41,"endTime":1774.11,"body":"room. Actually, a little while"},{"speaker":"Charles Goldfarb","startTime":1768.41,"endTime":1774.11,"body":"back I had to the exact same"},{"speaker":"Charles Goldfarb","startTime":1774.11,"endTime":1777.47,"body":"patient back to back in the or"},{"speaker":"Charles Goldfarb","startTime":1774.11,"endTime":1777.47,"body":"same exact case. So medial EPA"},{"speaker":"Charles Goldfarb","startTime":1777.47,"endTime":1780.26,"body":"condo, what I was calling a non"},{"speaker":"Charles Goldfarb","startTime":1777.47,"endTime":1780.26,"body":"union, but I don't think that"},{"speaker":"Charles Goldfarb","startTime":1780.26,"endTime":1783.35,"body":"was the primary issue. I just"},{"speaker":"Charles Goldfarb","startTime":1780.26,"endTime":1783.35,"body":"don't think I can go the or and"},{"speaker":"Charles Goldfarb","startTime":1783.35,"endTime":1786.32,"body":"not address the medial"},{"speaker":"Charles Goldfarb","startTime":1783.35,"endTime":1786.32,"body":"epicondyle while I'm addressing"},{"speaker":"Charles Goldfarb","startTime":1786.32,"endTime":1789.65,"body":"the owner. So concept was treat"},{"speaker":"Charles Goldfarb","startTime":1786.32,"endTime":1789.65,"body":"the middle upper condyle non"},{"speaker":"Charles Goldfarb","startTime":1789.65,"endTime":1791.96,"body":"union and transpose thinner."},{"speaker":"Chris Dy","startTime":1792.71,"endTime":1796.19,"body":"So what do you what do"},{"speaker":"Chris Dy","startTime":1792.71,"endTime":1796.19,"body":"you tell the family about what"},{"speaker":"Chris Dy","startTime":1796.19,"endTime":1799.76,"body":"to expect in terms of you know,"},{"speaker":"Chris Dy","startTime":1796.19,"endTime":1799.76,"body":"this is a nerve thing now in"},{"speaker":"Chris Dy","startTime":1800.0,"endTime":1803.27,"body":"were suspecting that there is"},{"speaker":"Chris Dy","startTime":1800.0,"endTime":1803.27,"body":"this is essentially an ulnar"},{"speaker":"Chris Dy","startTime":1803.27,"endTime":1807.92,"body":"neuritis in the setting of a"},{"speaker":"Chris Dy","startTime":1803.27,"endTime":1807.92,"body":"recent medial elbow bony injury."},{"speaker":"Chris Dy","startTime":1808.19,"endTime":1812.39,"body":"And a neuritis is driving some"},{"speaker":"Chris Dy","startTime":1808.19,"endTime":1812.39,"body":"kind of guarding type reaction"},{"speaker":"Chris Dy","startTime":1812.39,"endTime":1814.94,"body":"that's causing co contraction of"},{"speaker":"Chris Dy","startTime":1812.39,"endTime":1814.94,"body":"the biceps and the triceps. Is"},{"speaker":"Chris Dy","startTime":1814.94,"endTime":1818.24,"body":"that accurate? So yeah, what"},{"speaker":"Chris Dy","startTime":1814.94,"endTime":1818.24,"body":"well said exactly. So then what"},{"speaker":"Chris Dy","startTime":1818.24,"endTime":1820.91,"body":"do you tell him what we're going"},{"speaker":"Chris Dy","startTime":1818.24,"endTime":1820.91,"body":"to do in terms of how to address"},{"speaker":"Chris Dy","startTime":1820.91,"endTime":1822.89,"body":"the nonunion? And what you're"},{"speaker":"Chris Dy","startTime":1820.91,"endTime":1822.89,"body":"going to do with the nerve?"},{"speaker":"Chris Dy","startTime":1822.89,"endTime":1827.03,"body":"Sounds like you're gonna go for"},{"speaker":"Chris Dy","startTime":1822.89,"endTime":1827.03,"body":"some kind of transposition, not"},{"speaker":"Chris Dy","startTime":1827.03,"endTime":1829.04,"body":"just a decompression load,"},{"speaker":"Chris Dy","startTime":1827.03,"endTime":1829.04,"body":"right? Yeah,"},{"speaker":"Charles Goldfarb","startTime":1829.07,"endTime":1831.62,"body":"definitely."},{"speaker":"Charles Goldfarb","startTime":1829.07,"endTime":1831.62,"body":"Again, the young patients, I"},{"speaker":"Charles Goldfarb","startTime":1831.62,"endTime":1834.59,"body":"don't believe in terms in"},{"speaker":"Charles Goldfarb","startTime":1831.62,"endTime":1834.59,"body":"decompressions, I tell the"},{"speaker":"Charles Goldfarb","startTime":1834.59,"endTime":1838.31,"body":"family three things. One, we're"},{"speaker":"Charles Goldfarb","startTime":1834.59,"endTime":1838.31,"body":"going to transpose the nerve."},{"speaker":"Charles Goldfarb","startTime":1838.31,"endTime":1842.27,"body":"And I think that's the critical"},{"speaker":"Charles Goldfarb","startTime":1838.31,"endTime":1842.27,"body":"step of this procedure to we"},{"speaker":"Charles Goldfarb","startTime":1842.27,"endTime":1845.75,"body":"should fix the medial Appa"},{"speaker":"Charles Goldfarb","startTime":1842.27,"endTime":1845.75,"body":"condo. And we can talk about"},{"speaker":"Charles Goldfarb","startTime":1845.75,"endTime":1849.41,"body":"that. And then lastly, I always"},{"speaker":"Charles Goldfarb","startTime":1845.75,"endTime":1849.41,"body":"discussed the possibility of a"},{"speaker":"Charles Goldfarb","startTime":1849.41,"endTime":1852.83,"body":"joint release. Because if there"},{"speaker":"Charles Goldfarb","startTime":1849.41,"endTime":1852.83,"body":"had now you know, by the time he"},{"speaker":"Charles Goldfarb","startTime":1852.83,"endTime":1857.03,"body":"gets the oarsmen three to four"},{"speaker":"Charles Goldfarb","startTime":1852.83,"endTime":1857.03,"body":"months. And thankfully, what"},{"speaker":"Charles Goldfarb","startTime":1857.03,"endTime":1859.55,"body":"I've met, what I have seen"},{"speaker":"Charles Goldfarb","startTime":1857.03,"endTime":1859.55,"body":"happen is the patient goes to"},{"speaker":"Charles Goldfarb","startTime":1859.55,"endTime":1864.8,"body":"sleep, maybe things are a little"},{"speaker":"Charles Goldfarb","startTime":1859.55,"endTime":1864.8,"body":"bit better for motion. But then"},{"speaker":"Charles Goldfarb","startTime":1864.8,"endTime":1869.81,"body":"once you get in there, and you"},{"speaker":"Charles Goldfarb","startTime":1864.8,"endTime":1869.81,"body":"deal with some of the scar"},{"speaker":"Charles Goldfarb","startTime":1869.81,"endTime":1872.93,"body":"tissue that is, is kind of the"},{"speaker":"Charles Goldfarb","startTime":1869.81,"endTime":1872.93,"body":"reason I brought to UCL is a"},{"speaker":"Charles Goldfarb","startTime":1872.93,"endTime":1876.38,"body":"very similar pathology, there's"},{"speaker":"Charles Goldfarb","startTime":1872.93,"endTime":1876.38,"body":"a lot of scarring, there's a lot"},{"speaker":"Charles Goldfarb","startTime":1876.38,"endTime":1880.97,"body":"of hyperemia, and you work to"},{"speaker":"Charles Goldfarb","startTime":1876.38,"endTime":1880.97,"body":"transpose the nerve. And even"},{"speaker":"Charles Goldfarb","startTime":1880.97,"endTime":1884.36,"body":"before you fix the fracture"},{"speaker":"Charles Goldfarb","startTime":1880.97,"endTime":1884.36,"body":"motion is better, it may not be"},{"speaker":"Charles Goldfarb","startTime":1884.36,"endTime":1888.14,"body":"perfect, because I do think"},{"speaker":"Charles Goldfarb","startTime":1884.36,"endTime":1888.14,"body":"muscle tightness develops that"},{"speaker":"Charles Goldfarb","startTime":1888.14,"endTime":1891.2,"body":"don't believe this is typically"},{"speaker":"Charles Goldfarb","startTime":1888.14,"endTime":1891.2,"body":"a joint contracture. And if we"},{"speaker":"Charles Goldfarb","startTime":1891.2,"endTime":1894.23,"body":"can get them closed, I have to I"},{"speaker":"Charles Goldfarb","startTime":1891.2,"endTime":1894.23,"body":"have faith that therapy can get"},{"speaker":"Charles Goldfarb","startTime":1894.23,"endTime":1895.07,"body":"them all the way back."},{"speaker":"Chris Dy","startTime":1895.94,"endTime":1900.05,"body":"Yeah, no, I think"},{"speaker":"Chris Dy","startTime":1895.94,"endTime":1900.05,"body":"that's that's my experience with"},{"speaker":"Chris Dy","startTime":1900.05,"endTime":1905.39,"body":"this is limited, but you know,"},{"speaker":"Chris Dy","startTime":1900.05,"endTime":1905.39,"body":"I've found that it's typically"},{"speaker":"Chris Dy","startTime":1905.39,"endTime":1908.93,"body":"once you've addressed everything"},{"speaker":"Chris Dy","startTime":1905.39,"endTime":1908.93,"body":"else, in this timeline, there"},{"speaker":"Chris Dy","startTime":1908.93,"endTime":1910.46,"body":"isn't gonna be a lot of"},{"speaker":"Chris Dy","startTime":1908.93,"endTime":1910.46,"body":"contracts. I mean, what do you"},{"speaker":"Chris Dy","startTime":1910.46,"endTime":1913.31,"body":"think ends up being the type"},{"speaker":"Chris Dy","startTime":1910.46,"endTime":1913.31,"body":"thing that limits elbow"},{"speaker":"Chris Dy","startTime":1913.31,"endTime":1915.11,"body":"extension? I"},{"speaker":"Charles Goldfarb","startTime":1915.11,"endTime":1918.65,"body":"think it's the"},{"speaker":"Charles Goldfarb","startTime":1915.11,"endTime":1918.65,"body":"biceps. And I think there's some"},{"speaker":"Charles Goldfarb","startTime":1919.76,"endTime":1924.32,"body":"contracture of the muscle fibers"},{"speaker":"Charles Goldfarb","startTime":1919.76,"endTime":1924.32,"body":"that just need to be stretched"},{"speaker":"Charles Goldfarb","startTime":1924.32,"endTime":1926.9,"body":"out over time. And whether or"},{"speaker":"Charles Goldfarb","startTime":1924.32,"endTime":1926.9,"body":"not there truly is a joint"},{"speaker":"Charles Goldfarb","startTime":1926.9,"endTime":1929.54,"body":"component. I don't know we have"},{"speaker":"Charles Goldfarb","startTime":1926.9,"endTime":1929.54,"body":"done joint releases. And they've"},{"speaker":"Charles Goldfarb","startTime":1929.54,"endTime":1933.23,"body":"been very unsatisfying in this"},{"speaker":"Charles Goldfarb","startTime":1929.54,"endTime":1933.23,"body":"in this situation. And so I do"},{"speaker":"Charles Goldfarb","startTime":1933.23,"endTime":1935.63,"body":"think it's muscular and that's"},{"speaker":"Charles Goldfarb","startTime":1933.23,"endTime":1935.63,"body":"why I think therapy can make a"},{"speaker":"Charles Goldfarb","startTime":1935.63,"endTime":1939.02,"body":"difference in therapy can be"},{"speaker":"Charles Goldfarb","startTime":1935.63,"endTime":1939.02,"body":"effective once you've removed"},{"speaker":"Charles Goldfarb","startTime":1939.02,"endTime":1940.52,"body":"the pain generator, which is the"},{"speaker":"Charles Goldfarb","startTime":1939.02,"endTime":1940.52,"body":"nerve."},{"speaker":"Chris Dy","startTime":1940.91,"endTime":1944.21,"body":"So clean up the non"},{"speaker":"Chris Dy","startTime":1940.91,"endTime":1944.21,"body":"union, what a single screw like"},{"speaker":"Chris Dy","startTime":1944.21,"endTime":1945.92,"body":"what are you doing some fancy"},{"speaker":"Chris Dy","startTime":1944.21,"endTime":1945.92,"body":"Yeah,"},{"speaker":"Charles Goldfarb","startTime":1945.98,"endTime":1948.41,"body":"and I know if"},{"speaker":"Charles Goldfarb","startTime":1945.98,"endTime":1948.41,"body":"any listeners have different"},{"speaker":"Charles Goldfarb","startTime":1948.41,"endTime":1952.22,"body":"thoughts, I would welcome them."},{"speaker":"Charles Goldfarb","startTime":1948.41,"endTime":1952.22,"body":"What we have done here is we the"},{"speaker":"Charles Goldfarb","startTime":1952.22,"endTime":1955.49,"body":"patient is supine, which you"},{"speaker":"Charles Goldfarb","startTime":1952.22,"endTime":1955.49,"body":"know a lot of people prefer a"},{"speaker":"Charles Goldfarb","startTime":1955.49,"endTime":1959.15,"body":"prone position for acute medial"},{"speaker":"Charles Goldfarb","startTime":1955.49,"endTime":1959.15,"body":"epicondyle fractures. I"},{"speaker":"Charles Goldfarb","startTime":1959.15,"endTime":1963.44,"body":"typically do them all supine, I"},{"speaker":"Charles Goldfarb","startTime":1959.15,"endTime":1963.44,"body":"make a small incision anteriorly"},{"speaker":"Charles Goldfarb","startTime":1963.71,"endTime":1966.44,"body":"use or for your elevator in the"},{"speaker":"Charles Goldfarb","startTime":1963.71,"endTime":1966.44,"body":"mini CRM to identify the non"},{"speaker":"Charles Goldfarb","startTime":1966.44,"endTime":1970.64,"body":"union make a small incision,"},{"speaker":"Charles Goldfarb","startTime":1966.44,"endTime":1970.64,"body":"charrette, the what is the"},{"speaker":"Charles Goldfarb","startTime":1970.64,"endTime":1974.45,"body":"hypothesis or what we may call"},{"speaker":"Charles Goldfarb","startTime":1970.64,"endTime":1974.45,"body":"the growth plate as it is"},{"speaker":"Charles Goldfarb","startTime":1974.45,"endTime":1976.55,"body":"closing because that's what's"},{"speaker":"Charles Goldfarb","startTime":1974.45,"endTime":1976.55,"body":"happening here, the both plate"},{"speaker":"Charles Goldfarb","startTime":1976.55,"endTime":1979.82,"body":"is closing as a weak point to"},{"speaker":"Charles Goldfarb","startTime":1976.55,"endTime":1979.82,"body":"fracture. And then I take a"},{"speaker":"Charles Goldfarb","startTime":1979.82,"endTime":1982.34,"body":"little destroyers bone graft, I"},{"speaker":"Charles Goldfarb","startTime":1979.82,"endTime":1982.34,"body":"pack it in, and I put a"},{"speaker":"Charles Goldfarb","startTime":1982.34,"endTime":1987.65,"body":"cannulated screw. And that part"},{"speaker":"Charles Goldfarb","startTime":1982.34,"endTime":1987.65,"body":"is generally insight to not"},{"speaker":"Charles Goldfarb","startTime":1987.65,"endTime":1991.28,"body":"necessarily trying to reduce it."},{"speaker":"Charles Goldfarb","startTime":1987.65,"endTime":1991.28,"body":"Because typically, these are not"},{"speaker":"Charles Goldfarb","startTime":1991.28,"endTime":1992.81,"body":"wildly displaced. You"},{"speaker":"Chris Dy","startTime":1992.81,"endTime":1994.73,"body":"need the bone graft"},{"speaker":"Chris Dy","startTime":1992.81,"endTime":1994.73,"body":"always there. Do you? Can you do"},{"speaker":"Chris Dy","startTime":1994.73,"endTime":1997.85,"body":"you think that you? This is a"},{"speaker":"Chris Dy","startTime":1994.73,"endTime":1997.85,"body":"fracture that it hasn't healed?"},{"speaker":"Chris Dy","startTime":1997.85,"endTime":2000.94,"body":"Because of lack of any sort of"},{"speaker":"Chris Dy","startTime":1997.85,"endTime":2000.94,"body":"stability? Not necessarily"},{"speaker":"Chris Dy","startTime":2000.94,"endTime":2003.58,"body":"biology? I'm assuming? Or is"},{"speaker":"Chris Dy","startTime":2000.94,"endTime":2003.58,"body":"that that's kind of how I think"},{"speaker":"Chris Dy","startTime":2003.58,"endTime":2006.31,"body":"about nonunions. In general, is"},{"speaker":"Chris Dy","startTime":2003.58,"endTime":2006.31,"body":"that different for the prophecy"},{"speaker":"Chris Dy","startTime":2006.34,"endTime":2007.0,"body":"type fracture?"},{"speaker":"Charles Goldfarb","startTime":2007.0,"endTime":2009.301,"body":"Yeah, these"},{"speaker":"Charles Goldfarb","startTime":2007.0,"endTime":2009.301,"body":"are fibrous unions. So I don't"},{"speaker":"Charles Goldfarb","startTime":2009.356,"endTime":2012.424,"body":"know that we have to fix them."},{"speaker":"Charles Goldfarb","startTime":2009.356,"endTime":2012.424,"body":"But I feel like we should"},{"speaker":"Charles Goldfarb","startTime":2012.479,"endTime":2015.876,"body":"because we would hate to have to"},{"speaker":"Charles Goldfarb","startTime":2012.479,"endTime":2015.876,"body":"do another surgery. And we're"},{"speaker":"Charles Goldfarb","startTime":2015.93,"endTime":2019.218,"body":"not adding much to the surgical"},{"speaker":"Charles Goldfarb","startTime":2015.93,"endTime":2019.218,"body":"intervention is one of those"},{"speaker":"Charles Goldfarb","startTime":2019.273,"endTime":2022.67,"body":"which is sort of lame, the way I"},{"speaker":"Charles Goldfarb","startTime":2019.273,"endTime":2022.67,"body":"just said it. But But I think"},{"speaker":"Charles Goldfarb","startTime":2022.725,"endTime":2024.04,"body":"it's the right approach."},{"speaker":"Chris Dy","startTime":2024.34,"endTime":2028.15,"body":"I do enjoy heckling"},{"speaker":"Chris Dy","startTime":2024.34,"endTime":2028.15,"body":"the trainee, I mean, encouraging"},{"speaker":"Chris Dy","startTime":2028.15,"endTime":2029.8,"body":"the trainee as they're"},{"speaker":"Chris Dy","startTime":2028.15,"endTime":2029.8,"body":"harvesting disarrayed"},{"speaker":"Chris Dy","startTime":2029.8,"endTime":2032.74,"body":"histographs. So that was one of"},{"speaker":"Chris Dy","startTime":2029.8,"endTime":2032.74,"body":"my favorite parts of the day,"},{"speaker":"Charles Goldfarb","startTime":2032.8,"endTime":2036.07,"body":"for sure. And"},{"speaker":"Charles Goldfarb","startTime":2032.8,"endTime":2036.07,"body":"what I've learned in these"},{"speaker":"Charles Goldfarb","startTime":2036.07,"endTime":2040.0,"body":"situations, you know, you want"},{"speaker":"Charles Goldfarb","startTime":2036.07,"endTime":2040.0,"body":"to harvest your bone graft from"},{"speaker":"Charles Goldfarb","startTime":2040.0,"endTime":2043.3,"body":"a location that is zero risk"},{"speaker":"Charles Goldfarb","startTime":2040.0,"endTime":2043.3,"body":"honestly, or as low risk as"},{"speaker":"Charles Goldfarb","startTime":2043.3,"endTime":2046.36,"body":"possible from either tendons"},{"speaker":"Charles Goldfarb","startTime":2043.3,"endTime":2046.36,"body":"being irritated or nerves being"},{"speaker":"Charles Goldfarb","startTime":2046.36,"endTime":2049.99,"body":"irritated. And then so I tend to"},{"speaker":"Charles Goldfarb","startTime":2046.36,"endTime":2049.99,"body":"come proximal to the open"},{"speaker":"Charles Goldfarb","startTime":2049.99,"endTime":2053.38,"body":"destroyers growth plate, I tend"},{"speaker":"Charles Goldfarb","startTime":2049.99,"endTime":2053.38,"body":"to sort of work over near the"},{"speaker":"Charles Goldfarb","startTime":2053.38,"endTime":2057.28,"body":"second compartment. And then"},{"speaker":"Charles Goldfarb","startTime":2053.38,"endTime":2057.28,"body":"sometimes you just don't find a"},{"speaker":"Charles Goldfarb","startTime":2057.28,"endTime":2058.21,"body":"lot of motivation."},{"speaker":"Chris Dy","startTime":2058.21,"endTime":2060.948,"body":"And I go, I go deep to"},{"speaker":"Chris Dy","startTime":2058.21,"endTime":2060.948,"body":"the second compartment, I think"},{"speaker":"Chris Dy","startTime":2060.999,"endTime":2064.245,"body":"because of the lessons that you"},{"speaker":"Chris Dy","startTime":2060.999,"endTime":2064.245,"body":"have, you and our other partners"},{"speaker":"Chris Dy","startTime":2064.296,"endTime":2067.542,"body":"have taught me. So we're radial,"},{"speaker":"Chris Dy","startTime":2064.296,"endTime":2067.542,"body":"your radial to Listers, we were"},{"speaker":"Chris Dy","startTime":2067.593,"endTime":2070.129,"body":"underneath the second"},{"speaker":"Chris Dy","startTime":2067.593,"endTime":2070.129,"body":"compartment. Because I don't"},{"speaker":"Chris Dy","startTime":2070.18,"endTime":2073.172,"body":"want to mess with anything"},{"speaker":"Chris Dy","startTime":2070.18,"endTime":2073.172,"body":"dealing with the EPL and putting"},{"speaker":"Chris Dy","startTime":2073.223,"endTime":2076.317,"body":"that at risk, then you know, you"},{"speaker":"Chris Dy","startTime":2073.223,"endTime":2076.317,"body":"tend to find enough and then"},{"speaker":"Chris Dy","startTime":2076.368,"endTime":2079.31,"body":"usually the attending finds"},{"speaker":"Chris Dy","startTime":2076.368,"endTime":2079.31,"body":"more. That's always a fun part"},{"speaker":"Chris Dy","startTime":2079.36,"endTime":2081.998,"body":"of it. So anyway, you've"},{"speaker":"Chris Dy","startTime":2079.36,"endTime":2081.998,"body":"stabilized the bone. You've"},{"speaker":"Chris Dy","startTime":2082.049,"endTime":2084.838,"body":"transposed the nerve at a"},{"speaker":"Chris Dy","startTime":2082.049,"endTime":2084.838,"body":"professional transposition, I"},{"speaker":"Chris Dy","startTime":2084.889,"endTime":2087.983,"body":"think is your go to. What's your"},{"speaker":"Chris Dy","startTime":2084.889,"endTime":2087.983,"body":"postdoc protocol for this is"},{"speaker":"Chris Dy","startTime":2088.034,"endTime":2091.28,"body":"different Are you splinting them"},{"speaker":"Chris Dy","startTime":2088.034,"endTime":2091.28,"body":"in extension, immediately after"},{"speaker":"Chris Dy","startTime":2091.331,"endTime":2094.526,"body":"surgery? Are you splitting them"},{"speaker":"Chris Dy","startTime":2091.331,"endTime":2094.526,"body":"at all you want to work on with"},{"speaker":"Chris Dy","startTime":2094.577,"endTime":2097.57,"body":"therapy Day Zero, day one, day"},{"speaker":"Chris Dy","startTime":2094.577,"endTime":2097.57,"body":"three. What's your protocol?"},{"speaker":"Charles Goldfarb","startTime":2097.63,"endTime":2100.09,"body":"Yeah,"},{"speaker":"Charles Goldfarb","startTime":2097.63,"endTime":2100.09,"body":"typically, you know, we It"},{"speaker":"Charles Goldfarb","startTime":2100.09,"endTime":2103.33,"body":"brings up a question which I'll"},{"speaker":"Charles Goldfarb","startTime":2100.09,"endTime":2103.33,"body":"circle back to, but I typically"},{"speaker":"Charles Goldfarb","startTime":2103.33,"endTime":2105.94,"body":"try to give them a period of"},{"speaker":"Charles Goldfarb","startTime":2103.33,"endTime":2105.94,"body":"rest different than my other"},{"speaker":"Charles Goldfarb","startTime":2105.94,"endTime":2109.0,"body":"nerves different than my older"},{"speaker":"Charles Goldfarb","startTime":2105.94,"endTime":2109.0,"body":"owner, other owners. So I"},{"speaker":"Charles Goldfarb","startTime":2109.0,"endTime":2111.97,"body":"typically splint them for a week"},{"speaker":"Charles Goldfarb","startTime":2109.0,"endTime":2111.97,"body":"or so and then have them start"},{"speaker":"Charles Goldfarb","startTime":2111.97,"endTime":2116.02,"body":"therapy without necessarily"},{"speaker":"Charles Goldfarb","startTime":2111.97,"endTime":2116.02,"body":"needing a splint after surgery,"},{"speaker":"Charles Goldfarb","startTime":2116.17,"endTime":2118.57,"body":"as long as I trust them."},{"speaker":"Charles Goldfarb","startTime":2116.17,"endTime":2118.57,"body":"Occasionally families want that"},{"speaker":"Charles Goldfarb","startTime":2118.57,"endTime":2122.05,"body":"split long arm split after"},{"speaker":"Charles Goldfarb","startTime":2118.57,"endTime":2122.05,"body":"surgery, but to get them moving."},{"speaker":"Charles Goldfarb","startTime":2122.08,"endTime":2124.18,"body":"And I think that period of rest"},{"speaker":"Charles Goldfarb","startTime":2122.08,"endTime":2124.18,"body":"can be helpful because I'm"},{"speaker":"Charles Goldfarb","startTime":2124.18,"endTime":2128.2,"body":"trying to break that cycle. And"},{"speaker":"Charles Goldfarb","startTime":2124.18,"endTime":2128.2,"body":"I think transposing the old"},{"speaker":"Charles Goldfarb","startTime":2128.2,"endTime":2131.74,"body":"nerve is part of breaking the"},{"speaker":"Charles Goldfarb","startTime":2128.2,"endTime":2131.74,"body":"cycle, but just, I'll take"},{"speaker":"Charles Goldfarb","startTime":2131.74,"endTime":2132.64,"body":"anything I can get."},{"speaker":"Chris Dy","startTime":2133.21,"endTime":2136.21,"body":"And then you're"},{"speaker":"Chris Dy","startTime":2133.21,"endTime":2136.21,"body":"splinting an extension. Yeah,"},{"speaker":"Charles Goldfarb","startTime":2136.24,"endTime":2139.15,"body":"I mean, if, if"},{"speaker":"Charles Goldfarb","startTime":2136.24,"endTime":2139.15,"body":"I was going to splint at the"},{"speaker":"Charles Goldfarb","startTime":2139.15,"endTime":2143.26,"body":"time of surgery, for a limited"},{"speaker":"Charles Goldfarb","startTime":2139.15,"endTime":2143.26,"body":"period of time, it would be an"},{"speaker":"Charles Goldfarb","startTime":2143.26,"endTime":2145.96,"body":"extension, it's always an"},{"speaker":"Charles Goldfarb","startTime":2143.26,"endTime":2145.96,"body":"extension when you have a"},{"speaker":"Charles Goldfarb","startTime":2145.96,"endTime":2149.38,"body":"flexion contracture. And again,"},{"speaker":"Charles Goldfarb","startTime":2145.96,"endTime":2149.38,"body":"this is a little different. So I"},{"speaker":"Charles Goldfarb","startTime":2149.38,"endTime":2153.55,"body":"don't feel that after splint an"},{"speaker":"Charles Goldfarb","startTime":2149.38,"endTime":2153.55,"body":"extension. And then going back"},{"speaker":"Charles Goldfarb","startTime":2153.55,"endTime":2157.09,"body":"to the point I previously made"},{"speaker":"Charles Goldfarb","startTime":2153.55,"endTime":2157.09,"body":"some question, you know, that"},{"speaker":"Charles Goldfarb","startTime":2157.09,"endTime":2160.06,"body":"hand surgeon perspective on"},{"speaker":"Charles Goldfarb","startTime":2157.09,"endTime":2160.06,"body":"these Peri articular, joint"},{"speaker":"Charles Goldfarb","startTime":2160.06,"endTime":2162.76,"body":"fractures and kids is getting"},{"speaker":"Charles Goldfarb","startTime":2160.06,"endTime":2162.76,"body":"moving, right? We don't want to"},{"speaker":"Charles Goldfarb","startTime":2162.76,"endTime":2166.21,"body":"stiff elbow, get them moving,"},{"speaker":"Charles Goldfarb","startTime":2162.76,"endTime":2166.21,"body":"the pediatric orthopedic surgeon"},{"speaker":"Charles Goldfarb","startTime":2166.21,"endTime":2170.65,"body":"perspective is shut them down"},{"speaker":"Charles Goldfarb","startTime":2166.21,"endTime":2170.65,"body":"for three, four weeks and then"},{"speaker":"Charles Goldfarb","startTime":2170.65,"endTime":2173.74,"body":"get them moving. And so"},{"speaker":"Charles Goldfarb","startTime":2170.65,"endTime":2173.74,"body":"sometimes I wonder whether"},{"speaker":"Charles Goldfarb","startTime":2173.8,"endTime":2178.81,"body":"trying to move kids early, which"},{"speaker":"Charles Goldfarb","startTime":2173.8,"endTime":2178.81,"body":"is always the trend can"},{"speaker":"Charles Goldfarb","startTime":2178.84,"endTime":2183.55,"body":"contribute to this nerve"},{"speaker":"Charles Goldfarb","startTime":2178.84,"endTime":2183.55,"body":"reactivity issue, and a slower"},{"speaker":"Charles Goldfarb","startTime":2183.55,"endTime":2185.92,"body":"approach might be beneficial,"},{"speaker":"Charles Goldfarb","startTime":2183.55,"endTime":2185.92,"body":"right."},{"speaker":"Chris Dy","startTime":2185.92,"endTime":2188.5,"body":"And an adolescent"},{"speaker":"Chris Dy","startTime":2185.92,"endTime":2188.5,"body":"elbow is different than an adult"},{"speaker":"Chris Dy","startTime":2188.5,"endTime":2192.16,"body":"elbow in terms of, you know,"},{"speaker":"Chris Dy","startTime":2188.5,"endTime":2192.16,"body":"predilection for stiffness for"},{"speaker":"Chris Dy","startTime":2192.16,"endTime":2195.43,"body":"developing a joint contracture,"},{"speaker":"Chris Dy","startTime":2192.16,"endTime":2195.43,"body":"especially if you've addressed"},{"speaker":"Chris Dy","startTime":2195.46,"endTime":2198.28,"body":"what you think was the"},{"speaker":"Chris Dy","startTime":2195.46,"endTime":2198.28,"body":"contributing cause to her"},{"speaker":"Chris Dy","startTime":2198.28,"endTime":2200.05,"body":"limited motion. Right,"},{"speaker":"Charles Goldfarb","startTime":2200.08,"endTime":2202.99,"body":"exactly,"},{"speaker":"Charles Goldfarb","startTime":2200.08,"endTime":2202.99,"body":"exactly. So we, you know,"},{"speaker":"Charles Goldfarb","startTime":2203.02,"endTime":2205.24,"body":"whether we splint or not for a"},{"speaker":"Charles Goldfarb","startTime":2203.02,"endTime":2205.24,"body":"brief period of time we start"},{"speaker":"Charles Goldfarb","startTime":2205.24,"endTime":2208.48,"body":"early therapy. And it's I"},{"speaker":"Charles Goldfarb","startTime":2205.24,"endTime":2208.48,"body":"wouldn't say these are like"},{"speaker":"Charles Goldfarb","startTime":2208.48,"endTime":2210.94,"body":"homeruns, immediately perfect"},{"speaker":"Charles Goldfarb","startTime":2208.48,"endTime":2210.94,"body":"motion. I think there is some"},{"speaker":"Charles Goldfarb","startTime":2210.94,"endTime":2214.84,"body":"work involved. But I think we,"},{"speaker":"Charles Goldfarb","startTime":2210.94,"endTime":2214.84,"body":"every time I've done this, we've"},{"speaker":"Charles Goldfarb","startTime":2214.84,"endTime":2219.22,"body":"seen clear gains, if not"},{"speaker":"Charles Goldfarb","startTime":2214.84,"endTime":2219.22,"body":"perfection, clear gains."},{"speaker":"Chris Dy","startTime":2219.79,"endTime":2222.55,"body":"So as we bring things"},{"speaker":"Chris Dy","startTime":2219.79,"endTime":2222.55,"body":"to a close, can you just"},{"speaker":"Chris Dy","startTime":2222.55,"endTime":2226.42,"body":"summarize for me how you think"},{"speaker":"Chris Dy","startTime":2222.55,"endTime":2226.42,"body":"these patients do overall sounds"},{"speaker":"Chris Dy","startTime":2226.42,"endTime":2229.66,"body":"like they do pretty well and"},{"speaker":"Chris Dy","startTime":2226.42,"endTime":2229.66,"body":"kind of what the arc of recovery"},{"speaker":"Chris Dy","startTime":2229.66,"endTime":2230.89,"body":"or the timeline looks like."},{"speaker":"Charles Goldfarb","startTime":2230.89,"endTime":2233.302,"body":"Yeah, one"},{"speaker":"Charles Goldfarb","startTime":2230.89,"endTime":2233.302,"body":"final point. And I'll answer"},{"speaker":"Charles Goldfarb","startTime":2233.365,"endTime":2236.793,"body":"that, that question. It's not"},{"speaker":"Charles Goldfarb","startTime":2233.365,"endTime":2236.793,"body":"always those treated non"},{"speaker":"Charles Goldfarb","startTime":2236.857,"endTime":2240.666,"body":"operatively. So some patients"},{"speaker":"Charles Goldfarb","startTime":2236.857,"endTime":2240.666,"body":"who have an ORIF of the medial"},{"speaker":"Charles Goldfarb","startTime":2240.729,"endTime":2244.538,"body":"epicondyle, acutely can develop"},{"speaker":"Charles Goldfarb","startTime":2240.729,"endTime":2244.538,"body":"this issue, which is sort of"},{"speaker":"Charles Goldfarb","startTime":2244.601,"endTime":2248.664,"body":"reinforces the the ulnar nerve,"},{"speaker":"Charles Goldfarb","startTime":2244.601,"endTime":2248.664,"body":"because, you know, almost no one"},{"speaker":"Charles Goldfarb","startTime":2248.728,"endTime":2252.346,"body":"transposes the ulnar nerve in"},{"speaker":"Charles Goldfarb","startTime":2248.728,"endTime":2252.346,"body":"that situation that they're"},{"speaker":"Charles Goldfarb","startTime":2252.409,"endTime":2255.837,"body":"fixing the medial lateral"},{"speaker":"Charles Goldfarb","startTime":2252.409,"endTime":2255.837,"body":"condyle. And I think is just"},{"speaker":"Charles Goldfarb","startTime":2255.901,"endTime":2259.71,"body":"that that precipitates more"},{"speaker":"Charles Goldfarb","startTime":2255.901,"endTime":2259.71,"body":"scarring. And so what's going on"},{"speaker":"Charles Goldfarb","startTime":2259.773,"endTime":2263.646,"body":"the ulnar nerve, it's not the"},{"speaker":"Charles Goldfarb","startTime":2259.773,"endTime":2263.646,"body":"fracture, it's the ulnar nerve."},{"speaker":"Charles Goldfarb","startTime":2263.709,"endTime":2267.708,"body":"And so I always and I encourage"},{"speaker":"Charles Goldfarb","startTime":2263.709,"endTime":2267.708,"body":"all listeners to always examine"},{"speaker":"Charles Goldfarb","startTime":2267.772,"endTime":2271.581,"body":"for the old learner, but not"},{"speaker":"Charles Goldfarb","startTime":2267.772,"endTime":2271.581,"body":"just once. So you do it at that"},{"speaker":"Charles Goldfarb","startTime":2271.644,"endTime":2275.453,"body":"two week or six week mark, and"},{"speaker":"Charles Goldfarb","startTime":2271.644,"endTime":2275.453,"body":"the owner may seem quiescent,"},{"speaker":"Charles Goldfarb","startTime":2275.516,"endTime":2276.85,"body":"but it'll change. And"},{"speaker":"Chris Dy","startTime":2277.0,"endTime":2278.83,"body":"how long does it take"},{"speaker":"Chris Dy","startTime":2277.0,"endTime":2278.83,"body":"people to get better after your"},{"speaker":"Chris Dy","startTime":2278.83,"endTime":2279.55,"body":"surgery think?"},{"speaker":"Charles Goldfarb","startTime":2280.54,"endTime":2283.75,"body":"I think three"},{"speaker":"Charles Goldfarb","startTime":2280.54,"endTime":2283.75,"body":"months and then things will"},{"speaker":"Charles Goldfarb","startTime":2283.78,"endTime":2286.39,"body":"maybe still improve a bit more,"},{"speaker":"Charles Goldfarb","startTime":2283.78,"endTime":2286.39,"body":"but you're pretty plateaued at"},{"speaker":"Charles Goldfarb","startTime":2286.39,"endTime":2287.02,"body":"three months."},{"speaker":"Chris Dy","startTime":2287.56,"endTime":2289.57,"body":"Okay, well, you know,"},{"speaker":"Chris Dy","startTime":2287.56,"endTime":2289.57,"body":"now that I've been thinking"},{"speaker":"Chris Dy","startTime":2289.57,"endTime":2294.01,"body":"about a prior case that I've"},{"speaker":"Chris Dy","startTime":2289.57,"endTime":2294.01,"body":"addressed with our partner David"},{"speaker":"Chris Dy","startTime":2294.01,"endTime":2298.75,"body":"Brogan actually had, I think she"},{"speaker":"Chris Dy","startTime":2294.01,"endTime":2298.75,"body":"was a late teenager early 20s."},{"speaker":"Chris Dy","startTime":2299.56,"endTime":2302.65,"body":"Very painful, medial inner"},{"speaker":"Chris Dy","startTime":2299.56,"endTime":2302.65,"body":"brachial continues through Roma,"},{"speaker":"Chris Dy","startTime":2302.65,"endTime":2305.05,"body":"who actually had a similar co"},{"speaker":"Chris Dy","startTime":2302.65,"endTime":2305.05,"body":"contraction situation of the"},{"speaker":"Chris Dy","startTime":2305.05,"endTime":2309.16,"body":"biceps and the triceps. And"},{"speaker":"Chris Dy","startTime":2305.05,"endTime":2309.16,"body":"David did a very elegant"},{"speaker":"Chris Dy","startTime":2309.55,"endTime":2313.3,"body":"neuroma, certain painful neuroma"},{"speaker":"Chris Dy","startTime":2309.55,"endTime":2313.3,"body":"surgery. And that situation was"},{"speaker":"Chris Dy","startTime":2313.3,"endTime":2315.34,"body":"fixed. And I think it's"},{"speaker":"Chris Dy","startTime":2313.3,"endTime":2315.34,"body":"analogous to what you're"},{"speaker":"Chris Dy","startTime":2315.34,"endTime":2318.76,"body":"describing. Now, we didn't go so"},{"speaker":"Chris Dy","startTime":2315.34,"endTime":2318.76,"body":"far as to publish it. It is on"},{"speaker":"Chris Dy","startTime":2318.76,"endTime":2322.54,"body":"our department website, patient"},{"speaker":"Chris Dy","startTime":2318.76,"endTime":2322.54,"body":"successful patient case series."},{"speaker":"Chris Dy","startTime":2322.87,"endTime":2326.5,"body":"So you can I guess we can we can"},{"speaker":"Chris Dy","startTime":2322.87,"endTime":2326.5,"body":"we can show that off. But that's"},{"speaker":"Chris Dy","startTime":2326.5,"endTime":2329.53,"body":"a great case. Thank you for"},{"speaker":"Chris Dy","startTime":2326.5,"endTime":2329.53,"body":"sharing that. And hopefully"},{"speaker":"Chris Dy","startTime":2329.53,"endTime":2332.62,"body":"people have, you know, will"},{"speaker":"Chris Dy","startTime":2329.53,"endTime":2332.62,"body":"learn from this or if you've"},{"speaker":"Chris Dy","startTime":2332.62,"endTime":2335.23,"body":"encountered this before, and you"},{"speaker":"Chris Dy","startTime":2332.62,"endTime":2335.23,"body":"have a similar different"},{"speaker":"Chris Dy","startTime":2335.23,"endTime":2338.65,"body":"experience. Let us know. Send us"},{"speaker":"Chris Dy","startTime":2335.23,"endTime":2338.65,"body":"an email and podcast@gmail.com"},{"speaker":"Chris Dy","startTime":2339.07,"endTime":2339.37,"body":"Yeah,"},{"speaker":"Charles Goldfarb","startTime":2339.4,"endTime":2341.83,"body":"I love that."},{"speaker":"Charles Goldfarb","startTime":2339.4,"endTime":2341.83,"body":"Have a good busy month of"},{"speaker":"Charles Goldfarb","startTime":2341.83,"endTime":2344.32,"body":"December and I look forward to"},{"speaker":"Charles Goldfarb","startTime":2341.83,"endTime":2344.32,"body":"catching up again soon."},{"speaker":"Chris Dy","startTime":2344.8,"endTime":2347.56,"body":"It is a day full of"},{"speaker":"Chris Dy","startTime":2344.8,"endTime":2347.56,"body":"activity. Take care."},{"speaker":"Charles Goldfarb","startTime":2349.27,"endTime":2351.25,"body":"Hey, Chris."},{"speaker":"Charles Goldfarb","startTime":2349.27,"endTime":2351.25,"body":"That was fun. Let's do it again"},{"speaker":"Charles Goldfarb","startTime":2351.25,"endTime":2351.76,"body":"real soon."},{"speaker":"Chris Dy","startTime":2351.76,"endTime":2354.345,"body":"Sounds good. Well, be"},{"speaker":"Chris Dy","startTime":2351.76,"endTime":2354.345,"body":"sure to check us out on Twitter"},{"speaker":"Chris Dy","startTime":2354.394,"endTime":2356.98,"body":"@handpodcast. Hey, Chuck, what's"},{"speaker":"Chris Dy","startTime":2354.394,"endTime":2356.98,"body":"your Twitter handle?"},{"speaker":"Charles Goldfarb","startTime":2356.98,"endTime":2360.16,"body":"Mine is"},{"speaker":"Charles Goldfarb","startTime":2356.98,"endTime":2360.16,"body":"@congenitalhand. What about you?"},{"speaker":"Chris Dy","startTime":2360.16,"endTime":2363.618,"body":"Mine is @ChrisDyMD"},{"speaker":"Chris Dy","startTime":2360.16,"endTime":2363.618,"body":"spelled d-y. And if you'd like"},{"speaker":"Chris Dy","startTime":2363.688,"endTime":2367.57,"body":"to email us, you can reach us at"},{"speaker":"Chris Dy","startTime":2363.688,"endTime":2367.57,"body":"handpodcast@gmail.com."},{"speaker":"Charles Goldfarb","startTime":2368.11,"endTime":2370.27,"body":"And remember,"},{"speaker":"Charles Goldfarb","startTime":2368.11,"endTime":2370.27,"body":"please subscribe wherever you"},{"speaker":"Charles Goldfarb","startTime":2370.27,"endTime":2371.68,"body":"get your podcast and be"},{"speaker":"Chris Dy","startTime":2371.68,"endTime":2373.99,"body":"sure to leave a review"},{"speaker":"Chris Dy","startTime":2371.68,"endTime":2373.99,"body":"that helps us get the word out."},{"speaker":"Charles Goldfarb","startTime":2374.38,"endTime":2376.69,"body":"Special thanks"},{"speaker":"Charles Goldfarb","startTime":2374.38,"endTime":2376.69,"body":"to Peter Martin for the amazing"},{"speaker":"Charles Goldfarb","startTime":2376.69,"endTime":2380.68,"body":"music. And remember, keep the"},{"speaker":"Charles Goldfarb","startTime":2376.69,"endTime":2380.68,"body":"upper hand. Come back next time"}]}