{"version":"1.0.0","segments":[{"speaker":"Charles Goldfarb","startTime":0.0,"endTime":7.14,"body":"Chuck, welcome"},{"speaker":"Charles Goldfarb","startTime":0.0,"endTime":7.14,"body":"to the upper hand podcast where"},{"speaker":"Charles Goldfarb","startTime":7.14,"endTime":8.88,"body":"Chuck and Chris talk hand"},{"speaker":"Charles Goldfarb","startTime":7.14,"endTime":8.88,"body":"surgery."},{"speaker":"Chris Dy","startTime":9.54,"endTime":11.46,"body":"We are two hand"},{"speaker":"Chris Dy","startTime":9.54,"endTime":11.46,"body":"surgeons at Washington"},{"speaker":"Chris Dy","startTime":11.46,"endTime":14.4,"body":"University in St Louis, here to"},{"speaker":"Chris Dy","startTime":11.46,"endTime":14.4,"body":"talk about all things hand"},{"speaker":"Chris Dy","startTime":14.4,"endTime":16.62,"body":"surgery related, from technical"},{"speaker":"Chris Dy","startTime":14.4,"endTime":16.62,"body":"to personal."},{"speaker":"Charles Goldfarb","startTime":17.16,"endTime":19.14,"body":"Please"},{"speaker":"Charles Goldfarb","startTime":17.16,"endTime":19.14,"body":"subscribe wherever you get your"},{"speaker":"Charles Goldfarb","startTime":19.14,"endTime":20.84,"body":"podcasts, and thank"},{"speaker":"Chris Dy","startTime":20.84,"endTime":23.54,"body":"you in advance for"},{"speaker":"Chris Dy","startTime":20.84,"endTime":23.54,"body":"leaving a review and rating that"},{"speaker":"Chris Dy","startTime":23.54,"endTime":26.0,"body":"helps us get the word out. You"},{"speaker":"Chris Dy","startTime":23.54,"endTime":26.0,"body":"can email us at"},{"speaker":"Chris Dy","startTime":26.0,"endTime":29.48,"body":"handpodcast@gmail.com so let's"},{"speaker":"Chris Dy","startTime":26.0,"endTime":29.48,"body":"get to the episode."},{"speaker":"Charles Goldfarb","startTime":30.5,"endTime":31.4,"body":"Oh, hey Chris,"},{"speaker":"Chris Dy","startTime":31.52,"endTime":32.36,"body":"Hey Chuck. How are"},{"speaker":"Chris Dy","startTime":31.52,"endTime":32.36,"body":"you?"},{"speaker":"Charles Goldfarb","startTime":32.36,"endTime":34.396,"body":"I'm great."},{"speaker":"Charles Goldfarb","startTime":32.36,"endTime":34.396,"body":"It's Saturday morning talking to"},{"speaker":"Charles Goldfarb","startTime":34.444,"endTime":35.96,"body":"you. What could be better? Yeah,"},{"speaker":"Chris Dy","startTime":36.32,"endTime":37.82,"body":"well, it could be"},{"speaker":"Chris Dy","startTime":36.32,"endTime":37.82,"body":"better for outside. It's"},{"speaker":"Chris Dy","startTime":37.82,"endTime":40.1,"body":"actually pretty nice morning,"},{"speaker":"Chris Dy","startTime":37.82,"endTime":40.1,"body":"from what I understand."},{"speaker":"Charles Goldfarb","startTime":40.28,"endTime":42.7,"body":"It was a nice"},{"speaker":"Charles Goldfarb","startTime":40.28,"endTime":42.7,"body":"morning. I had an early coffee,"},{"speaker":"Charles Goldfarb","startTime":42.88,"endTime":46.96,"body":"and now we're chatting and yeah,"},{"speaker":"Charles Goldfarb","startTime":42.88,"endTime":46.96,"body":"hopefully it's gonna be a great"},{"speaker":"Chris Dy","startTime":47.2,"endTime":49.36,"body":"day. I think it's a"},{"speaker":"Chris Dy","startTime":47.2,"endTime":49.36,"body":"nice reprieve from the triple"},{"speaker":"Chris Dy","startTime":49.36,"endTime":51.52,"body":"digit Fahrenheit weather we've"},{"speaker":"Chris Dy","startTime":49.36,"endTime":51.52,"body":"been having. I think this"},{"speaker":"Chris Dy","startTime":51.52,"endTime":54.7,"body":"weekend will be nice, but it's"},{"speaker":"Chris Dy","startTime":51.52,"endTime":54.7,"body":"back into the upper 90s and"},{"speaker":"Chris Dy","startTime":54.76,"endTime":56.5,"body":"close to 100 next week."},{"speaker":"Charles Goldfarb","startTime":56.56,"endTime":58.72,"body":"It feels weird"},{"speaker":"Charles Goldfarb","startTime":56.56,"endTime":58.72,"body":"to say, but I think we haven't"},{"speaker":"Charles Goldfarb","startTime":58.72,"endTime":61.56,"body":"had a bad summer heat wise. I"},{"speaker":"Charles Goldfarb","startTime":58.72,"endTime":61.56,"body":"mean, it is getting there now."},{"speaker":"Charles Goldfarb","startTime":61.56,"endTime":64.2,"body":"In August is always the worst,"},{"speaker":"Charles Goldfarb","startTime":61.56,"endTime":64.2,"body":"but compared to much of the"},{"speaker":"Charles Goldfarb","startTime":64.2,"endTime":66.42,"body":"country, St Louis has not been"},{"speaker":"Charles Goldfarb","startTime":64.2,"endTime":66.42,"body":"so terrible."},{"speaker":"Chris Dy","startTime":66.96,"endTime":68.94,"body":"Yeah. I mean, I think"},{"speaker":"Chris Dy","startTime":66.96,"endTime":68.94,"body":"that there have been days where"},{"speaker":"Chris Dy","startTime":68.94,"endTime":71.7,"body":"we've had monsoons, so the"},{"speaker":"Chris Dy","startTime":68.94,"endTime":71.7,"body":"humidity has risen, which has"},{"speaker":"Chris Dy","startTime":71.7,"endTime":75.72,"body":"been challenging. But to your"},{"speaker":"Chris Dy","startTime":71.7,"endTime":75.72,"body":"sage advice, a few years ago, we"},{"speaker":"Chris Dy","startTime":75.78,"endTime":79.8,"body":"decided to no pun, totally"},{"speaker":"Chris Dy","startTime":75.78,"endTime":79.8,"body":"intended. But I mean, take the"},{"speaker":"Chris Dy","startTime":79.8,"endTime":83.3,"body":"plunge and put in the pool, and"},{"speaker":"Chris Dy","startTime":79.8,"endTime":83.3,"body":"that's been paying dividends in"},{"speaker":"Chris Dy","startTime":83.3,"endTime":86.24,"body":"terms of having some ability to"},{"speaker":"Chris Dy","startTime":83.3,"endTime":86.24,"body":"cool off."},{"speaker":"Charles Goldfarb","startTime":87.08,"endTime":90.14,"body":"It's great"},{"speaker":"Charles Goldfarb","startTime":87.08,"endTime":90.14,"body":"when your kids use the pool. I"},{"speaker":"Charles Goldfarb","startTime":90.14,"endTime":93.62,"body":"have a pool that no one ever"},{"speaker":"Charles Goldfarb","startTime":90.14,"endTime":93.62,"body":"gets in, and yet I clean it"},{"speaker":"Charles Goldfarb","startTime":93.62,"endTime":97.04,"body":"every week, and it kills me"},{"speaker":"Charles Goldfarb","startTime":93.62,"endTime":97.04,"body":"every day."},{"speaker":"Chris Dy","startTime":97.46,"endTime":99.68,"body":"So you got you, you do"},{"speaker":"Chris Dy","startTime":97.46,"endTime":99.68,"body":"the cleaning yourself now."},{"speaker":"Charles Goldfarb","startTime":99.92,"endTime":100.72,"body":"No, let's"},{"speaker":"Chris Dy","startTime":103.36,"endTime":106.6,"body":"see, I think I told"},{"speaker":"Chris Dy","startTime":103.36,"endTime":106.6,"body":"you this, and one of our"},{"speaker":"Chris Dy","startTime":106.6,"endTime":111.88,"body":"partners in the peds ortho"},{"speaker":"Chris Dy","startTime":106.6,"endTime":111.88,"body":"division feels similarly. I like"},{"speaker":"Chris Dy","startTime":111.88,"endTime":116.5,"body":"the night swim. It's actually a"},{"speaker":"Chris Dy","startTime":111.88,"endTime":116.5,"body":"really nice way to just relax,"},{"speaker":"Chris Dy","startTime":116.56,"endTime":120.66,"body":"unwind, no devices, put on some"},{"speaker":"Chris Dy","startTime":116.56,"endTime":120.66,"body":"music, and just spend 1520"},{"speaker":"Chris Dy","startTime":121.02,"endTime":123.84,"body":"minutes in a pool. It's very"},{"speaker":"Chris Dy","startTime":121.02,"endTime":123.84,"body":"relaxing for me, and it makes me"},{"speaker":"Chris Dy","startTime":123.84,"endTime":125.64,"body":"feel like I'm getting return on"},{"speaker":"Chris Dy","startTime":123.84,"endTime":125.64,"body":"investment."},{"speaker":"Charles Goldfarb","startTime":127.32,"endTime":129.78,"body":"I need some of"},{"speaker":"Charles Goldfarb","startTime":127.32,"endTime":129.78,"body":"that. Sorry. I have a post viral"},{"speaker":"Charles Goldfarb","startTime":129.78,"endTime":132.36,"body":"syndrome, as I've been told,"},{"speaker":"Charles Goldfarb","startTime":129.78,"endTime":132.36,"body":"that's been going on for three"},{"speaker":"Charles Goldfarb","startTime":132.36,"endTime":134.28,"body":"weeks. But this is post work."},{"speaker":"Chris Dy","startTime":134.58,"endTime":137.76,"body":"This is like, post"},{"speaker":"Chris Dy","startTime":134.58,"endTime":137.76,"body":"work. Kids in bed after dinner,"},{"speaker":"Chris Dy","startTime":137.82,"endTime":141.86,"body":"like everybody's like, usually"},{"speaker":"Chris Dy","startTime":137.82,"endTime":141.86,"body":"at that point my wife is is"},{"speaker":"Chris Dy","startTime":141.86,"endTime":144.02,"body":"working out. Because I'm the"},{"speaker":"Chris Dy","startTime":141.86,"endTime":144.02,"body":"morning workout person. She's"},{"speaker":"Chris Dy","startTime":144.02,"endTime":147.92,"body":"the evening. So I try to, you"},{"speaker":"Chris Dy","startTime":144.02,"endTime":147.92,"body":"know, unwind, stay up a little"},{"speaker":"Chris Dy","startTime":147.92,"endTime":150.74,"body":"longer so we can hang out if"},{"speaker":"Chris Dy","startTime":147.92,"endTime":150.74,"body":"she's done working out, and then"},{"speaker":"Chris Dy","startTime":150.74,"endTime":153.56,"body":"some in the pool, just hanging"},{"speaker":"Chris Dy","startTime":150.74,"endTime":153.56,"body":"out a little bit. I"},{"speaker":"Charles Goldfarb","startTime":153.56,"endTime":156.08,"body":"love it. I"},{"speaker":"Charles Goldfarb","startTime":153.56,"endTime":156.08,"body":"love it. That is, that is great."},{"speaker":"Charles Goldfarb","startTime":156.08,"endTime":157.46,"body":"I have to consider that."},{"speaker":"Charles Goldfarb","startTime":156.08,"endTime":157.46,"body":"Because, I"},{"speaker":"Chris Dy","startTime":157.46,"endTime":159.62,"body":"mean, as soon as I as"},{"speaker":"Chris Dy","startTime":157.46,"endTime":159.62,"body":"soon as I lay on the couch to"},{"speaker":"Chris Dy","startTime":159.62,"endTime":162.22,"body":"watch TV, I'm out. So it's true."},{"speaker":"Charles Goldfarb","startTime":162.58,"endTime":166.0,"body":"It's true."},{"speaker":"Charles Goldfarb","startTime":162.58,"endTime":166.0,"body":"Usually my evening reprieves are"},{"speaker":"Charles Goldfarb","startTime":166.0,"endTime":169.6,"body":"reading, and it's usually trying"},{"speaker":"Charles Goldfarb","startTime":166.0,"endTime":169.6,"body":"to read something mindless, but"},{"speaker":"Charles Goldfarb","startTime":169.78,"endTime":172.78,"body":"lately it's been B school"},{"speaker":"Charles Goldfarb","startTime":169.78,"endTime":172.78,"body":"reading, which doesn't have the"},{"speaker":"Charles Goldfarb","startTime":172.78,"endTime":173.92,"body":"same effect. Yeah,"},{"speaker":"Chris Dy","startTime":173.92,"endTime":177.1,"body":"you're you're quite"},{"speaker":"Chris Dy","startTime":173.92,"endTime":177.1,"body":"busy. You know, we can talk more"},{"speaker":"Chris Dy","startTime":177.1,"endTime":180.1,"body":"about your B School experience"},{"speaker":"Chris Dy","startTime":177.1,"endTime":180.1,"body":"in a future episode, but I fear"},{"speaker":"Chris Dy","startTime":180.1,"endTime":184.26,"body":"you've had a recent trip up"},{"speaker":"Chris Dy","startTime":180.1,"endTime":184.26,"body":"north. Is that right? Yeah,"},{"speaker":"Charles Goldfarb","startTime":184.26,"endTime":187.98,"body":"I went to be"},{"speaker":"Charles Goldfarb","startTime":184.26,"endTime":187.98,"body":"the graduation speaker for"},{"speaker":"Charles Goldfarb","startTime":187.98,"endTime":192.06,"body":"Mayo's Fellowship, which was"},{"speaker":"Charles Goldfarb","startTime":187.98,"endTime":192.06,"body":"really a treat. Had a great"},{"speaker":"Charles Goldfarb","startTime":192.06,"endTime":194.46,"body":"trip, saw a lot of friends"},{"speaker":"Charles Goldfarb","startTime":192.06,"endTime":194.46,"body":"connected. You know, what's"},{"speaker":"Charles Goldfarb","startTime":194.46,"endTime":197.46,"body":"really nice about these is the"},{"speaker":"Charles Goldfarb","startTime":194.46,"endTime":197.46,"body":"ability to connect with the"},{"speaker":"Charles Goldfarb","startTime":197.46,"endTime":200.48,"body":"fellows. So we had a nice"},{"speaker":"Charles Goldfarb","startTime":197.46,"endTime":200.48,"body":"dinner, just the fellows and"},{"speaker":"Charles Goldfarb","startTime":200.48,"endTime":204.92,"body":"myself. The whole rest of the"},{"speaker":"Charles Goldfarb","startTime":200.48,"endTime":204.92,"body":"the next day was spent my giving"},{"speaker":"Charles Goldfarb","startTime":204.92,"endTime":207.62,"body":"talks, their giving talks. We"},{"speaker":"Charles Goldfarb","startTime":204.92,"endTime":207.62,"body":"spent about two hours in the lab"},{"speaker":"Charles Goldfarb","startTime":207.62,"endTime":211.16,"body":"together doing dissections, very"},{"speaker":"Charles Goldfarb","startTime":207.62,"endTime":211.16,"body":"similarly to what you have"},{"speaker":"Charles Goldfarb","startTime":211.16,"endTime":214.22,"body":"established here, where the"},{"speaker":"Charles Goldfarb","startTime":211.16,"endTime":214.22,"body":"fellows request each of us to do"},{"speaker":"Charles Goldfarb","startTime":214.22,"endTime":217.16,"body":"a dissection and and we just did"},{"speaker":"Charles Goldfarb","startTime":214.22,"endTime":217.16,"body":"different things. And I told,"},{"speaker":"Charles Goldfarb","startTime":217.16,"endTime":219.86,"body":"told the fellows of mayo, just"},{"speaker":"Charles Goldfarb","startTime":217.16,"endTime":219.86,"body":"like we tell our fellows here,"},{"speaker":"Charles Goldfarb","startTime":219.92,"endTime":222.94,"body":"kind of how we think about"},{"speaker":"Charles Goldfarb","startTime":219.92,"endTime":222.94,"body":"things. Yeah, I gave the talks I"},{"speaker":"Charles Goldfarb","startTime":222.94,"endTime":225.4,"body":"think are interesting, and we"},{"speaker":"Charles Goldfarb","startTime":222.94,"endTime":225.4,"body":"can discuss that briefly. And"},{"speaker":"Charles Goldfarb","startTime":225.4,"endTime":228.88,"body":"then had a nice graduation"},{"speaker":"Charles Goldfarb","startTime":225.4,"endTime":228.88,"body":"dinner where I thought it was"},{"speaker":"Charles Goldfarb","startTime":228.88,"endTime":232.24,"body":"kind of cute the mayo attendings"},{"speaker":"Charles Goldfarb","startTime":228.88,"endTime":232.24,"body":"write a limerick about each"},{"speaker":"Charles Goldfarb","startTime":232.24,"endTime":236.74,"body":"fellow and share those. So that"},{"speaker":"Charles Goldfarb","startTime":232.24,"endTime":236.74,"body":"was creative and cute. And came"},{"speaker":"Charles Goldfarb","startTime":236.74,"endTime":240.24,"body":"home. So it was very nice. The"},{"speaker":"Charles Goldfarb","startTime":236.74,"endTime":240.24,"body":"Mayo Clinic is a really"},{"speaker":"Charles Goldfarb","startTime":240.24,"endTime":242.88,"body":"impressive place. And not that"},{"speaker":"Charles Goldfarb","startTime":240.24,"endTime":242.88,"body":"anyone would ever doubt that"},{"speaker":"Charles Goldfarb","startTime":242.88,"endTime":246.84,"body":"they have, they have a really"},{"speaker":"Charles Goldfarb","startTime":242.88,"endTime":246.84,"body":"amazing facilities. And it was,"},{"speaker":"Charles Goldfarb","startTime":246.84,"endTime":252.06,"body":"it was fun to see it, it's, it's"},{"speaker":"Charles Goldfarb","startTime":246.84,"endTime":252.06,"body":"different than what we have. I"},{"speaker":"Charles Goldfarb","startTime":252.06,"endTime":255.0,"body":"wouldn't say better in any, in"},{"speaker":"Charles Goldfarb","startTime":252.06,"endTime":255.0,"body":"any form or fashion. It's just"},{"speaker":"Charles Goldfarb","startTime":255.0,"endTime":255.42,"body":"different."},{"speaker":"Chris Dy","startTime":256.14,"endTime":259.44,"body":"Yeah, no, I've gone up"},{"speaker":"Chris Dy","startTime":256.14,"endTime":259.44,"body":"there. I went up there when, you"},{"speaker":"Chris Dy","startTime":259.44,"endTime":262.16,"body":"know, I think when I was"},{"speaker":"Chris Dy","startTime":259.44,"endTime":262.16,"body":"relatively new attending, and"},{"speaker":"Chris Dy","startTime":262.16,"endTime":265.88,"body":"attended their brachial plexus"},{"speaker":"Chris Dy","startTime":262.16,"endTime":265.88,"body":"course, which they which was"},{"speaker":"Chris Dy","startTime":265.88,"endTime":268.46,"body":"great course, international"},{"speaker":"Chris Dy","startTime":265.88,"endTime":268.46,"body":"faculty, fantastic. A lot of"},{"speaker":"Chris Dy","startTime":268.46,"endTime":271.22,"body":"what we've done with the"},{"speaker":"Chris Dy","startTime":268.46,"endTime":271.22,"body":"Washington course was modeled"},{"speaker":"Chris Dy","startTime":271.22,"endTime":275.36,"body":"after how they've structured"},{"speaker":"Chris Dy","startTime":271.22,"endTime":275.36,"body":"their course. And, you know,"},{"speaker":"Chris Dy","startTime":275.36,"endTime":278.3,"body":"went up there as during my"},{"speaker":"Chris Dy","startTime":275.36,"endTime":278.3,"body":"government travel, government"},{"speaker":"Chris Dy","startTime":279.14,"endTime":284.02,"body":"scholarship travels a couple"},{"speaker":"Chris Dy","startTime":279.14,"endTime":284.02,"body":"years ago and really enjoyed it."},{"speaker":"Chris Dy","startTime":284.5,"endTime":287.02,"body":"So it's, it's a fantastic place,"},{"speaker":"Chris Dy","startTime":284.5,"endTime":287.02,"body":"I think, you know, like you"},{"speaker":"Chris Dy","startTime":287.02,"endTime":288.82,"body":"said, there's a lot of"},{"speaker":"Chris Dy","startTime":287.02,"endTime":288.82,"body":"differences. It makes you"},{"speaker":"Chris Dy","startTime":288.82,"endTime":292.0,"body":"appreciate those differences and"},{"speaker":"Chris Dy","startTime":288.82,"endTime":292.0,"body":"different approaches. Yeah,"},{"speaker":"Charles Goldfarb","startTime":292.18,"endTime":295.66,"body":"it is. It is a"},{"speaker":"Charles Goldfarb","startTime":292.18,"endTime":295.66,"body":"lesson to residents and fellows"},{"speaker":"Charles Goldfarb","startTime":295.66,"endTime":298.36,"body":"who may be listening and medical"},{"speaker":"Charles Goldfarb","startTime":295.66,"endTime":298.36,"body":"students who may be listening,"},{"speaker":"Charles Goldfarb","startTime":298.36,"endTime":301.56,"body":"and that there's a lot of"},{"speaker":"Charles Goldfarb","startTime":298.36,"endTime":301.56,"body":"different. Ways to run a"},{"speaker":"Charles Goldfarb","startTime":301.56,"endTime":306.72,"body":"practice and have a how one"},{"speaker":"Charles Goldfarb","startTime":301.56,"endTime":306.72,"body":"exists in relation to the care"},{"speaker":"Charles Goldfarb","startTime":306.72,"endTime":310.14,"body":"they provide and and it's really"},{"speaker":"Charles Goldfarb","startTime":306.72,"endTime":310.14,"body":"important to understand those I"},{"speaker":"Charles Goldfarb","startTime":310.14,"endTime":312.6,"body":"you know, to some degree in"},{"speaker":"Charles Goldfarb","startTime":310.14,"endTime":312.6,"body":"residency, although that's not"},{"speaker":"Charles Goldfarb","startTime":312.6,"endTime":314.88,"body":"the primary goal in residency"},{"speaker":"Charles Goldfarb","startTime":312.6,"endTime":314.88,"body":"and fellowship, you know, I"},{"speaker":"Charles Goldfarb","startTime":314.88,"endTime":318.36,"body":"think you learn a lot in"},{"speaker":"Charles Goldfarb","startTime":314.88,"endTime":318.36,"body":"addition to hand surgery, if you"},{"speaker":"Charles Goldfarb","startTime":318.36,"endTime":320.9,"body":"look carefully. So I think it"},{"speaker":"Charles Goldfarb","startTime":318.36,"endTime":320.9,"body":"does matter for fellowship."},{"speaker":"Charles Goldfarb","startTime":320.9,"endTime":324.2,"body":"Obviously, it matters for life,"},{"speaker":"Charles Goldfarb","startTime":320.9,"endTime":324.2,"body":"and you're going back up there"},{"speaker":"Charles Goldfarb","startTime":324.2,"endTime":326.72,"body":"in February. I don't know in"},{"speaker":"Charles Goldfarb","startTime":324.2,"endTime":326.72,"body":"what capacity, but as a visiting"},{"speaker":"Charles Goldfarb","startTime":326.72,"endTime":328.1,"body":"professor in some way."},{"speaker":"Chris Dy","startTime":328.46,"endTime":330.98,"body":"Yeah, it was. It's a"},{"speaker":"Chris Dy","startTime":328.46,"endTime":330.98,"body":"tremendous honor. But I was"},{"speaker":"Chris Dy","startTime":330.98,"endTime":334.88,"body":"invited to be the Morton spinner"},{"speaker":"Chris Dy","startTime":330.98,"endTime":334.88,"body":"visiting professor and in"},{"speaker":"Chris Dy","startTime":334.88,"endTime":338.18,"body":"peripheral nerve surgery. So"},{"speaker":"Chris Dy","startTime":334.88,"endTime":338.18,"body":"that's named after Robert"},{"speaker":"Chris Dy","startTime":338.18,"endTime":342.64,"body":"spinners, Father Morton spinner,"},{"speaker":"Chris Dy","startTime":338.18,"endTime":342.64,"body":"who is a well known hand in"},{"speaker":"Chris Dy","startTime":342.64,"endTime":346.84,"body":"peripheral nerve surgeon, and"},{"speaker":"Chris Dy","startTime":342.64,"endTime":346.84,"body":"Rob is a one of the elite"},{"speaker":"Chris Dy","startTime":346.84,"endTime":349.66,"body":"neurosurgeons in peripheral"},{"speaker":"Chris Dy","startTime":346.84,"endTime":349.66,"body":"nerve and you know, honestly,"},{"speaker":"Chris Dy","startTime":349.66,"endTime":355.24,"body":"their their Plexus team, which"},{"speaker":"Chris Dy","startTime":349.66,"endTime":355.24,"body":"is Rob, Alex shin and Alan"},{"speaker":"Chris Dy","startTime":355.24,"endTime":358.96,"body":"Bishop. That team is the the"},{"speaker":"Chris Dy","startTime":355.24,"endTime":358.96,"body":"standard at which, you know, I"},{"speaker":"Chris Dy","startTime":358.96,"endTime":361.62,"body":"have tried to establish the"},{"speaker":"Chris Dy","startTime":358.96,"endTime":361.62,"body":"practice that David and I are"},{"speaker":"Chris Dy","startTime":361.62,"endTime":364.2,"body":"working on in terms of nerves."},{"speaker":"Chris Dy","startTime":361.62,"endTime":364.2,"body":"So huge honor to be invited to"},{"speaker":"Chris Dy","startTime":364.2,"endTime":368.88,"body":"come up. I believe it's sometime"},{"speaker":"Chris Dy","startTime":364.2,"endTime":368.88,"body":"in February. Very excited to do"},{"speaker":"Chris Dy","startTime":368.88,"endTime":371.28,"body":"that visiting professorship,"},{"speaker":"Chris Dy","startTime":368.88,"endTime":371.28,"body":"give a talk at ortho Grand"},{"speaker":"Chris Dy","startTime":371.28,"endTime":374.16,"body":"Rounds. I think it'll be really"},{"speaker":"Chris Dy","startTime":371.28,"endTime":374.16,"body":"fun. So thank you to the Mayo"},{"speaker":"Chris Dy","startTime":374.16,"endTime":377.28,"body":"team for inviting me to come"},{"speaker":"Chris Dy","startTime":374.16,"endTime":377.28,"body":"back. I will probably end up"},{"speaker":"Chris Dy","startTime":377.28,"endTime":379.98,"body":"mentioning it during my talk up"},{"speaker":"Chris Dy","startTime":377.28,"endTime":379.98,"body":"there. But I did apply for"},{"speaker":"Chris Dy","startTime":379.98,"endTime":382.76,"body":"residency. Didn't get an"},{"speaker":"Chris Dy","startTime":379.98,"endTime":382.76,"body":"interview. I did apply for hand"},{"speaker":"Chris Dy","startTime":382.76,"endTime":384.98,"body":"fellowship, didn't get an"},{"speaker":"Chris Dy","startTime":382.76,"endTime":384.98,"body":"interview. So this feels really"},{"speaker":"Chris Dy","startTime":384.98,"endTime":388.28,"body":"good to go back and be invited"},{"speaker":"Chris Dy","startTime":384.98,"endTime":388.28,"body":"to do this. So yeah,"},{"speaker":"Charles Goldfarb","startTime":388.28,"endTime":391.88,"body":"I heard they"},{"speaker":"Charles Goldfarb","startTime":388.28,"endTime":391.88,"body":"usually hold that that visiting"},{"speaker":"Charles Goldfarb","startTime":391.88,"endTime":394.52,"body":"professorship in May, but in"},{"speaker":"Charles Goldfarb","startTime":391.88,"endTime":394.52,"body":"special honor for you, they"},{"speaker":"Charles Goldfarb","startTime":394.52,"endTime":397.64,"body":"moved it to February so that you"},{"speaker":"Charles Goldfarb","startTime":394.52,"endTime":397.64,"body":"could enjoy the Rochester"},{"speaker":"Charles Goldfarb","startTime":397.64,"endTime":398.18,"body":"winter."},{"speaker":"Chris Dy","startTime":398.24,"endTime":402.16,"body":"Oh, yeah, of course,"},{"speaker":"Chris Dy","startTime":398.24,"endTime":402.16,"body":"of course. And you know, I kind"},{"speaker":"Chris Dy","startTime":402.16,"endTime":404.92,"body":"of feel like, you know, you"},{"speaker":"Chris Dy","startTime":402.16,"endTime":404.92,"body":"Michael Jordan got cut from the,"},{"speaker":"Chris Dy","startTime":404.92,"endTime":408.52,"body":"you know, the freshman high"},{"speaker":"Chris Dy","startTime":404.92,"endTime":408.52,"body":"school team. Caitlin Clark"},{"speaker":"Chris Dy","startTime":408.52,"endTime":412.18,"body":"didn't make the Olympic squad."},{"speaker":"Chris Dy","startTime":408.52,"endTime":412.18,"body":"My chance to show that I can, I"},{"speaker":"Chris Dy","startTime":412.18,"endTime":415.6,"body":"can, I can hang with the guys up"},{"speaker":"Chris Dy","startTime":412.18,"endTime":415.6,"body":"there, but and the gals, but"},{"speaker":"Chris Dy","startTime":415.6,"endTime":418.24,"body":"it's, I mean, honestly, their"},{"speaker":"Chris Dy","startTime":415.6,"endTime":418.24,"body":"nerve team is amazing, and"},{"speaker":"Chris Dy","startTime":418.3,"endTime":421.8,"body":"we're, we're doing our best to"},{"speaker":"Chris Dy","startTime":418.3,"endTime":421.8,"body":"to really emulate what they've"},{"speaker":"Chris Dy","startTime":421.8,"endTime":426.12,"body":"been able to do up there. So,"},{"speaker":"Chris Dy","startTime":421.8,"endTime":426.12,"body":"um, well, we did send off our"},{"speaker":"Chris Dy","startTime":426.12,"endTime":429.12,"body":"fellows since the last time we"},{"speaker":"Chris Dy","startTime":426.12,"endTime":429.12,"body":"recorded. And I know our last"},{"speaker":"Chris Dy","startTime":429.12,"endTime":432.72,"body":"episode was focused on pearls"},{"speaker":"Chris Dy","startTime":429.12,"endTime":432.72,"body":"for our graduates, it's been"},{"speaker":"Chris Dy","startTime":432.72,"endTime":435.3,"body":"interesting to welcome our new"},{"speaker":"Chris Dy","startTime":432.72,"endTime":435.3,"body":"fellows. We've got three new"},{"speaker":"Chris Dy","startTime":435.3,"endTime":438.66,"body":"fellows on board, and you talk"},{"speaker":"Chris Dy","startTime":435.3,"endTime":438.66,"body":"about differences even one day"},{"speaker":"Chris Dy","startTime":438.66,"endTime":442.22,"body":"in the or half day in the or a"},{"speaker":"Chris Dy","startTime":438.66,"endTime":442.22,"body":"half day in clinic with with a"},{"speaker":"Chris Dy","startTime":442.22,"endTime":445.04,"body":"new fellow, and then a full day"},{"speaker":"Chris Dy","startTime":442.22,"endTime":445.04,"body":"in clinic the next day, just"},{"speaker":"Chris Dy","startTime":445.04,"endTime":449.24,"body":"differences and exam and"},{"speaker":"Chris Dy","startTime":445.04,"endTime":449.24,"body":"approach. And, you know, it is,"},{"speaker":"Chris Dy","startTime":449.24,"endTime":450.68,"body":"it's going to be a fun year. I"},{"speaker":"Chris Dy","startTime":449.24,"endTime":450.68,"body":"think,"},{"speaker":"Charles Goldfarb","startTime":451.46,"endTime":452.9,"body":"yeah, it's"},{"speaker":"Charles Goldfarb","startTime":451.46,"endTime":452.9,"body":"going to be a fun year. And"},{"speaker":"Charles Goldfarb","startTime":452.9,"endTime":456.62,"body":"I've, you know, I've gotten a"},{"speaker":"Charles Goldfarb","startTime":452.9,"endTime":456.62,"body":"little started, you know, our"},{"speaker":"Charles Goldfarb","startTime":456.62,"endTime":459.86,"body":"fellowship began on Thursday,"},{"speaker":"Charles Goldfarb","startTime":456.62,"endTime":459.86,"body":"which was August 1, and this a"},{"speaker":"Charles Goldfarb","startTime":459.86,"endTime":463.42,"body":"little time with fellows. And"},{"speaker":"Charles Goldfarb","startTime":459.86,"endTime":463.42,"body":"yeah, it'll be fun. I am working"},{"speaker":"Charles Goldfarb","startTime":464.08,"endTime":467.08,"body":"with a plastic surgery fellow"},{"speaker":"Charles Goldfarb","startTime":464.08,"endTime":467.08,"body":"first, which will be great for"},{"speaker":"Charles Goldfarb","startTime":467.08,"endTime":470.8,"body":"two months. And look forward to"},{"speaker":"Charles Goldfarb","startTime":467.08,"endTime":470.8,"body":"it. You know, there's certain"},{"speaker":"Charles Goldfarb","startTime":470.8,"endTime":475.36,"body":"things that plastics fellows are"},{"speaker":"Charles Goldfarb","startTime":470.8,"endTime":475.36,"body":"interested in, and a lot of that"},{"speaker":"Charles Goldfarb","startTime":475.36,"endTime":478.72,"body":"tends to be bread and butter,"},{"speaker":"Charles Goldfarb","startTime":475.36,"endTime":478.72,"body":"hand rather than flaps, because"},{"speaker":"Charles Goldfarb","startTime":478.72,"endTime":481.56,"body":"most of them are are skilled in"},{"speaker":"Charles Goldfarb","startTime":478.72,"endTime":481.56,"body":"that domain, they tend to be"},{"speaker":"Charles Goldfarb","startTime":481.56,"endTime":483.78,"body":"less interested as a"},{"speaker":"Charles Goldfarb","startTime":481.56,"endTime":483.78,"body":"generalization, and things like"},{"speaker":"Charles Goldfarb","startTime":483.78,"endTime":488.64,"body":"elbow arthroscopy, which is easy"},{"speaker":"Charles Goldfarb","startTime":483.78,"endTime":488.64,"body":"to understand, but, yeah, it's"},{"speaker":"Charles Goldfarb","startTime":488.64,"endTime":491.76,"body":"always super fun and the"},{"speaker":"Charles Goldfarb","startTime":488.64,"endTime":491.76,"body":"process, and let's be honest,"},{"speaker":"Charles Goldfarb","startTime":491.76,"endTime":492.9,"body":"you and I learn as well."},{"speaker":"Chris Dy","startTime":493.2,"endTime":495.84,"body":"Yeah, absolutely. I"},{"speaker":"Chris Dy","startTime":493.2,"endTime":495.84,"body":"learned a lot, you know, from"},{"speaker":"Chris Dy","startTime":495.84,"endTime":497.94,"body":"our different trainees, you"},{"speaker":"Chris Dy","startTime":495.84,"endTime":497.94,"body":"know. So one of the, one of our,"},{"speaker":"Chris Dy","startTime":497.94,"endTime":500.22,"body":"the new fellow that's on my"},{"speaker":"Chris Dy","startTime":497.94,"endTime":500.22,"body":"rotation right now was quoting"},{"speaker":"Chris Dy","startTime":500.22,"endTime":502.5,"body":"some literature I hadn't read"},{"speaker":"Chris Dy","startTime":500.22,"endTime":502.5,"body":"before. He's like, I'll send it"},{"speaker":"Chris Dy","startTime":502.5,"endTime":504.86,"body":"to you. I said, send it to you."},{"speaker":"Chris Dy","startTime":502.5,"endTime":504.86,"body":"I said I probably won't read it,"},{"speaker":"Chris Dy","startTime":504.86,"endTime":507.5,"body":"but actually said it to me, no,"},{"speaker":"Chris Dy","startTime":504.86,"endTime":507.5,"body":"I think it's it's been great."},{"speaker":"Chris Dy","startTime":507.5,"endTime":510.44,"body":"Dan's been fantastic on service."},{"speaker":"Chris Dy","startTime":507.5,"endTime":510.44,"body":"And then Nick colado, who you're"},{"speaker":"Chris Dy","startTime":510.44,"endTime":512.96,"body":"mentioning, did come to our"},{"speaker":"Chris Dy","startTime":510.44,"endTime":512.96,"body":"nerve clinic in the afternoon on"},{"speaker":"Chris Dy","startTime":512.96,"endTime":516.38,"body":"Thursday, and I enjoyed having"},{"speaker":"Chris Dy","startTime":512.96,"endTime":516.38,"body":"him there. So So here's to the"},{"speaker":"Chris Dy","startTime":516.38,"endTime":519.5,"body":"new academic year before we jump"},{"speaker":"Chris Dy","startTime":516.38,"endTime":519.5,"body":"into today's topic, which I"},{"speaker":"Chris Dy","startTime":519.5,"endTime":523.54,"body":"think will be of relevance to a"},{"speaker":"Chris Dy","startTime":519.5,"endTime":523.54,"body":"lot of people who are seeing"},{"speaker":"Chris Dy","startTime":523.54,"endTime":527.26,"body":"patients who are rock climbers."},{"speaker":"Chris Dy","startTime":523.54,"endTime":527.26,"body":"We should thank our sponsors at"},{"speaker":"Chris Dy","startTime":527.26,"endTime":527.92,"body":"practice. Link,"},{"speaker":"Charles Goldfarb","startTime":528.16,"endTime":529.9,"body":"absolutely,"},{"speaker":"Charles Goldfarb","startTime":528.16,"endTime":529.9,"body":"the upper hand is sponsored by"},{"speaker":"Charles Goldfarb","startTime":529.9,"endTime":533.08,"body":"practicelink.com, the most"},{"speaker":"Charles Goldfarb","startTime":529.9,"endTime":533.08,"body":"widely used physician. Job"},{"speaker":"Charles Goldfarb","startTime":533.08,"endTime":536.56,"body":"search and career advancement"},{"speaker":"Charles Goldfarb","startTime":533.08,"endTime":536.56,"body":"resource. Becoming"},{"speaker":"Chris Dy","startTime":536.56,"endTime":538.84,"body":"a physician is hard."},{"speaker":"Chris Dy","startTime":536.56,"endTime":538.84,"body":"Finding the right job doesn't"},{"speaker":"Chris Dy","startTime":538.84,"endTime":541.32,"body":"have to be join practice link"},{"speaker":"Chris Dy","startTime":538.84,"endTime":541.32,"body":"for free today at"},{"speaker":"Chris Dy","startTime":541.32,"endTime":545.58,"body":"www.practicelink.com/the upper"},{"speaker":"Chris Dy","startTime":541.32,"endTime":545.58,"body":"hand."},{"speaker":"Charles Goldfarb","startTime":546.54,"endTime":549.12,"body":"So we are. I"},{"speaker":"Charles Goldfarb","startTime":546.54,"endTime":549.12,"body":"mean, we could probably start"},{"speaker":"Charles Goldfarb","startTime":549.12,"endTime":552.48,"body":"with the case, but I would say"},{"speaker":"Charles Goldfarb","startTime":549.12,"endTime":552.48,"body":"that there's rock climbing"},{"speaker":"Charles Goldfarb","startTime":552.48,"endTime":555.0,"body":"indoor and outdoor around St"},{"speaker":"Charles Goldfarb","startTime":552.48,"endTime":555.0,"body":"Louis. I don't know that I would"},{"speaker":"Charles Goldfarb","startTime":555.0,"endTime":558.72,"body":"describe us as a hotbed, but I"},{"speaker":"Charles Goldfarb","startTime":555.0,"endTime":558.72,"body":"think as much as I know we are"},{"speaker":"Charles Goldfarb","startTime":558.96,"endTime":563.66,"body":"as our community is active in"},{"speaker":"Charles Goldfarb","startTime":558.96,"endTime":563.66,"body":"rock climbing as much as any"},{"speaker":"Charles Goldfarb","startTime":563.66,"endTime":563.96,"body":"other"},{"speaker":"Chris Dy","startTime":564.26,"endTime":566.96,"body":"Well, I think it's a,"},{"speaker":"Chris Dy","startTime":564.26,"endTime":566.96,"body":"it's a it's an activity that has"},{"speaker":"Chris Dy","startTime":566.96,"endTime":571.94,"body":"really exploded in popularity. I"},{"speaker":"Chris Dy","startTime":566.96,"endTime":571.94,"body":"mean, I remember, this was late"},{"speaker":"Chris Dy","startTime":571.94,"endTime":575.0,"body":"90s, when I was finishing high"},{"speaker":"Chris Dy","startTime":571.94,"endTime":575.0,"body":"school, the prep school that I"},{"speaker":"Chris Dy","startTime":575.0,"endTime":578.06,"body":"went to had just put in a rock"},{"speaker":"Chris Dy","startTime":575.0,"endTime":578.06,"body":"climbing wall, which was like a"},{"speaker":"Chris Dy","startTime":578.06,"endTime":580.54,"body":"huge deal. But I think they're"},{"speaker":"Chris Dy","startTime":578.06,"endTime":580.54,"body":"everywhere now, and people are"},{"speaker":"Chris Dy","startTime":580.54,"endTime":583.96,"body":"climbing indoors and outdoors"},{"speaker":"Chris Dy","startTime":580.54,"endTime":583.96,"body":"still, generally terrifies me to"},{"speaker":"Chris Dy","startTime":583.96,"endTime":586.66,"body":"do anything that that risky, as"},{"speaker":"Chris Dy","startTime":583.96,"endTime":586.66,"body":"we've talked about before. I'm"},{"speaker":"Chris Dy","startTime":586.66,"endTime":589.66,"body":"pretty risk averse, but my son"},{"speaker":"Chris Dy","startTime":586.66,"endTime":589.66,"body":"loves going rock climbing."},{"speaker":"Chris Dy","startTime":589.66,"endTime":592.36,"body":"They've got one at their school,"},{"speaker":"Chris Dy","startTime":589.66,"endTime":592.36,"body":"of course. And then, you know,"},{"speaker":"Chris Dy","startTime":592.36,"endTime":595.36,"body":"one of the things that he"},{"speaker":"Chris Dy","startTime":592.36,"endTime":595.36,"body":"requested to do on his day,"},{"speaker":"Chris Dy","startTime":595.36,"endTime":599.08,"body":"where I hung out with him on his"},{"speaker":"Chris Dy","startTime":595.36,"endTime":599.08,"body":"birthday, was to go rock"},{"speaker":"Chris Dy","startTime":599.08,"endTime":601.32,"body":"climbing. So we've gone. Couple"},{"speaker":"Chris Dy","startTime":599.08,"endTime":601.32,"body":"of times, there's some really"},{"speaker":"Chris Dy","startTime":601.32,"endTime":605.34,"body":"cool gyms in St Louis, and it's,"},{"speaker":"Chris Dy","startTime":601.32,"endTime":605.34,"body":"it's, I'd love to do a little"},{"speaker":"Chris Dy","startTime":605.34,"endTime":607.5,"body":"more of it myself when we're in"},{"speaker":"Chris Dy","startTime":605.34,"endTime":607.5,"body":"there, because a very safe"},{"speaker":"Chris Dy","startTime":607.5,"endTime":609.96,"body":"environment. But a lot of times"},{"speaker":"Chris Dy","startTime":607.5,"endTime":609.96,"body":"I'm just watching him just"},{"speaker":"Chris Dy","startTime":609.96,"endTime":612.0,"body":"scamper up the wall. I mean,"},{"speaker":"Chris Dy","startTime":609.96,"endTime":612.0,"body":"it's amazing, like, the kid"},{"speaker":"Chris Dy","startTime":612.0,"endTime":614.34,"body":"gets, like, 40 feet in the air."},{"speaker":"Chris Dy","startTime":612.0,"endTime":614.34,"body":"And I'm like, I probably should"},{"speaker":"Chris Dy","startTime":614.34,"endTime":616.8,"body":"be more concerned. We actually"},{"speaker":"Chris Dy","startTime":614.34,"endTime":616.8,"body":"went with one of our partners"},{"speaker":"Chris Dy","startTime":616.8,"endTime":620.42,"body":"kids, and he was like, aren't"},{"speaker":"Chris Dy","startTime":616.8,"endTime":620.42,"body":"you? Are you a little worried?"},{"speaker":"Chris Dy","startTime":620.42,"endTime":623.48,"body":"I'm like, no, they're strapped"},{"speaker":"Chris Dy","startTime":620.42,"endTime":623.48,"body":"in. I feel like they're fine."},{"speaker":"Chris Dy","startTime":623.48,"endTime":623.78,"body":"But"},{"speaker":"Charles Goldfarb","startTime":624.86,"endTime":627.62,"body":"it's the it's"},{"speaker":"Charles Goldfarb","startTime":624.86,"endTime":627.62,"body":"the stage of life where you're,"},{"speaker":"Charles Goldfarb","startTime":627.62,"endTime":629.72,"body":"you know, nothing can hurt me."},{"speaker":"Charles Goldfarb","startTime":627.62,"endTime":629.72,"body":"You know, when you're a young"},{"speaker":"Charles Goldfarb","startTime":629.72,"endTime":631.82,"body":"kid and you're you're not"},{"speaker":"Charles Goldfarb","startTime":629.72,"endTime":631.82,"body":"completely they're not"},{"speaker":"Charles Goldfarb","startTime":631.82,"endTime":634.64,"body":"completely wrong in thinking"},{"speaker":"Charles Goldfarb","startTime":631.82,"endTime":634.64,"body":"that way. I love the risk"},{"speaker":"Charles Goldfarb","startTime":634.64,"endTime":640.04,"body":"averse. Chris, as as you have"},{"speaker":"Charles Goldfarb","startTime":634.64,"endTime":640.04,"body":"shared with us some of our"},{"speaker":"Charles Goldfarb","startTime":640.04,"endTime":643.06,"body":"listeners, including myself."},{"speaker":"Charles Goldfarb","startTime":640.04,"endTime":643.06,"body":"Honestly, I never went to a"},{"speaker":"Charles Goldfarb","startTime":643.06,"endTime":645.64,"body":"school, and yes, there was rock"},{"speaker":"Charles Goldfarb","startTime":643.06,"endTime":645.64,"body":"climbing when I went to school,"},{"speaker":"Charles Goldfarb","startTime":645.64,"endTime":649.3,"body":"but I never went to school where"},{"speaker":"Charles Goldfarb","startTime":645.64,"endTime":649.3,"body":"they had their own rock climbing"},{"speaker":"Charles Goldfarb","startTime":649.3,"endTime":653.56,"body":"gym or a wall. So you grew up"},{"speaker":"Charles Goldfarb","startTime":649.3,"endTime":653.56,"body":"and went to a school that had a"},{"speaker":"Charles Goldfarb","startTime":653.56,"endTime":656.74,"body":"rock climbing wall. And of"},{"speaker":"Charles Goldfarb","startTime":653.56,"endTime":656.74,"body":"course, the apple, as my mom"},{"speaker":"Charles Goldfarb","startTime":656.74,"endTime":661.08,"body":"used to say, The apple doesn't"},{"speaker":"Charles Goldfarb","startTime":656.74,"endTime":661.08,"body":"fall far from the tree. Nobody"},{"speaker":"Chris Dy","startTime":661.08,"endTime":663.66,"body":"here knows me from"},{"speaker":"Chris Dy","startTime":661.08,"endTime":663.66,"body":"high school, but I was, my"},{"speaker":"Chris Dy","startTime":663.66,"endTime":666.3,"body":"habitus was, I think, quite a"},{"speaker":"Chris Dy","startTime":663.66,"endTime":666.3,"body":"bit different in high school,"},{"speaker":"Chris Dy","startTime":666.3,"endTime":668.94,"body":"there was no way I was climbing"},{"speaker":"Chris Dy","startTime":666.3,"endTime":668.94,"body":"a rock climbing wall tell you"},{"speaker":"Chris Dy","startTime":668.94,"endTime":673.5,"body":"that. So things have changed,"},{"speaker":"Chris Dy","startTime":668.94,"endTime":673.5,"body":"and, you know, hopefully for the"},{"speaker":"Chris Dy","startTime":673.5,"endTime":675.96,"body":"better. But yes, I was fortunate"},{"speaker":"Chris Dy","startTime":673.5,"endTime":675.96,"body":"enough to go to a school that"},{"speaker":"Chris Dy","startTime":675.96,"endTime":680.22,"body":"was, let's just say, well,"},{"speaker":"Chris Dy","startTime":675.96,"endTime":680.22,"body":"resourced and and I'm fortunate"},{"speaker":"Chris Dy","startTime":680.22,"endTime":683.48,"body":"enough to be able to provide"},{"speaker":"Chris Dy","startTime":680.22,"endTime":683.48,"body":"that for for my children? Yeah,"},{"speaker":"Chris Dy","startTime":683.48,"endTime":684.08,"body":"absolutely,"},{"speaker":"Charles Goldfarb","startTime":684.08,"endTime":685.88,"body":"as my wife"},{"speaker":"Charles Goldfarb","startTime":684.08,"endTime":685.88,"body":"always said, you know, if you"},{"speaker":"Charles Goldfarb","startTime":685.88,"endTime":689.12,"body":"could afford the the excellent"},{"speaker":"Charles Goldfarb","startTime":685.88,"endTime":689.12,"body":"private school education, why"},{"speaker":"Charles Goldfarb","startTime":689.12,"endTime":693.02,"body":"would you not do that? And I"},{"speaker":"Charles Goldfarb","startTime":689.12,"endTime":693.02,"body":"always, you know, we had a Marty"},{"speaker":"Charles Goldfarb","startTime":693.02,"endTime":695.54,"body":"and I met with the fellows"},{"speaker":"Charles Goldfarb","startTime":693.02,"endTime":695.54,"body":"before they left a couple days"},{"speaker":"Charles Goldfarb","startTime":695.54,"endTime":698.66,"body":"before, just talk about life"},{"speaker":"Charles Goldfarb","startTime":695.54,"endTime":698.66,"body":"finances. And we do a little"},{"speaker":"Charles Goldfarb","startTime":698.66,"endTime":701.8,"body":"financial work. We talk about"},{"speaker":"Charles Goldfarb","startTime":698.66,"endTime":701.8,"body":"coding, of course, but outside"},{"speaker":"Charles Goldfarb","startTime":701.8,"endTime":705.76,"body":"of that, and I, one of my"},{"speaker":"Charles Goldfarb","startTime":701.8,"endTime":705.76,"body":"favorite things to say is the"},{"speaker":"Charles Goldfarb","startTime":705.76,"endTime":709.0,"body":"greatest, and I do believe this,"},{"speaker":"Charles Goldfarb","startTime":705.76,"endTime":709.0,"body":"the greatest gift my parents"},{"speaker":"Charles Goldfarb","startTime":709.0,"endTime":713.92,"body":"gave me was education, and it"},{"speaker":"Charles Goldfarb","startTime":709.0,"endTime":713.92,"body":"was great education, and I did"},{"speaker":"Charles Goldfarb","startTime":713.92,"endTime":716.68,"body":"not have medical debts. I meant"},{"speaker":"Charles Goldfarb","startTime":713.92,"endTime":716.68,"body":"not medical debts. I did not"},{"speaker":"Charles Goldfarb","startTime":716.68,"endTime":719.62,"body":"have school debts to pay. And"},{"speaker":"Charles Goldfarb","startTime":716.68,"endTime":719.62,"body":"that's an incredible gift and"},{"speaker":"Charles Goldfarb","startTime":719.86,"endTime":723.06,"body":"and certainly that is a goal for"},{"speaker":"Charles Goldfarb","startTime":719.86,"endTime":723.06,"body":"my children as well."},{"speaker":"Chris Dy","startTime":723.3,"endTime":726.0,"body":"Right? I was told I"},{"speaker":"Chris Dy","startTime":723.3,"endTime":726.0,"body":"was going to have the same gift"},{"speaker":"Chris Dy","startTime":726.0,"endTime":728.94,"body":"for medical school, and then the"},{"speaker":"Chris Dy","startTime":726.0,"endTime":728.94,"body":"stock market crashed right when"},{"speaker":"Chris Dy","startTime":728.94,"endTime":733.08,"body":"I was in medical school. So I am"},{"speaker":"Chris Dy","startTime":728.94,"endTime":733.08,"body":"happy to pay off my loans like"},{"speaker":"Chris Dy","startTime":733.08,"endTime":737.16,"body":"everybody else, but I'm almost"},{"speaker":"Chris Dy","startTime":733.08,"endTime":737.16,"body":"there. The interest rates so"},{"speaker":"Chris Dy","startTime":737.16,"endTime":739.62,"body":"damn good. Why would you pay it"},{"speaker":"Chris Dy","startTime":737.16,"endTime":739.62,"body":"off right away? So at least it"},{"speaker":"Chris Dy","startTime":739.62,"endTime":743.9,"body":"was a full time. So the today's"},{"speaker":"Chris Dy","startTime":739.62,"endTime":743.9,"body":"episode was actually originated"},{"speaker":"Chris Dy","startTime":743.9,"endTime":748.58,"body":"by an email that we got from a"},{"speaker":"Chris Dy","startTime":743.9,"endTime":748.58,"body":"listener, and he I asked Dr"},{"speaker":"Chris Dy","startTime":748.58,"endTime":751.88,"body":"Christopher McMullin, who is a"},{"speaker":"Chris Dy","startTime":748.58,"endTime":751.88,"body":"physiatrist and the associate PD"},{"speaker":"Chris Dy","startTime":751.88,"endTime":754.88,"body":"for the pm and our residency at"},{"speaker":"Chris Dy","startTime":751.88,"endTime":754.88,"body":"the University of Washington up"},{"speaker":"Chris Dy","startTime":754.88,"endTime":759.2,"body":"in the northwest, in Washington"},{"speaker":"Chris Dy","startTime":754.88,"endTime":759.2,"body":"State, he emailed me a question"},{"speaker":"Chris Dy","startTime":759.2,"endTime":761.92,"body":"about hydro, hydro dissection"},{"speaker":"Chris Dy","startTime":759.2,"endTime":761.92,"body":"for nerves. And we exchanged"},{"speaker":"Chris Dy","startTime":761.92,"endTime":764.8,"body":"some emails, and he said that he"},{"speaker":"Chris Dy","startTime":761.92,"endTime":764.8,"body":"does listen to the podcast. And"},{"speaker":"Chris Dy","startTime":764.8,"endTime":767.56,"body":"I was very excited about that."},{"speaker":"Chris Dy","startTime":764.8,"endTime":767.56,"body":"And I asked Chris if there was"},{"speaker":"Chris Dy","startTime":767.56,"endTime":770.32,"body":"something that he was interested"},{"speaker":"Chris Dy","startTime":767.56,"endTime":770.32,"body":"in hearing about, and he did say"},{"speaker":"Chris Dy","startTime":770.32,"endTime":773.62,"body":"that he sees a number of rock"},{"speaker":"Chris Dy","startTime":770.32,"endTime":773.62,"body":"climbers and looking for ways to"},{"speaker":"Chris Dy","startTime":773.62,"endTime":776.02,"body":"brush up on his hand knowledge."},{"speaker":"Chris Dy","startTime":773.62,"endTime":776.02,"body":"So that's why I started"},{"speaker":"Chris Dy","startTime":776.02,"endTime":779.2,"body":"listening to the podcast. And"},{"speaker":"Chris Dy","startTime":776.02,"endTime":779.2,"body":"some of the more technical"},{"speaker":"Chris Dy","startTime":779.2,"endTime":781.86,"body":"discussions are a little bit"},{"speaker":"Chris Dy","startTime":779.2,"endTime":781.86,"body":"outside of what a pm and our doc"},{"speaker":"Chris Dy","startTime":781.86,"endTime":786.72,"body":"would would typically take home"},{"speaker":"Chris Dy","startTime":781.86,"endTime":786.72,"body":"a lot from but he did ask about"},{"speaker":"Chris Dy","startTime":787.14,"endTime":790.02,"body":"to us to talk about climbing"},{"speaker":"Chris Dy","startTime":787.14,"endTime":790.02,"body":"injuries, pulley ruptures, but"},{"speaker":"Chris Dy","startTime":790.02,"endTime":792.6,"body":"any other kind of injuries that"},{"speaker":"Chris Dy","startTime":790.02,"endTime":792.6,"body":"are relevant to rock climbers,"},{"speaker":"Chris Dy","startTime":792.6,"endTime":795.72,"body":"which was perfectly timed"},{"speaker":"Chris Dy","startTime":792.6,"endTime":795.72,"body":"because we actually had recently"},{"speaker":"Chris Dy","startTime":795.72,"endTime":799.62,"body":"read an article in JHS center."},{"speaker":"Chris Dy","startTime":795.72,"endTime":799.62,"body":"It was a current concepts review"},{"speaker":"Chris Dy","startTime":799.62,"endTime":802.88,"body":"on on rock climbing injuries."},{"speaker":"Chris Dy","startTime":799.62,"endTime":802.88,"body":"Thank you, Chris, for writing"},{"speaker":"Chris Dy","startTime":802.88,"endTime":805.58,"body":"that in. And I think Chuck, if"},{"speaker":"Chris Dy","startTime":802.88,"endTime":805.58,"body":"you have a case that we could"},{"speaker":"Chris Dy","startTime":805.58,"endTime":807.14,"body":"talk about that'd be super"},{"speaker":"Chris Dy","startTime":805.58,"endTime":807.14,"body":"helpful."},{"speaker":"Charles Goldfarb","startTime":807.5,"endTime":810.2,"body":"First of all,"},{"speaker":"Charles Goldfarb","startTime":807.5,"endTime":810.2,"body":"I should say that, you know, we"},{"speaker":"Charles Goldfarb","startTime":810.2,"endTime":812.84,"body":"you and I brushed up on things"},{"speaker":"Charles Goldfarb","startTime":810.2,"endTime":812.84,"body":"that we like to make sure we"},{"speaker":"Charles Goldfarb","startTime":812.84,"endTime":817.34,"body":"don't miss any of the obvious"},{"speaker":"Charles Goldfarb","startTime":812.84,"endTime":817.34,"body":"issues. And so Laura Sims from"},{"speaker":"Charles Goldfarb","startTime":817.34,"endTime":821.86,"body":"the University of Saskatchewan"},{"speaker":"Charles Goldfarb","startTime":817.34,"endTime":821.86,"body":"had a good article in 2022 in"},{"speaker":"Charles Goldfarb","startTime":821.86,"endTime":824.74,"body":"general hand surgery entitled"},{"speaker":"Charles Goldfarb","startTime":821.86,"endTime":824.74,"body":"upper extremity injuries and"},{"speaker":"Charles Goldfarb","startTime":824.74,"endTime":827.26,"body":"rock climbers, diagnosis and"},{"speaker":"Charles Goldfarb","startTime":824.74,"endTime":827.26,"body":"management. I'll put this in the"},{"speaker":"Charles Goldfarb","startTime":827.26,"endTime":829.96,"body":"show note, show notes. And what"},{"speaker":"Charles Goldfarb","startTime":827.26,"endTime":829.96,"body":"was interesting about this"},{"speaker":"Charles Goldfarb","startTime":829.96,"endTime":835.3,"body":"article is it did emphasize"},{"speaker":"Charles Goldfarb","startTime":829.96,"endTime":835.3,"body":"other things besides finger"},{"speaker":"Charles Goldfarb","startTime":835.3,"endTime":838.72,"body":"issues. And I think those are"},{"speaker":"Charles Goldfarb","startTime":835.3,"endTime":838.72,"body":"all the pretty logical ones."},{"speaker":"Charles Goldfarb","startTime":838.72,"endTime":843.06,"body":"Whether it's TFCC from a"},{"speaker":"Charles Goldfarb","startTime":838.72,"endTime":843.06,"body":"rotational injury hook of the"},{"speaker":"Charles Goldfarb","startTime":843.06,"endTime":846.9,"body":"handmade, uh, elbow issues, like"},{"speaker":"Charles Goldfarb","startTime":843.06,"endTime":846.9,"body":"tendonitis, shoulder issues,"},{"speaker":"Charles Goldfarb","startTime":847.02,"endTime":850.2,"body":"those are all in play. But what"},{"speaker":"Charles Goldfarb","startTime":847.02,"endTime":850.2,"body":"most of us really think about"},{"speaker":"Charles Goldfarb","startTime":850.26,"endTime":853.5,"body":"with rock climbing is clear it's"},{"speaker":"Charles Goldfarb","startTime":850.26,"endTime":853.5,"body":"the flexor tendons from"},{"speaker":"Charles Goldfarb","startTime":853.5,"endTime":856.86,"body":"crimping, etc. So let me give"},{"speaker":"Charles Goldfarb","startTime":853.5,"endTime":856.86,"body":"you a case, and we'll use it as"},{"speaker":"Charles Goldfarb","startTime":856.86,"endTime":863.9,"body":"a jumping off. So I have a 32"},{"speaker":"Charles Goldfarb","startTime":856.86,"endTime":863.9,"body":"year old, fit young man who is"},{"speaker":"Charles Goldfarb","startTime":863.9,"endTime":868.16,"body":"an avid rock climber, not his"},{"speaker":"Charles Goldfarb","startTime":863.9,"endTime":868.16,"body":"job. He has a desk job during"},{"speaker":"Charles Goldfarb","startTime":868.16,"endTime":874.58,"body":"the day. He climbs three days a"},{"speaker":"Charles Goldfarb","startTime":868.16,"endTime":874.58,"body":"week plus, and came in with sort"},{"speaker":"Charles Goldfarb","startTime":874.58,"endTime":879.14,"body":"of an acute on chronic injury."},{"speaker":"Charles Goldfarb","startTime":874.58,"endTime":879.14,"body":"Had some middle finger pain,"},{"speaker":"Charles Goldfarb","startTime":879.98,"endTime":882.94,"body":"which was sort of at the base"},{"speaker":"Charles Goldfarb","startTime":879.98,"endTime":882.94,"body":"the finger, by his description."},{"speaker":"Charles Goldfarb","startTime":883.24,"endTime":887.62,"body":"And it got worse. He denied any"},{"speaker":"Charles Goldfarb","startTime":883.24,"endTime":887.62,"body":"sense of tearing. He had a"},{"speaker":"Charles Goldfarb","startTime":887.62,"endTime":892.36,"body":"little bit of swelling. Had"},{"speaker":"Charles Goldfarb","startTime":887.62,"endTime":892.36,"body":"maintained full mobility, but"},{"speaker":"Charles Goldfarb","startTime":892.36,"endTime":896.14,"body":"had pain, which prevented him"},{"speaker":"Charles Goldfarb","startTime":892.36,"endTime":896.14,"body":"from rock climbing. And when you"},{"speaker":"Charles Goldfarb","startTime":896.14,"endTime":898.6,"body":"get to the prevention stage,"},{"speaker":"Charles Goldfarb","startTime":896.14,"endTime":898.6,"body":"obviously that leads to the"},{"speaker":"Charles Goldfarb","startTime":898.6,"endTime":902.4,"body":"doctor's visit. Um. So how do"},{"speaker":"Charles Goldfarb","startTime":898.6,"endTime":902.4,"body":"you think about these things?"},{"speaker":"Charles Goldfarb","startTime":902.4,"endTime":904.74,"body":"What's running through your"},{"speaker":"Charles Goldfarb","startTime":902.4,"endTime":904.74,"body":"head? What testing Do you"},{"speaker":"Charles Goldfarb","startTime":904.74,"endTime":905.4,"body":"consider?"},{"speaker":"Chris Dy","startTime":906.36,"endTime":908.76,"body":"Well, first off, I"},{"speaker":"Chris Dy","startTime":906.36,"endTime":908.76,"body":"mean, I when I read the article,"},{"speaker":"Chris Dy","startTime":908.76,"endTime":912.06,"body":"I saw all the different grips,"},{"speaker":"Chris Dy","startTime":908.76,"endTime":912.06,"body":"and I was like, Man, I'm like,"},{"speaker":"Chris Dy","startTime":912.06,"endTime":915.12,"body":"not gripping things properly"},{"speaker":"Chris Dy","startTime":912.06,"endTime":915.12,"body":"when I'm doing my kind of twice"},{"speaker":"Chris Dy","startTime":915.12,"endTime":919.14,"body":"a year rock climbing indoors."},{"speaker":"Chris Dy","startTime":915.12,"endTime":919.14,"body":"But, yeah, no, I think that the"},{"speaker":"Chris Dy","startTime":919.14,"endTime":921.44,"body":"you know, the first thing you"},{"speaker":"Chris Dy","startTime":919.14,"endTime":921.44,"body":"think about, because of the way"},{"speaker":"Chris Dy","startTime":921.44,"endTime":923.42,"body":"that, you know, we've been"},{"speaker":"Chris Dy","startTime":921.44,"endTime":923.42,"body":"taught, is you think about, is"},{"speaker":"Chris Dy","startTime":923.42,"endTime":928.4,"body":"there a pulley rupture? And, you"},{"speaker":"Chris Dy","startTime":923.42,"endTime":928.4,"body":"know, the classic, you know,"},{"speaker":"Chris Dy","startTime":928.7,"endTime":931.16,"body":"vignette for a polypter Is"},{"speaker":"Chris Dy","startTime":928.7,"endTime":931.16,"body":"somebody feels a pop or a"},{"speaker":"Chris Dy","startTime":931.16,"endTime":933.8,"body":"sensation of tearing, and they"},{"speaker":"Chris Dy","startTime":931.16,"endTime":933.8,"body":"swell and they can't make a full"},{"speaker":"Chris Dy","startTime":933.8,"endTime":938.24,"body":"fist. Now, somebody doesn't have"},{"speaker":"Chris Dy","startTime":933.8,"endTime":938.24,"body":"to, kind of meet the classic"},{"speaker":"Chris Dy","startTime":938.24,"endTime":941.0,"body":"vignette to have an injury like"},{"speaker":"Chris Dy","startTime":938.24,"endTime":941.0,"body":"that, but that's the first thing"},{"speaker":"Chris Dy","startTime":941.0,"endTime":943.36,"body":"I'm thinking about. And then,"},{"speaker":"Chris Dy","startTime":941.0,"endTime":943.36,"body":"honestly, I learned a lot in"},{"speaker":"Chris Dy","startTime":943.36,"endTime":945.82,"body":"reading this article about some"},{"speaker":"Chris Dy","startTime":943.36,"endTime":945.82,"body":"of the other different things"},{"speaker":"Chris Dy","startTime":945.82,"endTime":948.1,"body":"that could happen in terms of,"},{"speaker":"Chris Dy","startTime":945.82,"endTime":948.1,"body":"you know, when the lumbar cool"},{"speaker":"Chris Dy","startTime":948.1,"endTime":950.32,"body":"shift, which was very"},{"speaker":"Chris Dy","startTime":948.1,"endTime":950.32,"body":"interesting. I think it depends"},{"speaker":"Chris Dy","startTime":950.32,"endTime":952.84,"body":"on what kind of grip the"},{"speaker":"Chris Dy","startTime":950.32,"endTime":952.84,"body":"patient's using. And we can talk"},{"speaker":"Chris Dy","startTime":952.84,"endTime":956.38,"body":"about that in more detail, about"},{"speaker":"Chris Dy","startTime":952.84,"endTime":956.38,"body":"how to think about that, how to"},{"speaker":"Chris Dy","startTime":956.38,"endTime":961.98,"body":"assess that. I think, you know,"},{"speaker":"Chris Dy","startTime":956.38,"endTime":961.98,"body":"the exam is critical. So"},{"speaker":"Chris Dy","startTime":961.98,"endTime":964.62,"body":"feeling, seeing where you know"},{"speaker":"Chris Dy","startTime":961.98,"endTime":964.62,"body":"if there's any clinically"},{"speaker":"Chris Dy","startTime":964.62,"endTime":967.2,"body":"visible lack of motion, you"},{"speaker":"Chris Dy","startTime":964.62,"endTime":967.2,"body":"said, Yes, full motion. If"},{"speaker":"Chris Dy","startTime":967.2,"endTime":970.14,"body":"there's any areas where there's"},{"speaker":"Chris Dy","startTime":967.2,"endTime":970.14,"body":"distinct ecchymosis or swelling"},{"speaker":"Chris Dy","startTime":970.14,"endTime":972.18,"body":"or tenderness, I think"},{"speaker":"Chris Dy","startTime":970.14,"endTime":972.18,"body":"tenderness is probably the"},{"speaker":"Chris Dy","startTime":972.18,"endTime":974.88,"body":"biggest thing for me on exam,"},{"speaker":"Chris Dy","startTime":972.18,"endTime":974.88,"body":"and then during that exam,"},{"speaker":"Chris Dy","startTime":974.88,"endTime":977.7,"body":"excluding other potential"},{"speaker":"Chris Dy","startTime":974.88,"endTime":977.7,"body":"issues, something more proximal,"},{"speaker":"Chris Dy","startTime":978.18,"endTime":981.14,"body":"or something like a collateral"},{"speaker":"Chris Dy","startTime":978.18,"endTime":981.14,"body":"ligament issue or a joint"},{"speaker":"Chris Dy","startTime":981.14,"endTime":983.24,"body":"sprain, or something like that,"},{"speaker":"Chris Dy","startTime":981.14,"endTime":983.24,"body":"which doesn't seem to be the"},{"speaker":"Chris Dy","startTime":983.24,"endTime":986.24,"body":"case here. So, and then we could"},{"speaker":"Chris Dy","startTime":983.24,"endTime":986.24,"body":"talk about imaging in a moment."},{"speaker":"Chris Dy","startTime":986.24,"endTime":989.12,"body":"But what is there anything else"},{"speaker":"Chris Dy","startTime":986.24,"endTime":989.12,"body":"you think about on the exam? I"},{"speaker":"Chris Dy","startTime":989.12,"endTime":989.72,"body":"think"},{"speaker":"Charles Goldfarb","startTime":990.92,"endTime":994.1,"body":"this will be a"},{"speaker":"Charles Goldfarb","startTime":990.92,"endTime":994.1,"body":"good video podcast for those who"},{"speaker":"Charles Goldfarb","startTime":994.1,"endTime":996.98,"body":"want to join us on YouTube, and"},{"speaker":"Charles Goldfarb","startTime":994.1,"endTime":996.98,"body":"we can talk about certain things"},{"speaker":"Charles Goldfarb","startTime":997.28,"endTime":1000.3,"body":"I would love to know, and I"},{"speaker":"Charles Goldfarb","startTime":997.28,"endTime":1000.3,"body":"really honestly, I would love to"},{"speaker":"Charles Goldfarb","startTime":1000.3,"endTime":1003.48,"body":"know, hopefully our listeners"},{"speaker":"Charles Goldfarb","startTime":1000.3,"endTime":1003.48,"body":"will as well. How do you examine"},{"speaker":"Charles Goldfarb","startTime":1003.48,"endTime":1006.6,"body":"in these situations? What are"},{"speaker":"Charles Goldfarb","startTime":1003.48,"endTime":1006.6,"body":"you testing? How do you look for"},{"speaker":"Charles Goldfarb","startTime":1006.6,"endTime":1011.22,"body":"bow string? How do you test FDS"},{"speaker":"Charles Goldfarb","startTime":1006.6,"endTime":1011.22,"body":"versus FDP? How do you palpate"},{"speaker":"Charles Goldfarb","startTime":1011.22,"endTime":1013.68,"body":"those kind of things? I think"},{"speaker":"Charles Goldfarb","startTime":1011.22,"endTime":1013.68,"body":"would be helpful to discuss and"},{"speaker":"Charles Goldfarb","startTime":1013.68,"endTime":1014.58,"body":"demonstrate. Maybe."},{"speaker":"Chris Dy","startTime":1015.42,"endTime":1018.12,"body":"Yeah, so, I mean, I"},{"speaker":"Chris Dy","startTime":1015.42,"endTime":1018.12,"body":"am. I don't have a great exam"},{"speaker":"Chris Dy","startTime":1018.12,"endTime":1021.14,"body":"specifically for bow stringing,"},{"speaker":"Chris Dy","startTime":1018.12,"endTime":1021.14,"body":"aside from tenderness along the"},{"speaker":"Chris Dy","startTime":1021.14,"endTime":1024.8,"body":"suspected areas. I mean, I think"},{"speaker":"Chris Dy","startTime":1021.14,"endTime":1024.8,"body":"the classic, you know, rupture"},{"speaker":"Chris Dy","startTime":1024.8,"endTime":1028.04,"body":"is going to be at a two, you"},{"speaker":"Chris Dy","startTime":1024.8,"endTime":1028.04,"body":"know, but that's not always the"},{"speaker":"Chris Dy","startTime":1028.04,"endTime":1031.16,"body":"case. I mean, there's tons of"},{"speaker":"Chris Dy","startTime":1028.04,"endTime":1031.16,"body":"pressure also over the PIP"},{"speaker":"Chris Dy","startTime":1031.22,"endTime":1034.4,"body":"during a lot of these grips. So"},{"speaker":"Chris Dy","startTime":1031.22,"endTime":1034.4,"body":"could be a three as well. But"},{"speaker":"Chris Dy","startTime":1034.4,"endTime":1036.92,"body":"seeing where they're tender,"},{"speaker":"Chris Dy","startTime":1034.4,"endTime":1036.92,"body":"whether where it is based on"},{"speaker":"Chris Dy","startTime":1036.92,"endTime":1039.2,"body":"from the, you know, in the area"},{"speaker":"Chris Dy","startTime":1036.92,"endTime":1039.2,"body":"between the Palmer digital"},{"speaker":"Chris Dy","startTime":1039.2,"endTime":1043.0,"body":"crease and the PIP crease, and"},{"speaker":"Chris Dy","startTime":1039.2,"endTime":1043.0,"body":"then trying to differentiate."},{"speaker":"Chris Dy","startTime":1043.0,"endTime":1045.4,"body":"So, yeah, if we're doing video,"},{"speaker":"Chris Dy","startTime":1043.0,"endTime":1045.4,"body":"so between the palm digital"},{"speaker":"Chris Dy","startTime":1045.4,"endTime":1049.12,"body":"crease and the PIP, and then"},{"speaker":"Chris Dy","startTime":1045.4,"endTime":1049.12,"body":"really trying to isolate the"},{"speaker":"Chris Dy","startTime":1049.12,"endTime":1051.88,"body":"FDS. So, you know, because of"},{"speaker":"Chris Dy","startTime":1049.12,"endTime":1051.88,"body":"the common, shared muscle belly,"},{"speaker":"Chris Dy","startTime":1051.88,"endTime":1055.96,"body":"oftentimes we'll kind of get the"},{"speaker":"Chris Dy","startTime":1051.88,"endTime":1055.96,"body":"fingers out and then try to get"},{"speaker":"Chris Dy","startTime":1055.96,"endTime":1063.24,"body":"the PIP flexing here and see if,"},{"speaker":"Chris Dy","startTime":1055.96,"endTime":1063.24,"body":"if that, if that elicits any"},{"speaker":"Chris Dy","startTime":1063.24,"endTime":1065.7,"body":"sort of limitations in motion"},{"speaker":"Chris Dy","startTime":1063.24,"endTime":1065.7,"body":"compared to the adjacent"},{"speaker":"Chris Dy","startTime":1065.7,"endTime":1068.46,"body":"fingers, and then you can"},{"speaker":"Chris Dy","startTime":1065.7,"endTime":1068.46,"body":"isolate the FDP by blocking the"},{"speaker":"Chris Dy","startTime":1068.46,"endTime":1073.38,"body":"FDP as well. So seeing how the"},{"speaker":"Chris Dy","startTime":1068.46,"endTime":1073.38,"body":"motion in those and if there is"},{"speaker":"Chris Dy","startTime":1073.38,"endTime":1076.68,"body":"differential glide, the odds of"},{"speaker":"Chris Dy","startTime":1073.38,"endTime":1076.68,"body":"there being anything crazy with"},{"speaker":"Chris Dy","startTime":1076.68,"endTime":1078.78,"body":"like a jersey finger or"},{"speaker":"Chris Dy","startTime":1076.68,"endTime":1078.78,"body":"something like that, you got to"},{"speaker":"Chris Dy","startTime":1078.78,"endTime":1081.32,"body":"make sure. But I think that's"},{"speaker":"Chris Dy","startTime":1078.78,"endTime":1081.32,"body":"less likely in this particular"},{"speaker":"Chris Dy","startTime":1081.32,"endTime":1081.98,"body":"situation. Yeah,"},{"speaker":"Charles Goldfarb","startTime":1082.34,"endTime":1084.44,"body":"I think that's"},{"speaker":"Charles Goldfarb","startTime":1082.34,"endTime":1084.44,"body":"well said, and for the younger"},{"speaker":"Charles Goldfarb","startTime":1084.44,"endTime":1088.22,"body":"listeners, I'm just going to"},{"speaker":"Charles Goldfarb","startTime":1084.44,"endTime":1088.22,"body":"make that hopefully maybe it was"},{"speaker":"Charles Goldfarb","startTime":1088.22,"endTime":1091.28,"body":"clear enough, maybe, maybe,"},{"speaker":"Charles Goldfarb","startTime":1088.22,"endTime":1091.28,"body":"maybe not. So what Chris was"},{"speaker":"Charles Goldfarb","startTime":1091.28,"endTime":1094.82,"body":"saying is, if you want to test"},{"speaker":"Charles Goldfarb","startTime":1091.28,"endTime":1094.82,"body":"FDS, if you keep the other"},{"speaker":"Charles Goldfarb","startTime":1094.82,"endTime":1097.76,"body":"fingers extended. So if you're"},{"speaker":"Charles Goldfarb","startTime":1094.82,"endTime":1097.76,"body":"going to test FDS and middle"},{"speaker":"Charles Goldfarb","startTime":1097.76,"endTime":1100.04,"body":"finger, you extend the other"},{"speaker":"Charles Goldfarb","startTime":1097.76,"endTime":1100.04,"body":"three fingers and ask the"},{"speaker":"Charles Goldfarb","startTime":1100.04,"endTime":1104.08,"body":"patient to flex, because the FTP"},{"speaker":"Charles Goldfarb","startTime":1100.04,"endTime":1104.08,"body":"is a common muscle belly"},{"speaker":"Charles Goldfarb","startTime":1104.56,"endTime":1107.2,"body":"isolated flexion of, say, the"},{"speaker":"Charles Goldfarb","startTime":1104.56,"endTime":1107.2,"body":"middle finger, which I have"},{"speaker":"Charles Goldfarb","startTime":1107.2,"endTime":1111.28,"body":"flexed here, is done only by the"},{"speaker":"Charles Goldfarb","startTime":1107.2,"endTime":1111.28,"body":"FDS. And so it's a great way to"},{"speaker":"Charles Goldfarb","startTime":1111.28,"endTime":1113.98,"body":"isolate the FDS, and you can do"},{"speaker":"Charles Goldfarb","startTime":1111.28,"endTime":1113.98,"body":"that for each finger. And then,"},{"speaker":"Charles Goldfarb","startTime":1113.98,"endTime":1117.4,"body":"as Chris said, test the FTP."},{"speaker":"Charles Goldfarb","startTime":1113.98,"endTime":1117.4,"body":"This is not only applicable for"},{"speaker":"Charles Goldfarb","startTime":1117.4,"endTime":1120.28,"body":"rock climbing. It's also"},{"speaker":"Charles Goldfarb","startTime":1117.4,"endTime":1120.28,"body":"applicable for give a laceration"},{"speaker":"Charles Goldfarb","startTime":1120.28,"endTime":1122.82,"body":"in the palm and you're trying to"},{"speaker":"Charles Goldfarb","startTime":1120.28,"endTime":1122.82,"body":"figure out what may be injured,"},{"speaker":"Charles Goldfarb","startTime":1122.82,"endTime":1126.48,"body":"and what gets tricky in this"},{"speaker":"Charles Goldfarb","startTime":1122.82,"endTime":1126.48,"body":"case and in a laceration case,"},{"speaker":"Charles Goldfarb","startTime":1126.48,"endTime":1130.74,"body":"is, what if you nick the sheath,"},{"speaker":"Charles Goldfarb","startTime":1126.48,"endTime":1130.74,"body":"you know, does that cause pain?"},{"speaker":"Charles Goldfarb","startTime":1130.74,"endTime":1133.68,"body":"What if you Nick a tendon and"},{"speaker":"Charles Goldfarb","startTime":1130.74,"endTime":1133.68,"body":"have a partial tendon injury?"},{"speaker":"Charles Goldfarb","startTime":1133.68,"endTime":1137.04,"body":"And so you're not only looking"},{"speaker":"Charles Goldfarb","startTime":1133.68,"endTime":1137.04,"body":"for the ability to flex, you're"},{"speaker":"Charles Goldfarb","startTime":1137.04,"endTime":1139.5,"body":"looking for pain with flexion."},{"speaker":"Charles Goldfarb","startTime":1137.04,"endTime":1139.5,"body":"And I'll say one other thing"},{"speaker":"Charles Goldfarb","startTime":1139.5,"endTime":1142.1,"body":"before I turn it back to you"},{"speaker":"Charles Goldfarb","startTime":1139.5,"endTime":1142.1,"body":"this article I thought was"},{"speaker":"Charles Goldfarb","startTime":1142.1,"endTime":1146.12,"body":"really helpful to test for bow"},{"speaker":"Charles Goldfarb","startTime":1142.1,"endTime":1146.12,"body":"stringing. Which, which we, you"},{"speaker":"Charles Goldfarb","startTime":1146.12,"endTime":1149.18,"body":"know, is not the easiest thing"},{"speaker":"Charles Goldfarb","startTime":1146.12,"endTime":1149.18,"body":"to test for. It often is seen on"},{"speaker":"Charles Goldfarb","startTime":1149.18,"endTime":1153.2,"body":"imaging more easily is basically"},{"speaker":"Charles Goldfarb","startTime":1149.18,"endTime":1153.2,"body":"it's resisted PIP flexion and"},{"speaker":"Charles Goldfarb","startTime":1153.2,"endTime":1157.94,"body":"potentially palpable. I honestly"},{"speaker":"Charles Goldfarb","startTime":1153.2,"endTime":1157.94,"body":"can't say I've ever palpated bow"},{"speaker":"Charles Goldfarb","startTime":1157.94,"endTime":1160.9,"body":"stringing in this kind of"},{"speaker":"Charles Goldfarb","startTime":1157.94,"endTime":1160.9,"body":"situation and a patient that"},{"speaker":"Charles Goldfarb","startTime":1160.9,"endTime":1163.54,"body":"didn't feel a pop. I'm not sure"},{"speaker":"Charles Goldfarb","startTime":1160.9,"endTime":1163.54,"body":"we're really worried about both"},{"speaker":"Charles Goldfarb","startTime":1163.54,"endTime":1165.58,"body":"training, but it's something you"},{"speaker":"Charles Goldfarb","startTime":1163.54,"endTime":1165.58,"body":"want to test for."},{"speaker":"Chris Dy","startTime":1165.82,"endTime":1167.86,"body":"Yeah, and I think"},{"speaker":"Chris Dy","startTime":1165.82,"endTime":1167.86,"body":"that's, that's well said. And,"},{"speaker":"Chris Dy","startTime":1167.86,"endTime":1170.62,"body":"you know, I think that as you're"},{"speaker":"Chris Dy","startTime":1167.86,"endTime":1170.62,"body":"examining the other thing that"},{"speaker":"Chris Dy","startTime":1170.62,"endTime":1173.32,"body":"tends to be in differential is"},{"speaker":"Chris Dy","startTime":1170.62,"endTime":1173.32,"body":"more of a generalized flexor"},{"speaker":"Chris Dy","startTime":1173.32,"endTime":1176.62,"body":"Tina synovitis kind of thing,"},{"speaker":"Chris Dy","startTime":1173.32,"endTime":1176.62,"body":"not necessarily along the lines"},{"speaker":"Chris Dy","startTime":1176.62,"endTime":1180.1,"body":"of trigger finger, but probably"},{"speaker":"Chris Dy","startTime":1176.62,"endTime":1180.1,"body":"in this similar family and that,"},{"speaker":"Chris Dy","startTime":1180.1,"endTime":1182.94,"body":"I think would be diagnosed with"},{"speaker":"Chris Dy","startTime":1180.1,"endTime":1182.94,"body":"kind of palpate pain with"},{"speaker":"Chris Dy","startTime":1182.94,"endTime":1185.28,"body":"palpation, a little more"},{"speaker":"Chris Dy","startTime":1182.94,"endTime":1185.28,"body":"proximally than what we've been"},{"speaker":"Chris Dy","startTime":1185.28,"endTime":1187.92,"body":"talking about so near the distal"},{"speaker":"Chris Dy","startTime":1185.28,"endTime":1187.92,"body":"Palmer crease, proximal to the"},{"speaker":"Chris Dy","startTime":1187.92,"endTime":1191.04,"body":"Palmer digital crease would get"},{"speaker":"Chris Dy","startTime":1187.92,"endTime":1191.04,"body":"you, give you a good sense of"},{"speaker":"Chris Dy","startTime":1191.04,"endTime":1194.16,"body":"that, but I completely agree. I"},{"speaker":"Chris Dy","startTime":1191.04,"endTime":1194.16,"body":"think the bow string is probably"},{"speaker":"Chris Dy","startTime":1194.16,"endTime":1198.96,"body":"more more readily diagnosed on"},{"speaker":"Chris Dy","startTime":1194.16,"endTime":1198.96,"body":"imaging. Probably would get a"},{"speaker":"Chris Dy","startTime":1198.96,"endTime":1202.04,"body":"fluorescing image just. For"},{"speaker":"Chris Dy","startTime":1198.96,"endTime":1202.04,"body":"exclusion sake, but not"},{"speaker":"Chris Dy","startTime":1202.04,"endTime":1204.74,"body":"necessarily. Sometimes, if"},{"speaker":"Chris Dy","startTime":1202.04,"endTime":1204.74,"body":"you're going the MRI route,"},{"speaker":"Chris Dy","startTime":1204.92,"endTime":1209.06,"body":"having a plain film type image"},{"speaker":"Chris Dy","startTime":1204.92,"endTime":1209.06,"body":"is helpful for authorization in"},{"speaker":"Chris Dy","startTime":1209.06,"endTime":1212.0,"body":"the United States, but I think"},{"speaker":"Chris Dy","startTime":1209.06,"endTime":1212.0,"body":"ultrasound is really helpful in"},{"speaker":"Chris Dy","startTime":1212.0,"endTime":1214.82,"body":"this particular situation. Yes,"},{"speaker":"Charles Goldfarb","startTime":1214.88,"endTime":1217.22,"body":"totally agree."},{"speaker":"Charles Goldfarb","startTime":1214.88,"endTime":1217.22,"body":"I mean, MRI can be utilized, and"},{"speaker":"Charles Goldfarb","startTime":1217.22,"endTime":1219.38,"body":"it's institution dependent. How"},{"speaker":"Charles Goldfarb","startTime":1217.22,"endTime":1219.38,"body":"good are your ultra"},{"speaker":"Charles Goldfarb","startTime":1219.38,"endTime":1223.72,"body":"stenographers? Are you the hand"},{"speaker":"Charles Goldfarb","startTime":1219.38,"endTime":1223.72,"body":"surgeon doing ultrasound? But"},{"speaker":"Charles Goldfarb","startTime":1223.72,"endTime":1227.86,"body":"ultrasound is my first choice. I"},{"speaker":"Charles Goldfarb","startTime":1223.72,"endTime":1227.86,"body":"know you do some ultrasound. Is"},{"speaker":"Charles Goldfarb","startTime":1227.86,"endTime":1230.14,"body":"this something you would feel"},{"speaker":"Charles Goldfarb","startTime":1227.86,"endTime":1230.14,"body":"comfortable ultrasounding"},{"speaker":"Charles Goldfarb","startTime":1230.14,"endTime":1231.58,"body":"yourself? Or do you send this"},{"speaker":"Charles Goldfarb","startTime":1230.14,"endTime":1231.58,"body":"out?"},{"speaker":"Chris Dy","startTime":1231.94,"endTime":1233.86,"body":"I don't. I mean, I"},{"speaker":"Chris Dy","startTime":1231.94,"endTime":1233.86,"body":"think if I worked at it a bit, I"},{"speaker":"Chris Dy","startTime":1233.86,"endTime":1236.56,"body":"could do it. But to be honest,"},{"speaker":"Chris Dy","startTime":1233.86,"endTime":1236.56,"body":"from a practical perspective, we"},{"speaker":"Chris Dy","startTime":1236.56,"endTime":1239.74,"body":"don't have a probe small enough"},{"speaker":"Chris Dy","startTime":1236.56,"endTime":1239.74,"body":"in the clinic where I work to do"},{"speaker":"Chris Dy","startTime":1239.74,"endTime":1243.54,"body":"it, so the small footprint probe"},{"speaker":"Chris Dy","startTime":1239.74,"endTime":1243.54,"body":"tends to live in the two other"},{"speaker":"Chris Dy","startTime":1243.54,"endTime":1247.02,"body":"locations where I don't go. So"},{"speaker":"Chris Dy","startTime":1243.54,"endTime":1247.02,"body":"it just, honestly, it's just, I"},{"speaker":"Chris Dy","startTime":1247.02,"endTime":1249.72,"body":"think, easier for me, and I feel"},{"speaker":"Chris Dy","startTime":1247.02,"endTime":1249.72,"body":"more confident sending it to one"},{"speaker":"Chris Dy","startTime":1249.72,"endTime":1253.26,"body":"of our partners in our pm and"},{"speaker":"Chris Dy","startTime":1249.72,"endTime":1253.26,"body":"our department division that do"},{"speaker":"Chris Dy","startTime":1253.26,"endTime":1255.6,"body":"this quite readily. And"},{"speaker":"Chris Dy","startTime":1253.26,"endTime":1255.6,"body":"obviously we have radiologists"},{"speaker":"Chris Dy","startTime":1255.6,"endTime":1257.88,"body":"who are skilled as well."},{"speaker":"Chris Dy","startTime":1255.6,"endTime":1257.88,"body":"Perfect,"},{"speaker":"Charles Goldfarb","startTime":1257.88,"endTime":1260.22,"body":"perfect. Yeah,"},{"speaker":"Charles Goldfarb","startTime":1257.88,"endTime":1260.22,"body":"we are in a very enviable"},{"speaker":"Charles Goldfarb","startTime":1260.22,"endTime":1262.98,"body":"situation where we have multiple"},{"speaker":"Charles Goldfarb","startTime":1260.22,"endTime":1262.98,"body":"different providers who can put"},{"speaker":"Charles Goldfarb","startTime":1262.98,"endTime":1267.44,"body":"providers who can provide this"},{"speaker":"Charles Goldfarb","startTime":1262.98,"endTime":1267.44,"body":"service. So you see the patient,"},{"speaker":"Charles Goldfarb","startTime":1267.56,"endTime":1270.38,"body":"they have some vague discomfort,"},{"speaker":"Charles Goldfarb","startTime":1267.56,"endTime":1270.38,"body":"let's say near the palm of"},{"speaker":"Charles Goldfarb","startTime":1270.38,"endTime":1275.42,"body":"digital crease, no palpable bow"},{"speaker":"Charles Goldfarb","startTime":1270.38,"endTime":1275.42,"body":"springing, no ganglions, some"},{"speaker":"Charles Goldfarb","startTime":1275.42,"endTime":1278.3,"body":"mild discomfort with resisted"},{"speaker":"Charles Goldfarb","startTime":1275.42,"endTime":1278.3,"body":"flexion, but nothing dramatic."},{"speaker":"Charles Goldfarb","startTime":1278.3,"endTime":1281.5,"body":"But you know the guy said that,"},{"speaker":"Charles Goldfarb","startTime":1278.3,"endTime":1281.5,"body":"hey, I haven't climbed in two"},{"speaker":"Charles Goldfarb","startTime":1281.5,"endTime":1284.98,"body":"weeks. It feels a little better,"},{"speaker":"Charles Goldfarb","startTime":1281.5,"endTime":1284.98,"body":"but I still have pain, and so is"},{"speaker":"Charles Goldfarb","startTime":1284.98,"endTime":1288.58,"body":"your next step in ultrasound? Or"},{"speaker":"Charles Goldfarb","startTime":1284.98,"endTime":1288.58,"body":"would you consider an injection"},{"speaker":"Charles Goldfarb","startTime":1288.58,"endTime":1290.68,"body":"on that first clinic visit? Or"},{"speaker":"Charles Goldfarb","startTime":1288.58,"endTime":1290.68,"body":"what do you"},{"speaker":"Chris Dy","startTime":1290.68,"endTime":1292.6,"body":"do? I wouldn't"},{"speaker":"Chris Dy","startTime":1290.68,"endTime":1292.6,"body":"necessarily go straight to an"},{"speaker":"Chris Dy","startTime":1292.6,"endTime":1296.8,"body":"injection. I think if I was, you"},{"speaker":"Chris Dy","startTime":1292.6,"endTime":1296.8,"body":"know, I think if they're rock"},{"speaker":"Chris Dy","startTime":1296.8,"endTime":1300.34,"body":"climbers, tend to be a different"},{"speaker":"Chris Dy","startTime":1296.8,"endTime":1300.34,"body":"breed. They love rock climbing,"},{"speaker":"Chris Dy","startTime":1300.76,"endTime":1304.02,"body":"and they're very apt to continue"},{"speaker":"Chris Dy","startTime":1300.76,"endTime":1304.02,"body":"climbing through a lot of stuff."},{"speaker":"Chris Dy","startTime":1304.02,"endTime":1308.04,"body":"But if it says a lot, if this"},{"speaker":"Chris Dy","startTime":1304.02,"endTime":1308.04,"body":"patient can't climb one thing"},{"speaker":"Chris Dy","startTime":1308.04,"endTime":1310.98,"body":"that we didn't talk about, but"},{"speaker":"Chris Dy","startTime":1308.04,"endTime":1310.98,"body":"you know, if, if this was not"},{"speaker":"Chris Dy","startTime":1310.98,"endTime":1314.04,"body":"the middle finger, but if it was"},{"speaker":"Chris Dy","startTime":1310.98,"endTime":1314.04,"body":"the ring or the small, I think"},{"speaker":"Chris Dy","startTime":1314.04,"endTime":1317.82,"body":"the differential changes a bit"},{"speaker":"Chris Dy","startTime":1314.04,"endTime":1317.82,"body":"to talk about hook of handmade"},{"speaker":"Chris Dy","startTime":1317.82,"endTime":1321.44,"body":"issues, and with the FDP ring"},{"speaker":"Chris Dy","startTime":1317.82,"endTime":1321.44,"body":"and small running over the hook"},{"speaker":"Chris Dy","startTime":1321.44,"endTime":1325.22,"body":"of the handmade and with that"},{"speaker":"Chris Dy","startTime":1321.44,"endTime":1325.22,"body":"kind of repetitive grip through"},{"speaker":"Chris Dy","startTime":1325.22,"endTime":1327.98,"body":"the FDPs that can really put a"},{"speaker":"Chris Dy","startTime":1325.22,"endTime":1327.98,"body":"lot of pressure on the handmade."},{"speaker":"Chris Dy","startTime":1328.16,"endTime":1331.46,"body":"And if your your suspicion is"},{"speaker":"Chris Dy","startTime":1328.16,"endTime":1331.46,"body":"more for a stress reaction or"},{"speaker":"Chris Dy","startTime":1331.46,"endTime":1334.88,"body":"eventually a non displaced"},{"speaker":"Chris Dy","startTime":1331.46,"endTime":1334.88,"body":"hookah handmade fracture, then"},{"speaker":"Chris Dy","startTime":1334.88,"endTime":1337.46,"body":"there might be a role for a"},{"speaker":"Chris Dy","startTime":1334.88,"endTime":1337.46,"body":"straight up cast immobilization,"},{"speaker":"Chris Dy","startTime":1337.76,"endTime":1340.16,"body":"which obviously would keep them"},{"speaker":"Chris Dy","startTime":1337.76,"endTime":1340.16,"body":"out of climbing for quite some"},{"speaker":"Chris Dy","startTime":1340.16,"endTime":1342.58,"body":"time. But I think my counseling"},{"speaker":"Chris Dy","startTime":1340.16,"endTime":1342.58,"body":"would probably be with this"},{"speaker":"Chris Dy","startTime":1342.58,"endTime":1346.72,"body":"middle finger patient to say,"},{"speaker":"Chris Dy","startTime":1342.58,"endTime":1346.72,"body":"why don't you stop climbing for"},{"speaker":"Chris Dy","startTime":1346.72,"endTime":1350.26,"body":"a bit? Let's see if things quiet"},{"speaker":"Chris Dy","startTime":1346.72,"endTime":1350.26,"body":"down even before jumping to an"},{"speaker":"Chris Dy","startTime":1350.26,"endTime":1353.14,"body":"ultrasound or an MRI. I may just"},{"speaker":"Chris Dy","startTime":1350.26,"endTime":1353.14,"body":"give them the option of activity"},{"speaker":"Chris Dy","startTime":1353.14,"endTime":1356.74,"body":"modification and a pulley rig,"},{"speaker":"Chris Dy","startTime":1353.14,"endTime":1356.74,"body":"because even if it's not truly a"},{"speaker":"Chris Dy","startTime":1356.74,"endTime":1359.8,"body":"pulley injury, that might make"},{"speaker":"Chris Dy","startTime":1356.74,"endTime":1359.8,"body":"them feel a bit better, and I"},{"speaker":"Chris Dy","startTime":1359.8,"endTime":1362.7,"body":"think that's something that can"},{"speaker":"Chris Dy","startTime":1359.8,"endTime":1362.7,"body":"be readily accomplished by our"},{"speaker":"Chris Dy","startTime":1362.7,"endTime":1366.18,"body":"therapy colleagues, or pulley"},{"speaker":"Chris Dy","startTime":1362.7,"endTime":1366.18,"body":"rings can also be purchased. You"},{"speaker":"Chris Dy","startTime":1366.18,"endTime":1368.1,"body":"know, on the on the interwebs, I"},{"speaker":"Chris Dy","startTime":1366.18,"endTime":1368.1,"body":"love"},{"speaker":"Charles Goldfarb","startTime":1369.54,"endTime":1371.16,"body":"all that. I"},{"speaker":"Charles Goldfarb","startTime":1369.54,"endTime":1371.16,"body":"want to, I want to follow up on"},{"speaker":"Charles Goldfarb","startTime":1371.16,"endTime":1374.52,"body":"a couple of those things. First"},{"speaker":"Charles Goldfarb","startTime":1371.16,"endTime":1374.52,"body":"of all, I'll start by saying"},{"speaker":"Charles Goldfarb","startTime":1374.52,"endTime":1378.96,"body":"many of these experienced"},{"speaker":"Charles Goldfarb","startTime":1374.52,"endTime":1378.96,"body":"climbers will take their fingers"},{"speaker":"Charles Goldfarb","startTime":1378.96,"endTime":1382.82,"body":"in advance, or will take their"},{"speaker":"Charles Goldfarb","startTime":1378.96,"endTime":1382.82,"body":"fingers in an effort to control"},{"speaker":"Charles Goldfarb","startTime":1382.82,"endTime":1385.94,"body":"discomfort and create their own"},{"speaker":"Charles Goldfarb","startTime":1382.82,"endTime":1385.94,"body":"pulley rings with tape. We all"},{"speaker":"Charles Goldfarb","startTime":1385.94,"endTime":1389.24,"body":"know the limitations of tape,"},{"speaker":"Charles Goldfarb","startTime":1385.94,"endTime":1389.24,"body":"though tape is uh, it feels good"},{"speaker":"Charles Goldfarb","startTime":1389.24,"endTime":1391.4,"body":"when you first put it on,"},{"speaker":"Charles Goldfarb","startTime":1389.24,"endTime":1391.4,"body":"whether you're taping your ankle"},{"speaker":"Charles Goldfarb","startTime":1391.4,"endTime":1395.48,"body":"or taping your fingers, but it"},{"speaker":"Charles Goldfarb","startTime":1391.4,"endTime":1395.48,"body":"doesn't tend to do much over"},{"speaker":"Charles Goldfarb","startTime":1395.48,"endTime":1399.08,"body":"time, especially with sweat. So"},{"speaker":"Charles Goldfarb","startTime":1395.48,"endTime":1399.08,"body":"pulley rings make sense and can"},{"speaker":"Charles Goldfarb","startTime":1399.08,"endTime":1401.92,"body":"be helpful, along with the"},{"speaker":"Charles Goldfarb","startTime":1399.08,"endTime":1401.92,"body":"typical non operative modalities"},{"speaker":"Charles Goldfarb","startTime":1401.92,"endTime":1405.7,"body":"like anti inflammatories, etc."},{"speaker":"Charles Goldfarb","startTime":1401.92,"endTime":1405.7,"body":"The other thing you said, which"},{"speaker":"Charles Goldfarb","startTime":1405.7,"endTime":1408.58,"body":"is interesting, which I totally"},{"speaker":"Charles Goldfarb","startTime":1405.7,"endTime":1408.58,"body":"agree with, is the hook of the"},{"speaker":"Charles Goldfarb","startTime":1408.58,"endTime":1413.2,"body":"hand, and so I have"},{"speaker":"Charles Goldfarb","startTime":1408.58,"endTime":1413.2,"body":"traditionally, and this is a"},{"speaker":"Charles Goldfarb","startTime":1413.2,"endTime":1415.6,"body":"little bit of a side, but not"},{"speaker":"Charles Goldfarb","startTime":1413.2,"endTime":1415.6,"body":"really diagnosed, hook of the"},{"speaker":"Charles Goldfarb","startTime":1415.6,"endTime":1419.5,"body":"hand, just by palpation, right?"},{"speaker":"Charles Goldfarb","startTime":1415.6,"endTime":1419.5,"body":"So you go about two centimeters"},{"speaker":"Charles Goldfarb","startTime":1419.5,"endTime":1423.06,"body":"distal and radial to your PISA"},{"speaker":"Charles Goldfarb","startTime":1419.5,"endTime":1423.06,"body":"form. PISA form is always at the"},{"speaker":"Charles Goldfarb","startTime":1423.06,"endTime":1426.42,"body":"risk crease and hoping the"},{"speaker":"Charles Goldfarb","startTime":1423.06,"endTime":1426.42,"body":"handmade is distal. And"},{"speaker":"Charles Goldfarb","startTime":1426.42,"endTime":1429.96,"body":"typically, it's an easy"},{"speaker":"Charles Goldfarb","startTime":1426.42,"endTime":1429.96,"body":"diagnosis, so to speak. I love"},{"speaker":"Charles Goldfarb","startTime":1430.02,"endTime":1433.56,"body":"this test, which I honestly"},{"speaker":"Charles Goldfarb","startTime":1430.02,"endTime":1433.56,"body":"haven't been doing for that many"},{"speaker":"Charles Goldfarb","startTime":1433.56,"endTime":1437.4,"body":"years, where you ask the patient"},{"speaker":"Charles Goldfarb","startTime":1433.56,"endTime":1437.4,"body":"to only deviate the wrist, even"},{"speaker":"Charles Goldfarb","startTime":1437.4,"endTime":1440.42,"body":"though I don't think that's"},{"speaker":"Charles Goldfarb","startTime":1437.4,"endTime":1440.42,"body":"vital, you extend the wrist a"},{"speaker":"Charles Goldfarb","startTime":1440.42,"endTime":1444.44,"body":"little bit, and then resist, you"},{"speaker":"Charles Goldfarb","startTime":1440.42,"endTime":1444.44,"body":"know, flex their fingers. And I"},{"speaker":"Charles Goldfarb","startTime":1444.44,"endTime":1447.86,"body":"resist them. If they have a hook"},{"speaker":"Charles Goldfarb","startTime":1444.44,"endTime":1447.86,"body":"of the hand manufacturer, they"},{"speaker":"Charles Goldfarb","startTime":1447.86,"endTime":1453.26,"body":"jump off the chair. It is"},{"speaker":"Charles Goldfarb","startTime":1447.86,"endTime":1453.26,"body":"really, really impressive. It's"},{"speaker":"Charles Goldfarb","startTime":1453.26,"endTime":1454.58,"body":"a super helpful test, yeah."},{"speaker":"Chris Dy","startTime":1454.58,"endTime":1457.04,"body":"And in addition to"},{"speaker":"Chris Dy","startTime":1454.58,"endTime":1457.04,"body":"what Chuck has shown us here on"},{"speaker":"Chris Dy","startTime":1457.04,"endTime":1459.68,"body":"the video, I mean, it's, it's"},{"speaker":"Chris Dy","startTime":1457.04,"endTime":1459.68,"body":"nicely laid out in this article,"},{"speaker":"Chris Dy","startTime":1459.68,"endTime":1462.34,"body":"you know, the other way to"},{"speaker":"Chris Dy","startTime":1459.68,"endTime":1462.34,"body":"increase the sensitivity of that"},{"speaker":"Chris Dy","startTime":1462.34,"endTime":1465.04,"body":"test will be to palpate on the"},{"speaker":"Chris Dy","startTime":1462.34,"endTime":1465.04,"body":"hook, as you're doing that"},{"speaker":"Chris Dy","startTime":1465.04,"endTime":1468.88,"body":"resisted FDP for the ring and"},{"speaker":"Chris Dy","startTime":1465.04,"endTime":1468.88,"body":"small. And again, I think that's"},{"speaker":"Chris Dy","startTime":1468.88,"endTime":1471.7,"body":"a really interesting and great"},{"speaker":"Chris Dy","startTime":1468.88,"endTime":1471.7,"body":"test, and probably can help you"},{"speaker":"Chris Dy","startTime":1471.7,"endTime":1474.28,"body":"quite a bit without any imaging."},{"speaker":"Chris Dy","startTime":1471.7,"endTime":1474.28,"body":"Yeah."},{"speaker":"Charles Goldfarb","startTime":1474.52,"endTime":1476.38,"body":"And just to be"},{"speaker":"Charles Goldfarb","startTime":1474.52,"endTime":1476.38,"body":"clear, I think we glossed over"},{"speaker":"Charles Goldfarb","startTime":1476.44,"endTime":1479.2,"body":"it a little bit, and this"},{"speaker":"Charles Goldfarb","startTime":1476.44,"endTime":1479.2,"body":"article will help but crimping."},{"speaker":"Charles Goldfarb","startTime":1479.2,"endTime":1481.26,"body":"For those who aren't familiar"},{"speaker":"Charles Goldfarb","startTime":1479.2,"endTime":1481.26,"body":"with it. You know, there's"},{"speaker":"Charles Goldfarb","startTime":1481.26,"endTime":1483.66,"body":"different there's open crimp,"},{"speaker":"Charles Goldfarb","startTime":1481.26,"endTime":1483.66,"body":"closed crimp, and there's all"},{"speaker":"Charles Goldfarb","startTime":1483.66,"endTime":1485.7,"body":"kind of different hand"},{"speaker":"Charles Goldfarb","startTime":1483.66,"endTime":1485.7,"body":"positions. And I'm not a"},{"speaker":"Charles Goldfarb","startTime":1485.7,"endTime":1489.66,"body":"climber, so just the concept of"},{"speaker":"Charles Goldfarb","startTime":1485.7,"endTime":1489.66,"body":"crimping in general is a little"},{"speaker":"Charles Goldfarb","startTime":1489.66,"endTime":1494.7,"body":"bit of MP flexion, typically"},{"speaker":"Charles Goldfarb","startTime":1489.66,"endTime":1494.7,"body":"maximum PIP flexion, 9200"},{"speaker":"Charles Goldfarb","startTime":1495.12,"endTime":1498.36,"body":"degrees, and the dips are"},{"speaker":"Charles Goldfarb","startTime":1495.12,"endTime":1498.36,"body":"usually extended. So it's just"},{"speaker":"Charles Goldfarb","startTime":1498.36,"endTime":1502.52,"body":"an unusual force. Load on the"},{"speaker":"Charles Goldfarb","startTime":1498.36,"endTime":1502.52,"body":"fingers, which really puts"},{"speaker":"Charles Goldfarb","startTime":1502.52,"endTime":1506.66,"body":"pressure on the FDS and the a"},{"speaker":"Charles Goldfarb","startTime":1502.52,"endTime":1506.66,"body":"two pulley, as you mentioned."},{"speaker":"Chris Dy","startTime":1507.8,"endTime":1509.24,"body":"Yeah. So they"},{"speaker":"Chris Dy","startTime":1507.8,"endTime":1509.24,"body":"mentioned, they also showed, in"},{"speaker":"Chris Dy","startTime":1509.24,"endTime":1513.14,"body":"one of these crimping pictures,"},{"speaker":"Chris Dy","startTime":1509.24,"endTime":1513.14,"body":"that the thumb is, you know, the"},{"speaker":"Chris Dy","startTime":1513.14,"endTime":1517.1,"body":"thumb is pressing down and"},{"speaker":"Chris Dy","startTime":1513.14,"endTime":1517.1,"body":"applying additional pressure"},{"speaker":"Chris Dy","startTime":1517.64,"endTime":1522.52,"body":"over p2 which again, will extra"},{"speaker":"Chris Dy","startTime":1517.64,"endTime":1522.52,"body":"load that, that Pip, kind of a"},{"speaker":"Chris Dy","startTime":1522.52,"endTime":1525.94,"body":"two, a three, kind of pulley"},{"speaker":"Chris Dy","startTime":1522.52,"endTime":1525.94,"body":"area on the index finger. And"},{"speaker":"Chris Dy","startTime":1525.94,"endTime":1528.76,"body":"then for the for the hook of the"},{"speaker":"Chris Dy","startTime":1525.94,"endTime":1528.76,"body":"handmade thing. I mean, it was"},{"speaker":"Chris Dy","startTime":1528.76,"endTime":1531.64,"body":"interesting. They had these."},{"speaker":"Chris Dy","startTime":1528.76,"endTime":1531.64,"body":"They showed this really weird"},{"speaker":"Chris Dy","startTime":1531.64,"endTime":1533.8,"body":"grip, which I would have never"},{"speaker":"Chris Dy","startTime":1531.64,"endTime":1533.8,"body":"thought about, but this under"},{"speaker":"Chris Dy","startTime":1533.8,"endTime":1536.74,"body":"cling grip, which is like, you"},{"speaker":"Chris Dy","startTime":1533.8,"endTime":1536.74,"body":"know, flexion of the wrist and"},{"speaker":"Chris Dy","startTime":1536.74,"endTime":1539.2,"body":"ulnar deviation, and then"},{"speaker":"Chris Dy","startTime":1536.74,"endTime":1539.2,"body":"pulling through the FDP ring and"},{"speaker":"Chris Dy","startTime":1539.2,"endTime":1541.56,"body":"small, like the exact setup you"},{"speaker":"Chris Dy","startTime":1539.2,"endTime":1541.56,"body":"would need for a hook of the"},{"speaker":"Chris Dy","startTime":1541.56,"endTime":1543.0,"body":"handmade stress reaction."},{"speaker":"Charles Goldfarb","startTime":1544.02,"endTime":1547.14,"body":"Yeah, all kind"},{"speaker":"Charles Goldfarb","startTime":1544.02,"endTime":1547.14,"body":"of, all kind of unusual"},{"speaker":"Charles Goldfarb","startTime":1547.14,"endTime":1549.3,"body":"dynamics. So would you have"},{"speaker":"Charles Goldfarb","startTime":1547.14,"endTime":1549.3,"body":"injected"},{"speaker":"Chris Dy","startTime":1549.3,"endTime":1551.22,"body":"this patient? You"},{"speaker":"Chris Dy","startTime":1549.3,"endTime":1551.22,"body":"mentioned that you asked that to"},{"speaker":"Chris Dy","startTime":1551.28,"endTime":1553.08,"body":"me, and I said, No, but yeah, I"},{"speaker":"Charles Goldfarb","startTime":1553.08,"endTime":1555.12,"body":"would not. And"},{"speaker":"Charles Goldfarb","startTime":1553.08,"endTime":1555.12,"body":"maybe there's if the listeners"},{"speaker":"Charles Goldfarb","startTime":1555.12,"endTime":1558.18,"body":"out there would do it. Maybe, if"},{"speaker":"Charles Goldfarb","startTime":1555.12,"endTime":1558.18,"body":"you live in Boulder, Colorado,"},{"speaker":"Charles Goldfarb","startTime":1558.18,"endTime":1560.72,"body":"and you have a huge population,"},{"speaker":"Charles Goldfarb","startTime":1558.18,"endTime":1560.72,"body":"maybe you are injecting on the"},{"speaker":"Charles Goldfarb","startTime":1560.72,"endTime":1565.46,"body":"first visit. I always hesitate"},{"speaker":"Charles Goldfarb","startTime":1560.72,"endTime":1565.46,"body":"to inject on a first visit for a"},{"speaker":"Charles Goldfarb","startTime":1565.46,"endTime":1569.18,"body":"lot of reasons, including the"},{"speaker":"Charles Goldfarb","startTime":1565.46,"endTime":1569.18,"body":"fact that the path understanding"},{"speaker":"Charles Goldfarb","startTime":1569.18,"endTime":1571.88,"body":"the pathology, I think, is"},{"speaker":"Charles Goldfarb","startTime":1569.18,"endTime":1571.88,"body":"helpful in these situations."},{"speaker":"Charles Goldfarb","startTime":1571.88,"endTime":1575.48,"body":"Giving it a chance to calm down"},{"speaker":"Charles Goldfarb","startTime":1571.88,"endTime":1575.48,"body":"without jumping to an injection"},{"speaker":"Charles Goldfarb","startTime":1576.26,"endTime":1578.66,"body":"is just my preference. So I send"},{"speaker":"Charles Goldfarb","startTime":1576.26,"endTime":1578.66,"body":"it for an ultrasound."},{"speaker":"Chris Dy","startTime":1578.72,"endTime":1580.72,"body":"Yeah. And I think"},{"speaker":"Chris Dy","startTime":1578.72,"endTime":1580.72,"body":"practically, just for a number"},{"speaker":"Chris Dy","startTime":1580.72,"endTime":1582.76,"body":"of conditions. I'll tell our"},{"speaker":"Chris Dy","startTime":1580.72,"endTime":1582.76,"body":"learners when they're with me,"},{"speaker":"Chris Dy","startTime":1582.76,"endTime":1585.28,"body":"it's like, I try not to put"},{"speaker":"Chris Dy","startTime":1582.76,"endTime":1585.28,"body":"needles in people the first time"},{"speaker":"Chris Dy","startTime":1585.28,"endTime":1587.5,"body":"I meet them, try not to book"},{"speaker":"Chris Dy","startTime":1585.28,"endTime":1587.5,"body":"surgery the first time I meet"},{"speaker":"Chris Dy","startTime":1587.5,"endTime":1590.38,"body":"them. And just I usually say,"},{"speaker":"Chris Dy","startTime":1587.5,"endTime":1590.38,"body":"Listen, if it's really bugging"},{"speaker":"Chris Dy","startTime":1590.38,"endTime":1592.72,"body":"you, we can consider an"},{"speaker":"Chris Dy","startTime":1590.38,"endTime":1592.72,"body":"injection, but we might want to"},{"speaker":"Chris Dy","startTime":1592.72,"endTime":1595.12,"body":"keep that in our back pocket for"},{"speaker":"Chris Dy","startTime":1592.72,"endTime":1595.12,"body":"a future visit if things don't"},{"speaker":"Chris Dy","startTime":1595.12,"endTime":1599.26,"body":"quiet down. So I would have"},{"speaker":"Chris Dy","startTime":1595.12,"endTime":1599.26,"body":"gotten an ultrasound too. Plain"},{"speaker":"Chris Dy","startTime":1599.26,"endTime":1601.44,"body":"films any use for you, or you"},{"speaker":"Chris Dy","startTime":1599.26,"endTime":1601.44,"body":"skip that step,"},{"speaker":"Charles Goldfarb","startTime":1602.22,"endTime":1604.44,"body":"I think what"},{"speaker":"Charles Goldfarb","startTime":1602.22,"endTime":1604.44,"body":"you said is really important. I"},{"speaker":"Charles Goldfarb","startTime":1604.44,"endTime":1606.96,"body":"don't think they're necessarily"},{"speaker":"Charles Goldfarb","startTime":1604.44,"endTime":1606.96,"body":"useful. And if I'm going to get"},{"speaker":"Charles Goldfarb","startTime":1606.96,"endTime":1609.72,"body":"them, I probably do a mini CRM,"},{"speaker":"Charles Goldfarb","startTime":1606.96,"endTime":1609.72,"body":"just because it's quick and not"},{"speaker":"Charles Goldfarb","startTime":1609.72,"endTime":1613.8,"body":"terribly costly. But if you're"},{"speaker":"Charles Goldfarb","startTime":1609.72,"endTime":1613.8,"body":"considering an MRI, you almost"},{"speaker":"Charles Goldfarb","startTime":1613.8,"endTime":1616.8,"body":"always have to have a playing"},{"speaker":"Charles Goldfarb","startTime":1613.8,"endTime":1616.8,"body":"films before our insurance"},{"speaker":"Charles Goldfarb","startTime":1616.8,"endTime":1620.78,"body":"companies in the US will pay for"},{"speaker":"Charles Goldfarb","startTime":1616.8,"endTime":1620.78,"body":"it. So there's that factor."},{"speaker":"Charles Goldfarb","startTime":1620.78,"endTime":1624.98,"body":"Before I share the results of"},{"speaker":"Charles Goldfarb","startTime":1620.78,"endTime":1624.98,"body":"the ultrasound, I know you're"},{"speaker":"Charles Goldfarb","startTime":1624.98,"endTime":1629.06,"body":"dying to know what we found. I'd"},{"speaker":"Charles Goldfarb","startTime":1624.98,"endTime":1629.06,"body":"like to thank checkpoint"},{"speaker":"Charles Goldfarb","startTime":1629.06,"endTime":1630.2,"body":"surgical, yes,"},{"speaker":"Chris Dy","startTime":1630.2,"endTime":1631.88,"body":"the upper hand is"},{"speaker":"Chris Dy","startTime":1630.2,"endTime":1631.88,"body":"sponsored by checkpoint"},{"speaker":"Chris Dy","startTime":1631.88,"endTime":1634.22,"body":"surgical, a provider of"},{"speaker":"Chris Dy","startTime":1631.88,"endTime":1634.22,"body":"innovative solutions for"},{"speaker":"Chris Dy","startTime":1634.22,"endTime":1637.4,"body":"peripheral nerve surgery as a"},{"speaker":"Chris Dy","startTime":1634.22,"endTime":1637.4,"body":"hand surgeon and a hand"},{"speaker":"Chris Dy","startTime":1637.4,"endTime":1640.96,"body":"therapist or a pm and our doc,"},{"speaker":"Chris Dy","startTime":1637.4,"endTime":1640.96,"body":"or anybody that to his listening"},{"speaker":"Chris Dy","startTime":1640.96,"endTime":1643.0,"body":"to his podcast. You know that"},{"speaker":"Chris Dy","startTime":1640.96,"endTime":1643.0,"body":"the nerves matter. It's why"},{"speaker":"Chris Dy","startTime":1643.0,"endTime":1645.52,"body":"checkpoint surgical is"},{"speaker":"Chris Dy","startTime":1643.0,"endTime":1645.52,"body":"singularly focused on elevating"},{"speaker":"Chris Dy","startTime":1645.52,"endTime":1647.74,"body":"the clinical practice of"},{"speaker":"Chris Dy","startTime":1645.52,"endTime":1647.74,"body":"peripheral nerve surgery with"},{"speaker":"Chris Dy","startTime":1647.74,"endTime":1650.32,"body":"innovative technologies that"},{"speaker":"Chris Dy","startTime":1647.74,"endTime":1650.32,"body":"help improve patient outcomes."},{"speaker":"Charles Goldfarb","startTime":1650.74,"endTime":1652.84,"body":"Checkpoint"},{"speaker":"Charles Goldfarb","startTime":1650.74,"endTime":1652.84,"body":"surgical portfolio includes a"},{"speaker":"Charles Goldfarb","startTime":1652.84,"endTime":1656.32,"body":"range of handheld intraoperative"},{"speaker":"Charles Goldfarb","startTime":1652.84,"endTime":1656.32,"body":"nerve stimulators, nerve cutting"},{"speaker":"Charles Goldfarb","startTime":1656.32,"endTime":1659.74,"body":"instruments and biomaterials. To"},{"speaker":"Charles Goldfarb","startTime":1656.32,"endTime":1659.74,"body":"learn more, visit"},{"speaker":"Charles Goldfarb","startTime":1659.74,"endTime":1664.02,"body":"www.checkpointsurgical.com"},{"speaker":"Charles Goldfarb","startTime":1659.74,"endTime":1664.02,"body":"checkpoint surgical driving"},{"speaker":"Charles Goldfarb","startTime":1664.08,"endTime":1666.24,"body":"innovation and nerve surgery."},{"speaker":"Chris Dy","startTime":1666.9,"endTime":1669.12,"body":"There are nerves"},{"speaker":"Chris Dy","startTime":1666.9,"endTime":1669.12,"body":"around the police too. So you"},{"speaker":"Chris Dy","startTime":1669.12,"endTime":1671.94,"body":"know, it's not something we"},{"speaker":"Chris Dy","startTime":1669.12,"endTime":1671.94,"body":"talked about for this particular"},{"speaker":"Chris Dy","startTime":1671.94,"endTime":1674.94,"body":"condition, but they did mention"},{"speaker":"Chris Dy","startTime":1671.94,"endTime":1674.94,"body":"that carpal tunnel syndrome"},{"speaker":"Chris Dy","startTime":1674.94,"endTime":1677.4,"body":"could be something that you see"},{"speaker":"Chris Dy","startTime":1674.94,"endTime":1677.4,"body":"transiently in climbers, just"},{"speaker":"Chris Dy","startTime":1677.4,"endTime":1680.78,"body":"given all the all the stress on"},{"speaker":"Chris Dy","startTime":1677.4,"endTime":1680.78,"body":"the lung flexors as they enter"},{"speaker":"Chris Dy","startTime":1680.78,"endTime":1681.56,"body":"the carpal tunnel."},{"speaker":"Charles Goldfarb","startTime":1681.86,"endTime":1684.62,"body":"That's exactly"},{"speaker":"Charles Goldfarb","startTime":1681.86,"endTime":1684.62,"body":"right. So, you know, I hate to,"},{"speaker":"Charles Goldfarb","startTime":1684.86,"endTime":1689.24,"body":"you know, build up the suspense"},{"speaker":"Charles Goldfarb","startTime":1684.86,"endTime":1689.24,"body":"around what was the outcome of"},{"speaker":"Charles Goldfarb","startTime":1689.24,"endTime":1692.72,"body":"the ultrasound? And I have to"},{"speaker":"Charles Goldfarb","startTime":1689.24,"endTime":1692.72,"body":"say, this is, not uncommonly,"},{"speaker":"Charles Goldfarb","startTime":1692.72,"endTime":1696.08,"body":"the outcome. It didn't show"},{"speaker":"Charles Goldfarb","startTime":1692.72,"endTime":1696.08,"body":"much. It was, you know, the"},{"speaker":"Charles Goldfarb","startTime":1696.08,"endTime":1699.26,"body":"pulleys were intact. And I think"},{"speaker":"Charles Goldfarb","startTime":1696.08,"endTime":1699.26,"body":"in general, we have a sense of"},{"speaker":"Charles Goldfarb","startTime":1699.26,"endTime":1701.56,"body":"when the pulleys were ruptured,"},{"speaker":"Charles Goldfarb","startTime":1699.26,"endTime":1701.56,"body":"whether there's bow stringing or"},{"speaker":"Charles Goldfarb","startTime":1701.56,"endTime":1706.42,"body":"just that more sudden traumatic"},{"speaker":"Charles Goldfarb","startTime":1701.56,"endTime":1706.42,"body":"event with Audible popping or"},{"speaker":"Charles Goldfarb","startTime":1706.6,"endTime":1710.32,"body":"tearing, and there was"},{"speaker":"Charles Goldfarb","startTime":1706.6,"endTime":1710.32,"body":"inflammation, and that's all we"},{"speaker":"Charles Goldfarb","startTime":1710.32,"endTime":1713.32,"body":"found. So there's inflammation"},{"speaker":"Charles Goldfarb","startTime":1710.32,"endTime":1713.32,"body":"on the ultrasound. Patient"},{"speaker":"Charles Goldfarb","startTime":1713.32,"endTime":1717.04,"body":"remains sore. He's tried anti"},{"speaker":"Charles Goldfarb","startTime":1713.32,"endTime":1717.04,"body":"inflammatories, he's tried"},{"speaker":"Charles Goldfarb","startTime":1717.04,"endTime":1721.38,"body":"taping. And so I, as we've"},{"speaker":"Charles Goldfarb","startTime":1717.04,"endTime":1721.38,"body":"talked about, I call my patients"},{"speaker":"Charles Goldfarb","startTime":1721.38,"endTime":1725.4,"body":"with test results and then"},{"speaker":"Charles Goldfarb","startTime":1721.38,"endTime":1725.4,"body":"decide where to go with it. If"},{"speaker":"Charles Goldfarb","startTime":1725.4,"endTime":1728.04,"body":"I'd called him, he was better,"},{"speaker":"Charles Goldfarb","startTime":1725.4,"endTime":1728.04,"body":"I'd say, you know, tape and try"},{"speaker":"Charles Goldfarb","startTime":1728.04,"endTime":1731.04,"body":"to get back to climbing. But I"},{"speaker":"Charles Goldfarb","startTime":1728.04,"endTime":1731.04,"body":"called him and he wasn't better."},{"speaker":"Charles Goldfarb","startTime":1731.1,"endTime":1733.56,"body":"So I say, come back to the"},{"speaker":"Charles Goldfarb","startTime":1731.1,"endTime":1733.56,"body":"office. How do you handle that?"},{"speaker":"Chris Dy","startTime":1734.16,"endTime":1737.22,"body":"Similarly, I tried to"},{"speaker":"Chris Dy","startTime":1734.16,"endTime":1737.22,"body":"be better about calling and try"},{"speaker":"Chris Dy","startTime":1737.22,"endTime":1739.74,"body":"to get a sense of that, you"},{"speaker":"Chris Dy","startTime":1737.22,"endTime":1739.74,"body":"know, whether it's a patient I"},{"speaker":"Chris Dy","startTime":1739.74,"endTime":1741.86,"body":"want to call her and whether I"},{"speaker":"Chris Dy","startTime":1739.74,"endTime":1741.86,"body":"think that's going to be an"},{"speaker":"Chris Dy","startTime":1741.86,"endTime":1744.68,"body":"effective conversation, or"},{"speaker":"Chris Dy","startTime":1741.86,"endTime":1744.68,"body":"whether they're the kind of"},{"speaker":"Chris Dy","startTime":1744.68,"endTime":1747.32,"body":"person that's better off coming"},{"speaker":"Chris Dy","startTime":1744.68,"endTime":1747.32,"body":"in back. I think in this"},{"speaker":"Chris Dy","startTime":1747.32,"endTime":1750.08,"body":"particular demographic, he"},{"speaker":"Chris Dy","startTime":1747.32,"endTime":1750.08,"body":"probably wanted you to text him,"},{"speaker":"Chris Dy","startTime":1750.08,"endTime":1754.46,"body":"but you wouldn't do that, so you"},{"speaker":"Chris Dy","startTime":1750.08,"endTime":1754.46,"body":"call them instead. Yeah, so I"},{"speaker":"Chris Dy","startTime":1754.46,"endTime":1757.58,"body":"agree. I think that, you know,"},{"speaker":"Chris Dy","startTime":1754.46,"endTime":1757.58,"body":"oftentimes it is not a poly"},{"speaker":"Chris Dy","startTime":1757.58,"endTime":1760.36,"body":"rupture, although that is what"},{"speaker":"Chris Dy","startTime":1757.58,"endTime":1760.36,"body":"we want to diagnose. I think"},{"speaker":"Chris Dy","startTime":1760.36,"endTime":1762.4,"body":"some of our I think our"},{"speaker":"Chris Dy","startTime":1760.36,"endTime":1762.4,"body":"residents or fellows may have"},{"speaker":"Chris Dy","startTime":1762.4,"endTime":1765.58,"body":"heard me tell the story, but I"},{"speaker":"Chris Dy","startTime":1762.4,"endTime":1765.58,"body":"remember one time in the fall,"},{"speaker":"Chris Dy","startTime":1765.58,"endTime":1769.48,"body":"it was like the first month or"},{"speaker":"Chris Dy","startTime":1765.58,"endTime":1769.48,"body":"six weeks of my hand surgery"},{"speaker":"Chris Dy","startTime":1769.48,"endTime":1772.96,"body":"fellowship. I was, of course, on"},{"speaker":"Chris Dy","startTime":1769.48,"endTime":1772.96,"body":"Dr galbians rotation to start,"},{"speaker":"Chris Dy","startTime":1773.56,"endTime":1780.3,"body":"and we were in his clinic, and I"},{"speaker":"Chris Dy","startTime":1773.56,"endTime":1780.3,"body":"saw a patient who felt a pop and"},{"speaker":"Chris Dy","startTime":1780.3,"endTime":1783.18,"body":"couldn't move his finger very"},{"speaker":"Chris Dy","startTime":1780.3,"endTime":1783.18,"body":"well. And he wasn't a rock"},{"speaker":"Chris Dy","startTime":1783.18,"endTime":1785.52,"body":"climber, but he was a manual"},{"speaker":"Chris Dy","startTime":1783.18,"endTime":1785.52,"body":"laborer, and, you know, was"},{"speaker":"Chris Dy","startTime":1785.52,"endTime":1787.86,"body":"pulling something heavy off of"},{"speaker":"Chris Dy","startTime":1785.52,"endTime":1787.86,"body":"his truck. And I came out of the"},{"speaker":"Chris Dy","startTime":1787.86,"endTime":1790.68,"body":"room, and I very nervously"},{"speaker":"Chris Dy","startTime":1787.86,"endTime":1790.68,"body":"presented to Dr gelberman, and"},{"speaker":"Chris Dy","startTime":1790.68,"endTime":1793.74,"body":"said, you know, Dr gelberman, I"},{"speaker":"Chris Dy","startTime":1790.68,"endTime":1793.74,"body":"think this patient has a pulley"},{"speaker":"Chris Dy","startTime":1793.74,"endTime":1797.1,"body":"rupture, you know, how would you"},{"speaker":"Chris Dy","startTime":1793.74,"endTime":1797.1,"body":"like us? You know, I would plan"},{"speaker":"Chris Dy","startTime":1797.1,"endTime":1799.68,"body":"on getting some additional"},{"speaker":"Chris Dy","startTime":1797.1,"endTime":1799.68,"body":"imaging. And then he just looks"},{"speaker":"Chris Dy","startTime":1799.68,"endTime":1805.34,"body":"at me. He and says, Chris, do"},{"speaker":"Chris Dy","startTime":1799.68,"endTime":1805.34,"body":"you think he actually has a poly"},{"speaker":"Chris Dy","startTime":1805.34,"endTime":1808.88,"body":"rupture? I said, Yes. And he"},{"speaker":"Chris Dy","startTime":1805.34,"endTime":1808.88,"body":"looks over as medical assistant"},{"speaker":"Chris Dy","startTime":1808.88,"endTime":1812.78,"body":"says, Tiffany, have I ever"},{"speaker":"Chris Dy","startTime":1808.88,"endTime":1812.78,"body":"diagnosed a polypter in clinic?"},{"speaker":"Chris Dy","startTime":1813.38,"endTime":1816.68,"body":"And Tiffany's like, no, of"},{"speaker":"Chris Dy","startTime":1813.38,"endTime":1816.68,"body":"course not. Dr government. He"},{"speaker":"Chris Dy","startTime":1816.68,"endTime":1819.5,"body":"looks over at Rhonda, Hand"},{"speaker":"Chris Dy","startTime":1816.68,"endTime":1819.5,"body":"Therapist that's in clinic,"},{"speaker":"Chris Dy","startTime":1819.5,"endTime":1822.58,"body":"says, Rhonda, have I ever"},{"speaker":"Chris Dy","startTime":1819.5,"endTime":1822.58,"body":"diagnosed a polyruptor in"},{"speaker":"Chris Dy","startTime":1822.58,"endTime":1826.06,"body":"clinic? Said, of course not. Dr"},{"speaker":"Chris Dy","startTime":1822.58,"endTime":1826.06,"body":"galberman, and he looks at me"},{"speaker":"Chris Dy","startTime":1826.06,"endTime":1831.7,"body":"and just walks into the room as"},{"speaker":"Chris Dy","startTime":1826.06,"endTime":1831.7,"body":"if he had a trigger figure. So"},{"speaker":"Chris Dy","startTime":1833.56,"endTime":1837.82,"body":"that's awesome. It got better."},{"speaker":"Chris Dy","startTime":1833.56,"endTime":1837.82,"body":"Oh, it's funny, this time of the"},{"speaker":"Chris Dy","startTime":1837.82,"endTime":1841.8,"body":"year always brings about such"},{"speaker":"Chris Dy","startTime":1837.82,"endTime":1841.8,"body":"fond memories of the beginning"},{"speaker":"Chris Dy","startTime":1841.8,"endTime":1843.96,"body":"of my fellowship, and some of"},{"speaker":"Chris Dy","startTime":1841.8,"endTime":1843.96,"body":"which I've already shared with"},{"speaker":"Chris Dy","startTime":1843.96,"endTime":1847.32,"body":"our new hand fellows during"},{"speaker":"Chris Dy","startTime":1843.96,"endTime":1847.32,"body":"their onboarding. But so yeah,"},{"speaker":"Chris Dy","startTime":1847.32,"endTime":1849.72,"body":"oftentimes it's not a pulley"},{"speaker":"Chris Dy","startTime":1847.32,"endTime":1849.72,"body":"rupture. We've talked a lot"},{"speaker":"Chris Dy","startTime":1850.2,"endTime":1852.66,"body":"about this concept of bow"},{"speaker":"Chris Dy","startTime":1850.2,"endTime":1852.66,"body":"stringing, and I think it"},{"speaker":"Chris Dy","startTime":1852.66,"endTime":1855.18,"body":"probably would be good to unpack"},{"speaker":"Chris Dy","startTime":1852.66,"endTime":1855.18,"body":"that a bit for the people that"},{"speaker":"Chris Dy","startTime":1855.18,"endTime":1858.12,"body":"are a little less experienced."},{"speaker":"Chris Dy","startTime":1855.18,"endTime":1858.12,"body":"But you know, the pulleys are,"},{"speaker":"Chris Dy","startTime":1858.48,"endTime":1862.76,"body":"they're series of very tight,"},{"speaker":"Chris Dy","startTime":1858.48,"endTime":1862.76,"body":"tight bands, essentially that"},{"speaker":"Chris Dy","startTime":1862.76,"endTime":1867.2,"body":"run around the bone throughout"},{"speaker":"Chris Dy","startTime":1862.76,"endTime":1867.2,"body":"the finger, and really hold the"},{"speaker":"Chris Dy","startTime":1867.2,"endTime":1870.98,"body":"flexor tendons tightly adherent"},{"speaker":"Chris Dy","startTime":1867.2,"endTime":1870.98,"body":"to the bone, so that they can"},{"speaker":"Chris Dy","startTime":1870.98,"endTime":1873.98,"body":"actually work across the joints"},{"speaker":"Chris Dy","startTime":1870.98,"endTime":1873.98,"body":"and lead to the flexion of the"},{"speaker":"Chris Dy","startTime":1873.98,"endTime":1880.3,"body":"of the PIP and dip. And if you"},{"speaker":"Chris Dy","startTime":1873.98,"endTime":1880.3,"body":"have a pulley rupture, that ring"},{"speaker":"Chris Dy","startTime":1880.3,"endTime":1883.66,"body":"opens up, and then it's no"},{"speaker":"Chris Dy","startTime":1880.3,"endTime":1883.66,"body":"longer holding those tendons"},{"speaker":"Chris Dy","startTime":1883.66,"endTime":1886.6,"body":"down to the bone, and you see"},{"speaker":"Chris Dy","startTime":1883.66,"endTime":1886.6,"body":"something called bow string. And"},{"speaker":"Chris Dy","startTime":1886.6,"endTime":1889.12,"body":"now in the setting, we would see"},{"speaker":"Chris Dy","startTime":1886.6,"endTime":1889.12,"body":"it more commonly, would be if"},{"speaker":"Chris Dy","startTime":1889.12,"endTime":1892.48,"body":"you had a trauma to the finger"},{"speaker":"Chris Dy","startTime":1889.12,"endTime":1892.48,"body":"and you had multiple pulleys"},{"speaker":"Chris Dy","startTime":1892.48,"endTime":1896.08,"body":"that were opened up, either from"},{"speaker":"Chris Dy","startTime":1892.48,"endTime":1896.08,"body":"the trauma or from the process"},{"speaker":"Chris Dy","startTime":1896.08,"endTime":1899.02,"body":"of repairing the tendons. Then"},{"speaker":"Chris Dy","startTime":1896.08,"endTime":1899.02,"body":"the tendons don't stick down to"},{"speaker":"Chris Dy","startTime":1899.02,"endTime":1902.46,"body":"the bone, and they come off of"},{"speaker":"Chris Dy","startTime":1899.02,"endTime":1902.46,"body":"the bone, and then they're less."},{"speaker":"Chris Dy","startTime":1902.46,"endTime":1906.06,"body":"They're not as their"},{"speaker":"Chris Dy","startTime":1902.46,"endTime":1906.06,"body":"biomechanical efficiency to flex"},{"speaker":"Chris Dy","startTime":1906.06,"endTime":1908.34,"body":"the joints is less because"},{"speaker":"Chris Dy","startTime":1906.06,"endTime":1908.34,"body":"they're further away from what"},{"speaker":"Chris Dy","startTime":1908.34,"endTime":1911.22,"body":"they're trying to move. So"},{"speaker":"Chris Dy","startTime":1908.34,"endTime":1911.22,"body":"that's the concept of bow"},{"speaker":"Chris Dy","startTime":1911.22,"endTime":1913.32,"body":"stringing. And then if you were"},{"speaker":"Chris Dy","startTime":1911.22,"endTime":1913.32,"body":"to image that either on"},{"speaker":"Chris Dy","startTime":1913.32,"endTime":1916.2,"body":"ultrasound or an MRI, what"},{"speaker":"Chris Dy","startTime":1913.32,"endTime":1916.2,"body":"you're looking for is to see the"},{"speaker":"Chris Dy","startTime":1916.2,"endTime":1919.02,"body":"distance from the and this is"},{"speaker":"Chris Dy","startTime":1916.2,"endTime":1919.02,"body":"helpful on MRI just because you"},{"speaker":"Chris Dy","startTime":1919.02,"endTime":1921.62,"body":"have the adjacent fingers in the"},{"speaker":"Chris Dy","startTime":1919.02,"endTime":1921.62,"body":"same cut, but you can clearly do"},{"speaker":"Chris Dy","startTime":1921.62,"endTime":1924.74,"body":"it on ultrasound. You'll see the"},{"speaker":"Chris Dy","startTime":1921.62,"endTime":1924.74,"body":"flexor tendons floating more"},{"speaker":"Chris Dy","startTime":1924.74,"endTime":1927.5,"body":"vulnerably. There's more space"},{"speaker":"Chris Dy","startTime":1924.74,"endTime":1927.5,"body":"between the bone and the tendons"},{"speaker":"Chris Dy","startTime":1927.5,"endTime":1930.2,"body":"at the area of the suspected"},{"speaker":"Chris Dy","startTime":1927.5,"endTime":1930.2,"body":"injury, as opposed to either"},{"speaker":"Chris Dy","startTime":1930.2,"endTime":1932.96,"body":"proximal, distal, on the finger"},{"speaker":"Chris Dy","startTime":1930.2,"endTime":1932.96,"body":"or on the adjacent fingers."},{"speaker":"Charles Goldfarb","startTime":1933.56,"endTime":1936.14,"body":"Really well"},{"speaker":"Charles Goldfarb","startTime":1933.56,"endTime":1936.14,"body":"explained. I have two additions."},{"speaker":"Charles Goldfarb","startTime":1936.14,"endTime":1941.74,"body":"The first is that, number one,"},{"speaker":"Charles Goldfarb","startTime":1936.14,"endTime":1941.74,"body":"we think about this a lot as we"},{"speaker":"Charles Goldfarb","startTime":1941.74,"endTime":1945.64,"body":"consider flexor tendon repairs,"},{"speaker":"Charles Goldfarb","startTime":1941.74,"endTime":1945.64,"body":"and we've made this point"},{"speaker":"Charles Goldfarb","startTime":1945.64,"endTime":1948.76,"body":"repetitively, if we're going to"},{"speaker":"Charles Goldfarb","startTime":1945.64,"endTime":1948.76,"body":"open a finger and do a flexor"},{"speaker":"Charles Goldfarb","startTime":1948.76,"endTime":1953.56,"body":"tendon repair, we try to work"},{"speaker":"Charles Goldfarb","startTime":1948.76,"endTime":1953.56,"body":"between the key pulleys being a"},{"speaker":"Charles Goldfarb","startTime":1953.56,"endTime":1957.88,"body":"two and a four, but only open"},{"speaker":"Charles Goldfarb","startTime":1953.56,"endTime":1957.88,"body":"what we have to because while"},{"speaker":"Charles Goldfarb","startTime":1957.88,"endTime":1961.86,"body":"the a two and a four are clearly"},{"speaker":"Charles Goldfarb","startTime":1957.88,"endTime":1961.86,"body":"the most important pulleys, if"},{"speaker":"Charles Goldfarb","startTime":1961.86,"endTime":1965.58,"body":"we have to sacrifice one or one"},{"speaker":"Charles Goldfarb","startTime":1961.86,"endTime":1965.58,"body":"has been injured, if we have the"},{"speaker":"Charles Goldfarb","startTime":1965.58,"endTime":1969.96,"body":"a three and the c2 and the a"},{"speaker":"Charles Goldfarb","startTime":1965.58,"endTime":1969.96,"body":"four intact, well, the"},{"speaker":"Charles Goldfarb","startTime":1969.96,"endTime":1972.96,"body":"likelihood of bow stringing is"},{"speaker":"Charles Goldfarb","startTime":1969.96,"endTime":1972.96,"body":"decreased. So that's super"},{"speaker":"Charles Goldfarb","startTime":1972.96,"endTime":1976.38,"body":"important. The second point is"},{"speaker":"Charles Goldfarb","startTime":1972.96,"endTime":1976.38,"body":"that while everything you said"},{"speaker":"Charles Goldfarb","startTime":1976.38,"endTime":1980.42,"body":"is true and you lose the"},{"speaker":"Charles Goldfarb","startTime":1976.38,"endTime":1980.42,"body":"mechanical advantage provided by"},{"speaker":"Charles Goldfarb","startTime":1980.42,"endTime":1983.72,"body":"the pulleys when they are"},{"speaker":"Charles Goldfarb","startTime":1980.42,"endTime":1983.72,"body":"injured, so flexion, strength"},{"speaker":"Charles Goldfarb","startTime":1983.72,"endTime":1987.86,"body":"and work reflection may be"},{"speaker":"Charles Goldfarb","startTime":1983.72,"endTime":1987.86,"body":"affected clinically. What you"},{"speaker":"Charles Goldfarb","startTime":1987.86,"endTime":1991.34,"body":"see is a lack of full extension,"},{"speaker":"Charles Goldfarb","startTime":1987.86,"endTime":1991.34,"body":"and Marty Boyer taught me that"},{"speaker":"Charles Goldfarb","startTime":1991.4,"endTime":1994.82,"body":"many years ago, and at first I"},{"speaker":"Charles Goldfarb","startTime":1991.4,"endTime":1994.82,"body":"just had a hard time wrapping my"},{"speaker":"Charles Goldfarb","startTime":1994.82,"endTime":1998.06,"body":"brain around it, but it's true,"},{"speaker":"Charles Goldfarb","startTime":1994.82,"endTime":1998.06,"body":"if you injured a two pulley, you"},{"speaker":"Charles Goldfarb","startTime":1998.06,"endTime":2000.78,"body":"may develop a pip flexion"},{"speaker":"Charles Goldfarb","startTime":1998.06,"endTime":2000.78,"body":"contracture. Now it's not going"},{"speaker":"Charles Goldfarb","startTime":2000.78,"endTime":2004.26,"body":"to be a huge contracture, but"},{"speaker":"Charles Goldfarb","startTime":2000.78,"endTime":2004.26,"body":"you just don't have full"},{"speaker":"Charles Goldfarb","startTime":2004.26,"endTime":2006.06,"body":"extension. That's really"},{"speaker":"Charles Goldfarb","startTime":2004.26,"endTime":2006.06,"body":"interesting."},{"speaker":"Chris Dy","startTime":2006.06,"endTime":2007.8,"body":"I think that's a"},{"speaker":"Chris Dy","startTime":2006.06,"endTime":2007.8,"body":"really good point, and I think"},{"speaker":"Chris Dy","startTime":2007.8,"endTime":2010.14,"body":"that's not stuff that's in the"},{"speaker":"Chris Dy","startTime":2007.8,"endTime":2010.14,"body":"textbook. So thank you for"},{"speaker":"Chris Dy","startTime":2010.14,"endTime":2013.5,"body":"bringing that out. I think that"},{"speaker":"Chris Dy","startTime":2010.14,"endTime":2013.5,"body":"there are people that would want"},{"speaker":"Chris Dy","startTime":2013.5,"endTime":2016.32,"body":"to know what how we would"},{"speaker":"Chris Dy","startTime":2013.5,"endTime":2016.32,"body":"approach this surgically, if it"},{"speaker":"Chris Dy","startTime":2016.32,"endTime":2020.54,"body":"actually was a surgical case,"},{"speaker":"Chris Dy","startTime":2016.32,"endTime":2020.54,"body":"but I will share a couple of"},{"speaker":"Chris Dy","startTime":2020.96,"endTime":2027.2,"body":"vignettes about surgery for"},{"speaker":"Chris Dy","startTime":2020.96,"endTime":2027.2,"body":"this. I don't know how many"},{"speaker":"Chris Dy","startTime":2027.2,"endTime":2030.92,"body":"you've done in practice. I've"},{"speaker":"Chris Dy","startTime":2027.2,"endTime":2030.92,"body":"probably I can count it on one"},{"speaker":"Chris Dy","startTime":2030.92,"endTime":2034.94,"body":"hand, and that would maybe be"},{"speaker":"Chris Dy","startTime":2030.92,"endTime":2034.94,"body":"generous. But interestingly"},{"speaker":"Chris Dy","startTime":2034.94,"endTime":2041.14,"body":"enough, I was asked by a faculty"},{"speaker":"Chris Dy","startTime":2034.94,"endTime":2041.14,"body":"member during my residency to to"},{"speaker":"Chris Dy","startTime":2041.14,"endTime":2044.44,"body":"help write a review article"},{"speaker":"Chris Dy","startTime":2041.14,"endTime":2044.44,"body":"about flex or pulley"},{"speaker":"Chris Dy","startTime":2044.44,"endTime":2049.24,"body":"reconstruction. And I said, of"},{"speaker":"Chris Dy","startTime":2044.44,"endTime":2049.24,"body":"course, being a resident, but"},{"speaker":"Chris Dy","startTime":2049.24,"endTime":2051.88,"body":"wanting to go into academics, I"},{"speaker":"Chris Dy","startTime":2049.24,"endTime":2051.88,"body":"think I was applying for hand"},{"speaker":"Chris Dy","startTime":2051.88,"endTime":2054.34,"body":"surgery, you know, soon as"},{"speaker":"Chris Dy","startTime":2051.88,"endTime":2054.34,"body":"needed to kind of get some"},{"speaker":"Chris Dy","startTime":2054.34,"endTime":2057.52,"body":"productivity. I said, of course."},{"speaker":"Chris Dy","startTime":2054.34,"endTime":2057.52,"body":"And I asked this faculty member"},{"speaker":"Chris Dy","startTime":2057.52,"endTime":2063.36,"body":"if they had any, uh, cases to"},{"speaker":"Chris Dy","startTime":2057.52,"endTime":2063.36,"body":"share. No cases, at least,"},{"speaker":"Chris Dy","startTime":2063.36,"endTime":2066.84,"body":"documented with pictures. And I"},{"speaker":"Chris Dy","startTime":2063.36,"endTime":2066.84,"body":"asked around the faculty, and"},{"speaker":"Chris Dy","startTime":2066.84,"endTime":2069.54,"body":"there was not a whole lot of"},{"speaker":"Chris Dy","startTime":2066.84,"endTime":2069.54,"body":"responses. So it's just and not"},{"speaker":"Chris Dy","startTime":2069.54,"endTime":2071.76,"body":"that's nothing against the"},{"speaker":"Chris Dy","startTime":2069.54,"endTime":2071.76,"body":"people that I worked with in"},{"speaker":"Chris Dy","startTime":2071.76,"endTime":2075.24,"body":"residency. We actually ended up"},{"speaker":"Chris Dy","startTime":2071.76,"endTime":2075.24,"body":"doing an article, a separate"},{"speaker":"Chris Dy","startTime":2075.24,"endTime":2077.88,"body":"article, because of that,"},{"speaker":"Chris Dy","startTime":2075.24,"endTime":2077.88,"body":"looking at in New York State,"},{"speaker":"Chris Dy","startTime":2077.88,"endTime":2081.56,"body":"how many pulley reconstructions"},{"speaker":"Chris Dy","startTime":2077.88,"endTime":2081.56,"body":"hand surgeons had done. It is"},{"speaker":"Chris Dy","startTime":2081.56,"endTime":2085.04,"body":"very, very small. So this is not"},{"speaker":"Chris Dy","startTime":2081.56,"endTime":2085.04,"body":"a surgery that's coming up"},{"speaker":"Chris Dy","startTime":2085.04,"endTime":2087.98,"body":"often, at least in New York"},{"speaker":"Chris Dy","startTime":2085.04,"endTime":2087.98,"body":"State. I don't know how many"},{"speaker":"Chris Dy","startTime":2087.98,"endTime":2090.38,"body":"rock climbers there are. Maybe"},{"speaker":"Chris Dy","startTime":2087.98,"endTime":2090.38,"body":"it's more, more coming up more"},{"speaker":"Chris Dy","startTime":2090.38,"endTime":2092.96,"body":"often in places where there's a"},{"speaker":"Chris Dy","startTime":2090.38,"endTime":2092.96,"body":"higher incidence of rock"},{"speaker":"Chris Dy","startTime":2092.96,"endTime":2095.9,"body":"climbing, but it's just not a"},{"speaker":"Chris Dy","startTime":2092.96,"endTime":2095.9,"body":"common operation. That's what"},{"speaker":"Chris Dy","startTime":2095.9,"endTime":2096.38,"body":"I'm trying to"},{"speaker":"Charles Goldfarb","startTime":2096.86,"endTime":2099.2,"body":"say. Oh for"},{"speaker":"Charles Goldfarb","startTime":2096.86,"endTime":2099.2,"body":"sure, I don't know that I've"},{"speaker":"Charles Goldfarb","startTime":2099.2,"endTime":2102.22,"body":"done. I don't think I've ever"},{"speaker":"Charles Goldfarb","startTime":2099.2,"endTime":2102.22,"body":"done one in a rock climbing"},{"speaker":"Charles Goldfarb","startTime":2102.22,"endTime":2105.94,"body":"situation. So I've done them, of"},{"speaker":"Charles Goldfarb","startTime":2102.22,"endTime":2105.94,"body":"course, for chronic flexor"},{"speaker":"Charles Goldfarb","startTime":2105.94,"endTime":2109.54,"body":"tendon issues. And, you know,"},{"speaker":"Charles Goldfarb","startTime":2105.94,"endTime":2109.54,"body":"stage reconstruction, that's the"},{"speaker":"Charles Goldfarb","startTime":2109.54,"endTime":2113.68,"body":"only setting. And I've done that"},{"speaker":"Charles Goldfarb","startTime":2109.54,"endTime":2113.68,"body":"maybe low double digits, if"},{"speaker":"Charles Goldfarb","startTime":2113.68,"endTime":2117.16,"body":"that, but probably between five"},{"speaker":"Charles Goldfarb","startTime":2113.68,"endTime":2117.16,"body":"and 12 or something. So really"},{"speaker":"Charles Goldfarb","startTime":2117.16,"endTime":2119.74,"body":"low numbers. There's nothing"},{"speaker":"Charles Goldfarb","startTime":2117.16,"endTime":2119.74,"body":"technically all that challenging"},{"speaker":"Charles Goldfarb","startTime":2119.74,"endTime":2123.42,"body":"about a lot is made in the hand"},{"speaker":"Charles Goldfarb","startTime":2119.74,"endTime":2123.42,"body":"surgery textbooks about how you"},{"speaker":"Charles Goldfarb","startTime":2123.42,"endTime":2128.1,"body":"wrap the reconstruction like the"},{"speaker":"Charles Goldfarb","startTime":2123.42,"endTime":2128.1,"body":"Palmaris, around the bone, under"},{"speaker":"Charles Goldfarb","startTime":2128.1,"endTime":2131.58,"body":"over the extensor tendon. But"},{"speaker":"Charles Goldfarb","startTime":2128.1,"endTime":2131.58,"body":"yeah, haven't done a lot of it."},{"speaker":"Charles Goldfarb","startTime":2131.76,"endTime":2136.92,"body":"And because number one, but the"},{"speaker":"Charles Goldfarb","startTime":2131.76,"endTime":2136.92,"body":"pulley ruptures are rare in the"},{"speaker":"Charles Goldfarb","startTime":2136.92,"endTime":2141.02,"body":"rock climbing population. And"},{"speaker":"Charles Goldfarb","startTime":2136.92,"endTime":2141.02,"body":"two, if you have a sorry. I keep"},{"speaker":"Charles Goldfarb","startTime":2141.02,"endTime":2145.04,"body":"saying flex chicken, if you have"},{"speaker":"Charles Goldfarb","startTime":2141.02,"endTime":2145.04,"body":"a pulley rupture, usually it's"},{"speaker":"Charles Goldfarb","startTime":2145.04,"endTime":2150.08,"body":"one pulley, and you do fine. And"},{"speaker":"Charles Goldfarb","startTime":2145.04,"endTime":2150.08,"body":"in a situation like the case I"},{"speaker":"Charles Goldfarb","startTime":2150.08,"endTime":2153.98,"body":"presented, the patient either"},{"speaker":"Charles Goldfarb","startTime":2150.08,"endTime":2153.98,"body":"gets better or you give them a"},{"speaker":"Charles Goldfarb","startTime":2153.98,"endTime":2157.7,"body":"cortisone injection and they get"},{"speaker":"Charles Goldfarb","startTime":2153.98,"endTime":2157.7,"body":"better and they move on. Yeah,"},{"speaker":"Chris Dy","startTime":2157.7,"endTime":2159.92,"body":"I think that's I think"},{"speaker":"Chris Dy","startTime":2157.7,"endTime":2159.92,"body":"that's true. You know, I think"},{"speaker":"Chris Dy","startTime":2159.98,"endTime":2163.06,"body":"for the people that are taking"},{"speaker":"Chris Dy","startTime":2159.98,"endTime":2163.06,"body":"tests, still, there are, it's a"},{"speaker":"Chris Dy","startTime":2163.06,"endTime":2166.48,"body":"testable topic, just because"},{"speaker":"Chris Dy","startTime":2163.06,"endTime":2166.48,"body":"hand surgeons like to talk about"},{"speaker":"Chris Dy","startTime":2166.48,"endTime":2168.7,"body":"it. You know, there are a couple"},{"speaker":"Chris Dy","startTime":2166.48,"endTime":2168.7,"body":"of different ways to do the"},{"speaker":"Chris Dy","startTime":2168.7,"endTime":2172.06,"body":"reconstruction of the pulley,"},{"speaker":"Chris Dy","startTime":2168.7,"endTime":2172.06,"body":"like Chuck was mentioning, if"},{"speaker":"Chris Dy","startTime":2172.06,"endTime":2177.58,"body":"they supposedly, there's a quote"},{"speaker":"Chris Dy","startTime":2172.06,"endTime":2177.58,"body":"ever present rim of pulley that"},{"speaker":"Chris Dy","startTime":2177.58,"endTime":2182.04,"body":"remains after a rupture that you"},{"speaker":"Chris Dy","startTime":2177.58,"endTime":2182.04,"body":"can use to to to weave a Palmers"},{"speaker":"Chris Dy","startTime":2182.04,"endTime":2185.28,"body":"through. So essentially"},{"speaker":"Chris Dy","startTime":2182.04,"endTime":2185.28,"body":"recreating that pulley, or you"},{"speaker":"Chris Dy","startTime":2185.28,"endTime":2188.1,"body":"can take a Palmaris or any sort"},{"speaker":"Chris Dy","startTime":2185.28,"endTime":2188.1,"body":"of other graft, and actually,"},{"speaker":"Chris Dy","startTime":2188.1,"endTime":2191.46,"body":"instead of weaving into that,"},{"speaker":"Chris Dy","startTime":2188.1,"endTime":2191.46,"body":"wrap it around the bone and use"},{"speaker":"Chris Dy","startTime":2191.46,"endTime":2193.68,"body":"that to help keep the tendon"},{"speaker":"Chris Dy","startTime":2191.46,"endTime":2193.68,"body":"down, you just need to make"},{"speaker":"Chris Dy","startTime":2193.68,"endTime":2197.16,"body":"sure, as you're wrapping it"},{"speaker":"Chris Dy","startTime":2193.68,"endTime":2197.16,"body":"around that you're not catching"},{"speaker":"Chris Dy","startTime":2197.16,"endTime":2199.92,"body":"the extensor tendon on the other"},{"speaker":"Chris Dy","startTime":2197.16,"endTime":2199.92,"body":"side, on the dorsal side of the"},{"speaker":"Chris Dy","startTime":2199.92,"endTime":2203.12,"body":"bone. So you need to make sure"},{"speaker":"Chris Dy","startTime":2199.92,"endTime":2203.12,"body":"your your loop passes underneath"},{"speaker":"Chris Dy","startTime":2203.12,"endTime":2206.42,"body":"the extensor tendon, adhered to"},{"speaker":"Chris Dy","startTime":2203.12,"endTime":2206.42,"body":"the bone, and then goes on top"},{"speaker":"Chris Dy","startTime":2206.42,"endTime":2209.72,"body":"of the flexor tendon to keep it"},{"speaker":"Chris Dy","startTime":2206.42,"endTime":2209.72,"body":"snug to the bone. And, you know,"},{"speaker":"Chris Dy","startTime":2209.72,"endTime":2212.06,"body":"there are a lot of different"},{"speaker":"Chris Dy","startTime":2209.72,"endTime":2212.06,"body":"ways to secure that kind of"},{"speaker":"Chris Dy","startTime":2212.06,"endTime":2215.24,"body":"loop. There's a whole There are"},{"speaker":"Chris Dy","startTime":2212.06,"endTime":2215.24,"body":"way too many ways to do"},{"speaker":"Chris Dy","startTime":2215.24,"endTime":2217.46,"body":"something that isn't really that"},{"speaker":"Chris Dy","startTime":2215.24,"endTime":2217.46,"body":"common."},{"speaker":"Charles Goldfarb","startTime":2218.54,"endTime":2220.72,"body":"Yeah, that's"},{"speaker":"Charles Goldfarb","startTime":2218.54,"endTime":2220.72,"body":"right. There's, you know, hand"},{"speaker":"Charles Goldfarb","startTime":2220.72,"endTime":2225.52,"body":"surgeons like, there's an"},{"speaker":"Charles Goldfarb","startTime":2220.72,"endTime":2225.52,"body":"academics bent and an anatomical"},{"speaker":"Charles Goldfarb","startTime":2225.52,"endTime":2228.1,"body":"bent to a lot of this stuff. And"},{"speaker":"Charles Goldfarb","startTime":2225.52,"endTime":2228.1,"body":"so sometimes topics get"},{"speaker":"Charles Goldfarb","startTime":2228.4,"endTime":2232.48,"body":"magnified out of proportion to"},{"speaker":"Charles Goldfarb","startTime":2228.4,"endTime":2232.48,"body":"prevalence. And this has been"},{"speaker":"Charles Goldfarb","startTime":2232.48,"endTime":2232.9,"body":"one, and"},{"speaker":"Chris Dy","startTime":2233.2,"endTime":2235.54,"body":"it says that this is"},{"speaker":"Chris Dy","startTime":2233.2,"endTime":2235.54,"body":"why I wrote two papers on flexor"},{"speaker":"Chris Dy","startTime":2235.54,"endTime":2241.3,"body":"pulley ruptures. And look at you"},{"speaker":"Chris Dy","startTime":2235.54,"endTime":2241.3,"body":"today. So that was fun, you"},{"speaker":"Chris Dy","startTime":2241.3,"endTime":2244.5,"body":"know. Thank you to Chris for"},{"speaker":"Chris Dy","startTime":2241.3,"endTime":2244.5,"body":"sharing that suggestion."},{"speaker":"Chris Dy","startTime":2244.62,"endTime":2247.02,"body":"Hopefully, that helps elucidate"},{"speaker":"Chris Dy","startTime":2244.62,"endTime":2247.02,"body":"some things. And if there are"},{"speaker":"Chris Dy","startTime":2247.02,"endTime":2249.6,"body":"any questions that you have"},{"speaker":"Chris Dy","startTime":2247.02,"endTime":2249.6,"body":"about that, or clarifications or"},{"speaker":"Chris Dy","startTime":2249.6,"endTime":2252.42,"body":"pearls you want to share from"},{"speaker":"Chris Dy","startTime":2249.6,"endTime":2252.42,"body":"your practice, please email us"},{"speaker":"Chris Dy","startTime":2252.42,"endTime":2254.28,"body":"the same thing to any listener"},{"speaker":"Chris Dy","startTime":2252.42,"endTime":2254.28,"body":"hand podcast@gmail.com"},{"speaker":"Charles Goldfarb","startTime":2255.54,"endTime":2257.4,"body":"Yeah, we would"},{"speaker":"Charles Goldfarb","startTime":2255.54,"endTime":2257.4,"body":"welcome some pearls. And again,"},{"speaker":"Charles Goldfarb","startTime":2257.4,"endTime":2259.8,"body":"Chris and I have admitted this"},{"speaker":"Charles Goldfarb","startTime":2257.4,"endTime":2259.8,"body":"is not something that we see"},{"speaker":"Charles Goldfarb","startTime":2260.1,"endTime":2264.8,"body":"despite our sports population,"},{"speaker":"Charles Goldfarb","startTime":2260.1,"endTime":2264.8,"body":"as much as others may so please"},{"speaker":"Charles Goldfarb","startTime":2264.8,"endTime":2267.8,"body":"share any any tidbits or any"},{"speaker":"Charles Goldfarb","startTime":2264.8,"endTime":2267.8,"body":"recommendations you have with"},{"speaker":"Charles Goldfarb","startTime":2267.8,"endTime":2270.02,"body":"us, and we'll share them with"},{"speaker":"Charles Goldfarb","startTime":2267.8,"endTime":2270.02,"body":"the audience. So thank you very"},{"speaker":"Charles Goldfarb","startTime":2270.02,"endTime":2270.62,"body":"much. Yes and"},{"speaker":"Chris Dy","startTime":2270.62,"endTime":2272.72,"body":"absolutely. And in the"},{"speaker":"Chris Dy","startTime":2270.62,"endTime":2272.72,"body":"therapists that are listening,"},{"speaker":"Chris Dy","startTime":2272.72,"endTime":2275.42,"body":"you may see a lot of these"},{"speaker":"Chris Dy","startTime":2272.72,"endTime":2275.42,"body":"patients too. So please send us"},{"speaker":"Chris Dy","startTime":2275.42,"endTime":2278.0,"body":"your pearls of wisdom, and we're"},{"speaker":"Chris Dy","startTime":2275.42,"endTime":2278.0,"body":"happy to share them on the air"},{"speaker":"Chris Dy","startTime":2278.54,"endTime":2279.32,"body":"until next time."},{"speaker":"Charles Goldfarb","startTime":2279.74,"endTime":2284.14,"body":"Fantastic."},{"speaker":"Charles Goldfarb","startTime":2279.74,"endTime":2284.14,"body":"Hey, Chris, that was fun. Let's"},{"speaker":"Charles Goldfarb","startTime":2284.14,"endTime":2285.28,"body":"do it again real soon."},{"speaker":"Chris Dy","startTime":2285.82,"endTime":2287.98,"body":"Sounds good. Well, be"},{"speaker":"Chris Dy","startTime":2285.82,"endTime":2287.98,"body":"sure to email us with topic"},{"speaker":"Chris Dy","startTime":2287.98,"endTime":2290.44,"body":"suggestions and feedback. You"},{"speaker":"Chris Dy","startTime":2287.98,"endTime":2290.44,"body":"can reach us at hand"},{"speaker":"Chris Dy","startTime":2290.44,"endTime":2290.98,"body":"podcast@gmail.com"},{"speaker":"Charles Goldfarb","startTime":2292.72,"endTime":2294.88,"body":"and remember,"},{"speaker":"Charles Goldfarb","startTime":2292.72,"endTime":2294.88,"body":"please subscribe wherever you"},{"speaker":"Charles Goldfarb","startTime":2294.88,"endTime":2295.84,"body":"get your podcast,"},{"speaker":"Chris Dy","startTime":2296.26,"endTime":2299.14,"body":"and be sure to leave a"},{"speaker":"Chris Dy","startTime":2296.26,"endTime":2299.14,"body":"review that helps us get the"},{"speaker":"Chris Dy","startTime":2299.14,"endTime":2300.72,"body":"word out. Special,"},{"speaker":"Charles Goldfarb","startTime":2300.72,"endTime":2302.76,"body":"thanks to"},{"speaker":"Charles Goldfarb","startTime":2300.72,"endTime":2302.76,"body":"Peter Martin for the amazing"},{"speaker":"Charles Goldfarb","startTime":2302.76,"endTime":2303.24,"body":"music,"},{"speaker":"Chris Dy","startTime":2303.9,"endTime":2306.18,"body":"and remember, keep the"},{"speaker":"Chris Dy","startTime":2303.9,"endTime":2306.18,"body":"upper hand. Come back next time"},{"speaker":"Chris Dy","startTime":2306.18,"endTime":2306.3,"body":"you"}]}