{"version":"1.0.0","segments":[{"speaker":"Charles Goldfarb","startTime":10.77,"endTime":13.35,"body":"Welcome to the"},{"speaker":"Charles Goldfarb","startTime":10.77,"endTime":13.35,"body":"upper hand, where Chuck and"},{"speaker":"Charles Goldfarb","startTime":13.35,"endTime":14.46,"body":"Chris talk hand surgery."},{"speaker":"Chris Dy","startTime":14.79,"endTime":16.56,"body":"We are two hand"},{"speaker":"Chris Dy","startTime":14.79,"endTime":16.56,"body":"surgeons at Washington"},{"speaker":"Chris Dy","startTime":16.56,"endTime":19.62,"body":"University in St. Louis, here to"},{"speaker":"Chris Dy","startTime":16.56,"endTime":19.62,"body":"talk about all aspects of hand"},{"speaker":"Chris Dy","startTime":19.62,"endTime":21.48,"body":"surgery from technical to"},{"speaker":"Chris Dy","startTime":19.62,"endTime":21.48,"body":"personal."},{"speaker":"Charles Goldfarb","startTime":22.049,"endTime":24.329,"body":"Thank you for"},{"speaker":"Charles Goldfarb","startTime":22.049,"endTime":24.329,"body":"subscribing wherever you get"},{"speaker":"Charles Goldfarb","startTime":24.329,"endTime":25.229,"body":"your podcasts."},{"speaker":"Chris Dy","startTime":25.47,"endTime":27.63,"body":"And be sure to leave a"},{"speaker":"Chris Dy","startTime":25.47,"endTime":27.63,"body":"review that helps us get the"},{"speaker":"Chris Dy","startTime":27.63,"endTime":28.17,"body":"word out."},{"speaker":"Charles Goldfarb","startTime":28.229,"endTime":29.159,"body":"Oh, hey,"},{"speaker":"Charles Goldfarb","startTime":28.229,"endTime":29.159,"body":"Chris."},{"speaker":"Chris Dy","startTime":29.489,"endTime":30.749,"body":"Hey, Chuck, how are"},{"speaker":"Chris Dy","startTime":29.489,"endTime":30.749,"body":"you?"},{"speaker":"Charles Goldfarb","startTime":31.169,"endTime":33.539,"body":"I am pretty"},{"speaker":"Charles Goldfarb","startTime":31.169,"endTime":33.539,"body":"fair. How are you today?"},{"speaker":"Chris Dy","startTime":34.05,"endTime":37.71,"body":"I'm doing all right."},{"speaker":"Chris Dy","startTime":34.05,"endTime":37.71,"body":"You know, I took a day off this"},{"speaker":"Chris Dy","startTime":37.71,"endTime":41.76,"body":"week, it was awesome. Yes. Yes,"},{"speaker":"Chris Dy","startTime":37.71,"endTime":41.76,"body":"I know, you missed me in"},{"speaker":"Chris Dy","startTime":41.76,"endTime":46.08,"body":"conference on Monday. But, you"},{"speaker":"Chris Dy","startTime":41.76,"endTime":46.08,"body":"know, a little bit of backstory."},{"speaker":"Chris Dy","startTime":46.53,"endTime":49.41,"body":"I took a day off on Monday"},{"speaker":"Chris Dy","startTime":46.53,"endTime":49.41,"body":"because I realized that, you"},{"speaker":"Chris Dy","startTime":49.41,"endTime":52.71,"body":"know, as great as it's been with"},{"speaker":"Chris Dy","startTime":49.41,"endTime":52.71,"body":"the pandemic, not traveling so"},{"speaker":"Chris Dy","startTime":52.71,"endTime":55.38,"body":"much. We talked about this a"},{"speaker":"Chris Dy","startTime":52.71,"endTime":55.38,"body":"little bit in the last episode."},{"speaker":"Chris Dy","startTime":56.07,"endTime":59.64,"body":"That also meant working more,"},{"speaker":"Chris Dy","startTime":56.07,"endTime":59.64,"body":"and then not having anything to"},{"speaker":"Chris Dy","startTime":59.64,"endTime":64.08,"body":"disrupt the normal kind of"},{"speaker":"Chris Dy","startTime":59.64,"endTime":64.08,"body":"cadence. And I think I needed"},{"speaker":"Chris Dy","startTime":64.11,"endTime":69.3,"body":"just a day to look forward to."},{"speaker":"Chris Dy","startTime":64.11,"endTime":69.3,"body":"So I took Monday off and ended"},{"speaker":"Chris Dy","startTime":69.3,"endTime":74.58,"body":"up taking my son and my daughter"},{"speaker":"Chris Dy","startTime":69.3,"endTime":74.58,"body":"to the St. Louis zoo. And I've"},{"speaker":"Chris Dy","startTime":74.58,"endTime":78.0,"body":"been wanting to do that because"},{"speaker":"Chris Dy","startTime":74.58,"endTime":78.0,"body":"my son's really into snakes"},{"speaker":"Chris Dy","startTime":78.0,"endTime":80.64,"body":"right now. But I didn't want to"},{"speaker":"Chris Dy","startTime":78.0,"endTime":80.64,"body":"take him on the weekend when"},{"speaker":"Chris Dy","startTime":80.64,"endTime":82.74,"body":"there would be a bunch of people"},{"speaker":"Chris Dy","startTime":80.64,"endTime":82.74,"body":"at the zoo. So we essentially"},{"speaker":"Chris Dy","startTime":82.74,"endTime":84.75,"body":"had a private Zoo experience."},{"speaker":"Charles Goldfarb","startTime":85.17,"endTime":88.05,"body":"Wow. And the"},{"speaker":"Charles Goldfarb","startTime":85.17,"endTime":88.05,"body":"St. Louis zoo is something- not"},{"speaker":"Charles Goldfarb","startTime":88.05,"endTime":90.6,"body":"only is it free, but it's a"},{"speaker":"Charles Goldfarb","startTime":88.05,"endTime":90.6,"body":"pretty darn good zoo."},{"speaker":"Chris Dy","startTime":91.26,"endTime":93.33,"body":"It is, it's a great"},{"speaker":"Chris Dy","startTime":91.26,"endTime":93.33,"body":"zoo. And I wouldn't say I mean,"},{"speaker":"Chris Dy","startTime":93.33,"endTime":96.36,"body":"there's no charge for admission,"},{"speaker":"Chris Dy","startTime":93.33,"endTime":96.36,"body":"you and I pay for it in taxpayer"},{"speaker":"Chris Dy","startTime":96.36,"endTime":98.85,"body":"dollars. And anybody who comes"},{"speaker":"Chris Dy","startTime":96.36,"endTime":98.85,"body":"to St. Louis can get it on our"},{"speaker":"Chris Dy","startTime":98.85,"endTime":102.93,"body":"dime. So, but it's a great zoo."},{"speaker":"Chris Dy","startTime":98.85,"endTime":102.93,"body":"It's a great zoo. There was"},{"speaker":"Chris Dy","startTime":102.96,"endTime":105.69,"body":"there were more staff there than"},{"speaker":"Chris Dy","startTime":102.96,"endTime":105.69,"body":"visitors. They did everything"},{"speaker":"Chris Dy","startTime":105.69,"endTime":109.68,"body":"right in terms of masks and"},{"speaker":"Chris Dy","startTime":105.69,"endTime":109.68,"body":"everything. And yeah, we went"},{"speaker":"Chris Dy","startTime":109.68,"endTime":112.05,"body":"through the reptile house two"},{"speaker":"Chris Dy","startTime":109.68,"endTime":112.05,"body":"and a half times."},{"speaker":"Charles Goldfarb","startTime":112.62,"endTime":115.08,"body":"I love it. So"},{"speaker":"Charles Goldfarb","startTime":112.62,"endTime":115.08,"body":"answer me two questions, please."},{"speaker":"Charles Goldfarb","startTime":115.32,"endTime":120.66,"body":"Number one, was it a great day?"},{"speaker":"Charles Goldfarb","startTime":115.32,"endTime":120.66,"body":"And number two, were you able to"},{"speaker":"Charles Goldfarb","startTime":120.66,"endTime":124.5,"body":"not think about work on that"},{"speaker":"Charles Goldfarb","startTime":120.66,"endTime":124.5,"body":"day? Because that's the key. If"},{"speaker":"Charles Goldfarb","startTime":124.5,"endTime":127.38,"body":"you spend your day thinking"},{"speaker":"Charles Goldfarb","startTime":124.5,"endTime":127.38,"body":"about what you might have gotten"},{"speaker":"Charles Goldfarb","startTime":127.38,"endTime":130.86,"body":"done, what you could have gotten"},{"speaker":"Charles Goldfarb","startTime":127.38,"endTime":130.86,"body":"done, then it's it's not only"},{"speaker":"Charles Goldfarb","startTime":130.86,"endTime":133.53,"body":"counterproductive. Well, it's"},{"speaker":"Charles Goldfarb","startTime":130.86,"endTime":133.53,"body":"counterproductive."},{"speaker":"Chris Dy","startTime":134.43,"endTime":136.95,"body":"Yeah, no, I completely"},{"speaker":"Chris Dy","startTime":134.43,"endTime":136.95,"body":"agree with you on that. I made"},{"speaker":"Chris Dy","startTime":136.95,"endTime":139.77,"body":"it a day where I couldn't think"},{"speaker":"Chris Dy","startTime":136.95,"endTime":139.77,"body":"about work too much, because I"},{"speaker":"Chris Dy","startTime":139.77,"endTime":144.21,"body":"had a five year old and a two"},{"speaker":"Chris Dy","startTime":139.77,"endTime":144.21,"body":"year old running around me. So"},{"speaker":"Chris Dy","startTime":144.21,"endTime":146.49,"body":"they didn't really let me do"},{"speaker":"Chris Dy","startTime":144.21,"endTime":146.49,"body":"that. And then also after the"},{"speaker":"Chris Dy","startTime":146.49,"endTime":153.15,"body":"zoo, I took I took Rafi on a"},{"speaker":"Chris Dy","startTime":146.49,"endTime":153.15,"body":"hike in Castlewood Park. And so"},{"speaker":"Chris Dy","startTime":153.15,"endTime":155.58,"body":"that was a good way to get"},{"speaker":"Chris Dy","startTime":153.15,"endTime":155.58,"body":"outside for both of us. And then"},{"speaker":"Chris Dy","startTime":155.58,"endTime":158.94,"body":"we got to do where we now"},{"speaker":"Chris Dy","startTime":155.58,"endTime":158.94,"body":"developed a tradition of getting"},{"speaker":"Chris Dy","startTime":158.97,"endTime":162.81,"body":"Dairy Queen blizzards after"},{"speaker":"Chris Dy","startTime":158.97,"endTime":162.81,"body":"hiking, which may or may not be"},{"speaker":"Chris Dy","startTime":162.81,"endTime":165.54,"body":"a good thing. But he loves the"},{"speaker":"Chris Dy","startTime":162.81,"endTime":165.54,"body":"fact you can turn the thing"},{"speaker":"Chris Dy","startTime":165.54,"endTime":168.0,"body":"upside down and it doesn't"},{"speaker":"Chris Dy","startTime":165.54,"endTime":168.0,"body":"spill."},{"speaker":"Charles Goldfarb","startTime":168.72,"endTime":171.03,"body":"Yeah, one of"},{"speaker":"Charles Goldfarb","startTime":168.72,"endTime":171.03,"body":"my kids, there's got to be a"},{"speaker":"Charles Goldfarb","startTime":171.06,"endTime":174.36,"body":"treat at the end of the effort,"},{"speaker":"Charles Goldfarb","startTime":171.06,"endTime":174.36,"body":"whatever the effort may be, and"},{"speaker":"Charles Goldfarb","startTime":174.36,"endTime":176.73,"body":"then that's okay. I think it's"},{"speaker":"Charles Goldfarb","startTime":174.36,"endTime":176.73,"body":"okay. The other two don't care"},{"speaker":"Charles Goldfarb","startTime":176.73,"endTime":177.21,"body":"as much."},{"speaker":"Chris Dy","startTime":178.02,"endTime":179.91,"body":"This may be a"},{"speaker":"Chris Dy","startTime":178.02,"endTime":179.91,"body":"dangerous precedent though."},{"speaker":"Chris Dy","startTime":179.91,"endTime":182.88,"body":"That's the only problem. The"},{"speaker":"Chris Dy","startTime":179.91,"endTime":182.88,"body":"blizzards will only get bigger"},{"speaker":"Chris Dy","startTime":182.88,"endTime":187.26,"body":"in size as as they progress in"},{"speaker":"Chris Dy","startTime":182.88,"endTime":187.26,"body":"age, which means my Blizzard"},{"speaker":"Chris Dy","startTime":187.26,"endTime":188.61,"body":"will also have to get bigger."},{"speaker":"Charles Goldfarb","startTime":189.54,"endTime":193.65,"body":"True. All"},{"speaker":"Charles Goldfarb","startTime":189.54,"endTime":193.65,"body":"right. What about any new"},{"speaker":"Charles Goldfarb","startTime":193.65,"endTime":195.57,"body":"exciting reviews? Are there any"},{"speaker":"Charles Goldfarb","startTime":193.65,"endTime":195.57,"body":"out there?"},{"speaker":"Chris Dy","startTime":196.89,"endTime":201.75,"body":"We do. One of our"},{"speaker":"Chris Dy","startTime":196.89,"endTime":201.75,"body":"longtime listeners, Dr. Paul"},{"speaker":"Chris Dy","startTime":201.78,"endTime":205.11,"body":"Inclan, also one of our"},{"speaker":"Chris Dy","startTime":201.78,"endTime":205.11,"body":"residents has finally left us a"},{"speaker":"Chris Dy","startTime":205.11,"endTime":208.29,"body":"review. So thank you, Paul, for"},{"speaker":"Chris Dy","startTime":205.11,"endTime":208.29,"body":"leaving the review. You know"},{"speaker":"Chris Dy","startTime":208.29,"endTime":211.92,"body":"what Chuck, he gave us five"},{"speaker":"Chris Dy","startTime":208.29,"endTime":211.92,"body":"stars, and I will say, I've"},{"speaker":"Chris Dy","startTime":211.92,"endTime":214.35,"body":"already filled out his"},{"speaker":"Chris Dy","startTime":211.92,"endTime":214.35,"body":"evaluation many months ago. So"},{"speaker":"Chris Dy","startTime":214.35,"endTime":218.49,"body":"there is no quid pro quo here."},{"speaker":"Chris Dy","startTime":214.35,"endTime":218.49,"body":"But he did say it's a wonderful"},{"speaker":"Chris Dy","startTime":218.49,"endTime":221.73,"body":"opportunity to passively learn"},{"speaker":"Chris Dy","startTime":218.49,"endTime":221.73,"body":"pearls for the trainee in a"},{"speaker":"Chris Dy","startTime":221.73,"endTime":224.91,"body":"package that is entertaining to"},{"speaker":"Chris Dy","startTime":221.73,"endTime":224.91,"body":"listen to. This has"},{"speaker":"Chris Dy","startTime":224.91,"endTime":229.41,"body":"significantly strengthened both"},{"speaker":"Chris Dy","startTime":224.91,"endTime":229.41,"body":"my fund of knowledge. Or Paul,"},{"speaker":"Chris Dy","startTime":229.41,"endTime":232.38,"body":"you wrote both but you can tell"},{"speaker":"Chris Dy","startTime":229.41,"endTime":232.38,"body":"us the second thing. Anyway, the"},{"speaker":"Chris Dy","startTime":232.38,"endTime":235.38,"body":"non hand episodes are useful for"},{"speaker":"Chris Dy","startTime":232.38,"endTime":235.38,"body":"surgeons and health care"},{"speaker":"Chris Dy","startTime":235.38,"endTime":237.6,"body":"providers from all fields. So"},{"speaker":"Chris Dy","startTime":235.38,"endTime":237.6,"body":"thank you, Paul, for the review."},{"speaker":"Chris Dy","startTime":237.6,"endTime":241.56,"body":"We appreciate you listening and"},{"speaker":"Chris Dy","startTime":237.6,"endTime":241.56,"body":"I basically give away every"},{"speaker":"Chris Dy","startTime":241.56,"endTime":245.76,"body":"question to every every answer"},{"speaker":"Chris Dy","startTime":241.56,"endTime":245.76,"body":"to every question I asked on the"},{"speaker":"Chris Dy","startTime":245.76,"endTime":247.38,"body":"rotation in the podcast."},{"speaker":"Charles Goldfarb","startTime":248.19,"endTime":251.34,"body":"That's a"},{"speaker":"Charles Goldfarb","startTime":248.19,"endTime":251.34,"body":"teaser. Absolutely. Good stuff."},{"speaker":"Chris Dy","startTime":251.34,"endTime":252.99,"body":"He caught onto that,"},{"speaker":"Chris Dy","startTime":251.34,"endTime":252.99,"body":"he caught on to that which is"},{"speaker":"Chris Dy","startTime":252.99,"endTime":257.25,"body":"good. So any, any any new cases"},{"speaker":"Chris Dy","startTime":252.99,"endTime":257.25,"body":"or anything cool?"},{"speaker":"Charles Goldfarb","startTime":257.52,"endTime":259.44,"body":"Yeah, I would."},{"speaker":"Charles Goldfarb","startTime":257.52,"endTime":259.44,"body":"Yes, I'd love to tell you about"},{"speaker":"Charles Goldfarb","startTime":259.44,"endTime":264.03,"body":"a case. And then I actually read"},{"speaker":"Charles Goldfarb","startTime":259.44,"endTime":264.03,"body":"an interesting article which I'd"},{"speaker":"Charles Goldfarb","startTime":264.03,"endTime":269.07,"body":"like to briefly discuss. So case"},{"speaker":"Charles Goldfarb","startTime":264.03,"endTime":269.07,"body":"wise recently had a Dupuytren's"},{"speaker":"Charles Goldfarb","startTime":269.88,"endTime":273.9,"body":"fasciectomy. So as we've talked"},{"speaker":"Charles Goldfarb","startTime":269.88,"endTime":273.9,"body":"about, I'm a huge fan of the"},{"speaker":"Charles Goldfarb","startTime":273.9,"endTime":278.22,"body":"needle fasciotomy in the clinic,"},{"speaker":"Charles Goldfarb","startTime":273.9,"endTime":278.22,"body":"and it's really cut down on the"},{"speaker":"Charles Goldfarb","startTime":278.22,"endTime":282.21,"body":"number of formal open"},{"speaker":"Charles Goldfarb","startTime":278.22,"endTime":282.21,"body":"fasciectomies, which honestly is"},{"speaker":"Charles Goldfarb","startTime":282.21,"endTime":286.65,"body":"a is a loss for our fellowship,"},{"speaker":"Charles Goldfarb","startTime":282.21,"endTime":286.65,"body":"in the sense that, that that"},{"speaker":"Charles Goldfarb","startTime":286.65,"endTime":291.21,"body":"skill set is very important."},{"speaker":"Charles Goldfarb","startTime":286.65,"endTime":291.21,"body":"It's very, it's is a technical"},{"speaker":"Charles Goldfarb","startTime":291.21,"endTime":296.07,"body":"procedure. Experience matters."},{"speaker":"Charles Goldfarb","startTime":291.21,"endTime":296.07,"body":"So I'm always happy when there"},{"speaker":"Charles Goldfarb","startTime":296.07,"endTime":299.28,"body":"is a a need to go to the"},{"speaker":"Charles Goldfarb","startTime":296.07,"endTime":299.28,"body":"operating room. And this patient"},{"speaker":"Charles Goldfarb","startTime":299.28,"endTime":303.33,"body":"had patient had three finger"},{"speaker":"Charles Goldfarb","startTime":299.28,"endTime":303.33,"body":"disease and classic"},{"speaker":"Charles Goldfarb","startTime":303.33,"endTime":306.48,"body":"pre-tendinous cord for the"},{"speaker":"Charles Goldfarb","startTime":303.33,"endTime":306.48,"body":"middle finger an intrinsic cord"},{"speaker":"Charles Goldfarb","startTime":306.48,"endTime":310.56,"body":"to the ring finger, and then a"},{"speaker":"Charles Goldfarb","startTime":306.48,"endTime":310.56,"body":"combination for the little"},{"speaker":"Charles Goldfarb","startTime":310.56,"endTime":316.41,"body":"finger and had previously had"},{"speaker":"Charles Goldfarb","startTime":310.56,"endTime":316.41,"body":"collagenase injection for a cord"},{"speaker":"Charles Goldfarb","startTime":316.41,"endTime":318.96,"body":"for the little finger, so the"},{"speaker":"Charles Goldfarb","startTime":316.41,"endTime":318.96,"body":"middle finger and the ring"},{"speaker":"Charles Goldfarb","startTime":318.96,"endTime":321.87,"body":"finger went fine. And I get to"},{"speaker":"Charles Goldfarb","startTime":318.96,"endTime":321.87,"body":"the to the ring finger, which"},{"speaker":"Charles Goldfarb","startTime":321.87,"endTime":324.9,"body":"had a maybe a 30-40 degree"},{"speaker":"Charles Goldfarb","startTime":321.87,"endTime":324.9,"body":"contracture at the MP joint and"},{"speaker":"Charles Goldfarb","startTime":324.9,"endTime":329.22,"body":"a 90 degree contracture at the"},{"speaker":"Charles Goldfarb","startTime":324.9,"endTime":329.22,"body":"PIP joint. And it was"},{"speaker":"Charles Goldfarb","startTime":329.22,"endTime":335.01,"body":"fascinating because the digital"},{"speaker":"Charles Goldfarb","startTime":329.22,"endTime":335.01,"body":"bundles were encased in"},{"speaker":"Charles Goldfarb","startTime":335.01,"endTime":339.12,"body":"Dupuytren's, not you know, it"},{"speaker":"Charles Goldfarb","startTime":335.01,"endTime":339.12,"body":"was they were spiraling and all"},{"speaker":"Charles Goldfarb","startTime":339.12,"endTime":343.71,"body":"that but truly encased in a"},{"speaker":"Charles Goldfarb","startTime":339.12,"endTime":343.71,"body":"concrete like fashion, which I"},{"speaker":"Charles Goldfarb","startTime":343.71,"endTime":346.08,"body":"have not seen terribly often."},{"speaker":"Chris Dy","startTime":346.98,"endTime":349.41,"body":"Do you think that it"},{"speaker":"Chris Dy","startTime":346.98,"endTime":349.41,"body":"was the collagenase playing a"},{"speaker":"Chris Dy","startTime":349.41,"endTime":351.75,"body":"role in that in terms of the"},{"speaker":"Chris Dy","startTime":349.41,"endTime":351.75,"body":"scar tissue around it? Or?"},{"speaker":"Charles Goldfarb","startTime":352.17,"endTime":354.72,"body":"I think that's"},{"speaker":"Charles Goldfarb","startTime":352.17,"endTime":354.72,"body":"an easy an easy answer. I'm not"},{"speaker":"Charles Goldfarb","startTime":354.72,"endTime":360.96,"body":"sure if it's true. I think in my"},{"speaker":"Charles Goldfarb","startTime":354.72,"endTime":360.96,"body":"mind, maybe it is. But Wow. So,"},{"speaker":"Charles Goldfarb","startTime":361.08,"endTime":364.23,"body":"you know, we we invited to the"},{"speaker":"Charles Goldfarb","startTime":361.08,"endTime":364.23,"body":"basic principles, you know, we"},{"speaker":"Charles Goldfarb","startTime":364.23,"endTime":367.02,"body":"found the bundle proximally,"},{"speaker":"Charles Goldfarb","startTime":364.23,"endTime":367.02,"body":"bundles proximally found them"},{"speaker":"Charles Goldfarb","startTime":367.02,"endTime":371.1,"body":"distally worked in between and"},{"speaker":"Charles Goldfarb","startTime":367.02,"endTime":371.1,"body":"it was it was a challenge. And"},{"speaker":"Charles Goldfarb","startTime":371.1,"endTime":374.91,"body":"then once we succeeded,"},{"speaker":"Charles Goldfarb","startTime":371.1,"endTime":374.91,"body":"everything was intact, and we"},{"speaker":"Charles Goldfarb","startTime":374.91,"endTime":379.35,"body":"deflated the tourniquet. And you"},{"speaker":"Charles Goldfarb","startTime":374.91,"endTime":379.35,"body":"can guess what we had. A white"},{"speaker":"Charles Goldfarb","startTime":379.35,"endTime":379.71,"body":"finger."},{"speaker":"Chris Dy","startTime":379.77,"endTime":382.44,"body":"A white finger"},{"speaker":"Chris Dy","startTime":379.77,"endTime":382.44,"body":"exactly. Well how much contrast"},{"speaker":"Chris Dy","startTime":382.44,"endTime":384.24,"body":"how much correction Did you get?"},{"speaker":"Charles Goldfarb","startTime":384.81,"endTime":386.31,"body":"100%"},{"speaker":"Charles Goldfarb","startTime":384.81,"endTime":386.31,"body":"correction, which was very"},{"speaker":"Charles Goldfarb","startTime":386.31,"endTime":389.73,"body":"satisfying. I've limited I've"},{"speaker":"Charles Goldfarb","startTime":386.31,"endTime":389.73,"body":"been talking about this, you may"},{"speaker":"Charles Goldfarb","startTime":389.73,"endTime":391.89,"body":"have heard me say this, I've"},{"speaker":"Charles Goldfarb","startTime":389.73,"endTime":391.89,"body":"been talking about this a lot. I"},{"speaker":"Charles Goldfarb","startTime":391.89,"endTime":395.91,"body":"rarely perform a volar plate"},{"speaker":"Charles Goldfarb","startTime":391.89,"endTime":395.91,"body":"release anymore. I have rarely"},{"speaker":"Charles Goldfarb","startTime":395.91,"endTime":398.46,"body":"found that necessary. Now"},{"speaker":"Charles Goldfarb","startTime":395.91,"endTime":398.46,"body":"sometimes I do a manipulation."},{"speaker":"Charles Goldfarb","startTime":398.64,"endTime":401.73,"body":"But with a little manipulation,"},{"speaker":"Charles Goldfarb","startTime":398.64,"endTime":401.73,"body":"complete excision of all the"},{"speaker":"Charles Goldfarb","startTime":401.73,"endTime":405.69,"body":"Dupuytren's, which you can"},{"speaker":"Charles Goldfarb","startTime":401.73,"endTime":405.69,"body":"requires a lot of work. I did"},{"speaker":"Charles Goldfarb","startTime":405.69,"endTime":409.92,"body":"not need to touch the volar"},{"speaker":"Charles Goldfarb","startTime":405.69,"endTime":409.92,"body":"plate, finger was white, you"},{"speaker":"Charles Goldfarb","startTime":409.92,"endTime":414.15,"body":"know, there's white and there's"},{"speaker":"Charles Goldfarb","startTime":409.92,"endTime":414.15,"body":"white. This was white, but not"},{"speaker":"Charles Goldfarb","startTime":414.15,"endTime":417.15,"body":"the deep white that truly scared"},{"speaker":"Charles Goldfarb","startTime":414.15,"endTime":417.15,"body":"me. But it made me a little"},{"speaker":"Charles Goldfarb","startTime":417.15,"endTime":421.59,"body":"nervous. So we did the usual"},{"speaker":"Charles Goldfarb","startTime":417.15,"endTime":421.59,"body":"stuff to fight spasm. And"},{"speaker":"Charles Goldfarb","startTime":421.59,"endTime":423.57,"body":"eventually the finger came"},{"speaker":"Charles Goldfarb","startTime":421.59,"endTime":423.57,"body":"around but but it took probably"},{"speaker":"Charles Goldfarb","startTime":423.57,"endTime":426.0,"body":"15 minutes of a little bit of"},{"speaker":"Charles Goldfarb","startTime":423.57,"endTime":426.0,"body":"angst."},{"speaker":"Chris Dy","startTime":426.33,"endTime":429.42,"body":"So for you What's the"},{"speaker":"Chris Dy","startTime":426.33,"endTime":429.42,"body":"stuff that you do so obviously,"},{"speaker":"Chris Dy","startTime":429.42,"endTime":432.0,"body":"you relaxed the extension"},{"speaker":"Chris Dy","startTime":429.42,"endTime":432.0,"body":"posture of the finger, you've"},{"speaker":"Chris Dy","startTime":432.0,"endTime":434.67,"body":"already visualized, the bundles."},{"speaker":"Chris Dy","startTime":432.0,"endTime":434.67,"body":"Are you using anything like a"},{"speaker":"Chris Dy","startTime":434.67,"endTime":438.24,"body":"topical papaverine or lidocaine"},{"speaker":"Chris Dy","startTime":434.67,"endTime":438.24,"body":"for spasm, anything like that?"},{"speaker":"Charles Goldfarb","startTime":438.51,"endTime":444.72,"body":"Usually it's"},{"speaker":"Charles Goldfarb","startTime":438.51,"endTime":444.72,"body":"warm water. And patience, I can"},{"speaker":"Charles Goldfarb","startTime":444.72,"endTime":447.03,"body":"find the water but finding the"},{"speaker":"Charles Goldfarb","startTime":444.72,"endTime":447.03,"body":"patience is a little harder for"},{"speaker":"Charles Goldfarb","startTime":447.03,"endTime":452.28,"body":"me. And in this case, we got"},{"speaker":"Charles Goldfarb","startTime":447.03,"endTime":452.28,"body":"some 2% lidocaine and dribbled"},{"speaker":"Charles Goldfarb","startTime":452.28,"endTime":455.04,"body":"that on as well. We did not have"},{"speaker":"Charles Goldfarb","startTime":452.28,"endTime":455.04,"body":"the papaverine at the surgery"},{"speaker":"Charles Goldfarb","startTime":455.04,"endTime":459.18,"body":"center. But you know, the real"},{"speaker":"Charles Goldfarb","startTime":455.04,"endTime":459.18,"body":"consolation or consoling factor"},{"speaker":"Charles Goldfarb","startTime":459.18,"endTime":462.63,"body":"for me was there was no bleeding"},{"speaker":"Charles Goldfarb","startTime":459.18,"endTime":462.63,"body":"vessel. You know, once the"},{"speaker":"Charles Goldfarb","startTime":462.63,"endTime":466.35,"body":"tourniquet was down, so that"},{"speaker":"Charles Goldfarb","startTime":462.63,"endTime":466.35,"body":"gave me some confidence. But"},{"speaker":"Charles Goldfarb","startTime":466.38,"endTime":468.06,"body":"gosh, that was a long time."},{"speaker":"Chris Dy","startTime":469.32,"endTime":472.26,"body":"So if it hadn't come"},{"speaker":"Chris Dy","startTime":469.32,"endTime":472.26,"body":"back, would you have you know,"},{"speaker":"Chris Dy","startTime":472.29,"endTime":475.32,"body":"relaxed the finger and pinned it"},{"speaker":"Chris Dy","startTime":472.29,"endTime":475.32,"body":"in a certain position? What do"},{"speaker":"Chris Dy","startTime":475.32,"endTime":476.4,"body":"you think you would have done?"},{"speaker":"Charles Goldfarb","startTime":479.0,"endTime":481.04,"body":"I don't think"},{"speaker":"Charles Goldfarb","startTime":479.0,"endTime":481.04,"body":"I ever got to the point thinking"},{"speaker":"Charles Goldfarb","startTime":481.04,"endTime":485.72,"body":"that it wouldn't come back had I"},{"speaker":"Charles Goldfarb","startTime":481.04,"endTime":485.72,"body":"had a digital artery injury and"},{"speaker":"Charles Goldfarb","startTime":485.72,"endTime":489.65,"body":"had to repair it at a smaller"},{"speaker":"Charles Goldfarb","startTime":485.72,"endTime":489.65,"body":"surgery center, then I would"},{"speaker":"Charles Goldfarb","startTime":489.65,"endTime":496.19,"body":"have had to process more. Again,"},{"speaker":"Charles Goldfarb","startTime":489.65,"endTime":496.19,"body":"it's it's knock on wood. I've"},{"speaker":"Charles Goldfarb","startTime":496.19,"endTime":499.19,"body":"never gone down that pathway"},{"speaker":"Charles Goldfarb","startTime":496.19,"endTime":499.19,"body":"where I had to really think"},{"speaker":"Charles Goldfarb","startTime":499.19,"endTime":504.38,"body":"about salvage, so to speak. I"},{"speaker":"Charles Goldfarb","startTime":499.19,"endTime":504.38,"body":"don't pin my fingers at all"},{"speaker":"Charles Goldfarb","startTime":504.38,"endTime":508.19,"body":"anymore. I put them in a resting"},{"speaker":"Charles Goldfarb","startTime":504.38,"endTime":508.19,"body":"soft dressing, let them sit for"},{"speaker":"Charles Goldfarb","startTime":508.19,"endTime":511.73,"body":"48-72 hours and then start"},{"speaker":"Charles Goldfarb","startTime":508.19,"endTime":511.73,"body":"therapy. I'm not sure what your"},{"speaker":"Charles Goldfarb","startTime":511.79,"endTime":513.98,"body":"what's your protocol is. But"},{"speaker":"Charles Goldfarb","startTime":511.79,"endTime":513.98,"body":"that's worked pretty well for"},{"speaker":"Charles Goldfarb","startTime":513.98,"endTime":514.19,"body":"me."},{"speaker":"Chris Dy","startTime":514.85,"endTime":517.04,"body":"Yeah, it depends on"},{"speaker":"Chris Dy","startTime":514.85,"endTime":517.04,"body":"the case, you know, so if a"},{"speaker":"Chris Dy","startTime":517.04,"endTime":519.44,"body":"Dupuytren's gets to the OR,"},{"speaker":"Chris Dy","startTime":517.04,"endTime":519.44,"body":"which, as you mentioned earlier,"},{"speaker":"Chris Dy","startTime":519.44,"endTime":522.95,"body":"it's not incredibly common"},{"speaker":"Chris Dy","startTime":519.44,"endTime":522.95,"body":"anymore. So I like to do these"},{"speaker":"Chris Dy","startTime":522.95,"endTime":526.43,"body":"awake. You know, I think that"},{"speaker":"Chris Dy","startTime":522.95,"endTime":526.43,"body":"it's useful to have the patient"},{"speaker":"Chris Dy","startTime":526.43,"endTime":529.01,"body":"involved in the process and"},{"speaker":"Chris Dy","startTime":526.43,"endTime":529.01,"body":"actually have them visualize the"},{"speaker":"Chris Dy","startTime":529.01,"endTime":532.91,"body":"correction. And sometimes it is"},{"speaker":"Chris Dy","startTime":529.01,"endTime":532.91,"body":"good to hear, have them hear how"},{"speaker":"Chris Dy","startTime":532.91,"endTime":535.43,"body":"we're working what we're"},{"speaker":"Chris Dy","startTime":532.91,"endTime":535.43,"body":"thinking about. And I show them"},{"speaker":"Chris Dy","startTime":535.43,"endTime":537.56,"body":"and say, Hey, is this enough? Do"},{"speaker":"Chris Dy","startTime":535.43,"endTime":537.56,"body":"you want more I can get you"},{"speaker":"Chris Dy","startTime":537.56,"endTime":541.25,"body":"more. And it also gives me the"},{"speaker":"Chris Dy","startTime":537.56,"endTime":541.25,"body":"advantage of getting them up to"},{"speaker":"Chris Dy","startTime":541.25,"endTime":546.29,"body":"therapy, the day of for a splint"},{"speaker":"Chris Dy","startTime":541.25,"endTime":546.29,"body":"rather than waiting a little bit"},{"speaker":"Chris Dy","startTime":546.29,"endTime":548.45,"body":"longer, not that they're going"},{"speaker":"Chris Dy","startTime":546.29,"endTime":548.45,"body":"to do a whole lot of therapy"},{"speaker":"Chris Dy","startTime":548.48,"endTime":551.57,"body":"exercising, but I think having"},{"speaker":"Chris Dy","startTime":548.48,"endTime":551.57,"body":"them get up for a nice splint"},{"speaker":"Chris Dy","startTime":551.63,"endTime":555.77,"body":"right after they leave and"},{"speaker":"Chris Dy","startTime":551.63,"endTime":555.77,"body":"recoveries is nice. You know,"},{"speaker":"Chris Dy","startTime":555.77,"endTime":559.85,"body":"one thing that I would want to"},{"speaker":"Chris Dy","startTime":555.77,"endTime":559.85,"body":"ask you is you mentioned not"},{"speaker":"Chris Dy","startTime":560.15,"endTime":563.9,"body":"routinely doing any volar plate"},{"speaker":"Chris Dy","startTime":560.15,"endTime":563.9,"body":"work and doing some"},{"speaker":"Chris Dy","startTime":563.9,"endTime":568.64,"body":"manipulation. How do you assess"},{"speaker":"Chris Dy","startTime":563.9,"endTime":568.64,"body":"before surgery how much of it is"},{"speaker":"Chris Dy","startTime":568.67,"endTime":571.85,"body":"a joint contracture kind of"},{"speaker":"Chris Dy","startTime":568.67,"endTime":571.85,"body":"issue? And when is it too much"},{"speaker":"Chris Dy","startTime":571.85,"endTime":574.19,"body":"surgery to do some work on the"},{"speaker":"Chris Dy","startTime":571.85,"endTime":574.19,"body":"joint itself?"},{"speaker":"Charles Goldfarb","startTime":576.04,"endTime":579.28,"body":"Well, the"},{"speaker":"Charles Goldfarb","startTime":576.04,"endTime":579.28,"body":"literature tells us and I think"},{"speaker":"Charles Goldfarb","startTime":579.28,"endTime":581.92,"body":"this is out of Baltimore, the"},{"speaker":"Charles Goldfarb","startTime":579.28,"endTime":581.92,"body":"literature tells us if you have"},{"speaker":"Charles Goldfarb","startTime":581.92,"endTime":586.18,"body":"to do a volar plate release,"},{"speaker":"Charles Goldfarb","startTime":581.92,"endTime":586.18,"body":"long term expect only about 50%"},{"speaker":"Charles Goldfarb","startTime":586.18,"endTime":589.69,"body":"improvement to that PIP joint."},{"speaker":"Charles Goldfarb","startTime":586.18,"endTime":589.69,"body":"And obviously for those who"},{"speaker":"Charles Goldfarb","startTime":589.69,"endTime":591.7,"body":"haven't done a lot of this we're"},{"speaker":"Charles Goldfarb","startTime":589.69,"endTime":591.7,"body":"not really talking about the MP"},{"speaker":"Charles Goldfarb","startTime":591.7,"endTime":595.12,"body":"joint because an MP joint"},{"speaker":"Charles Goldfarb","startTime":591.7,"endTime":595.12,"body":"responds beautifully every time"},{"speaker":"Charles Goldfarb","startTime":595.12,"endTime":598.39,"body":"to taking out the use of the pre"},{"speaker":"Charles Goldfarb","startTime":595.12,"endTime":598.39,"body":"tendenous cord maybe an abductor"},{"speaker":"Charles Goldfarb","startTime":598.39,"endTime":601.18,"body":"digiti, digiti minimi cord for"},{"speaker":"Charles Goldfarb","startTime":598.39,"endTime":601.18,"body":"the small finger, the PIP"},{"speaker":"Charles Goldfarb","startTime":601.24,"endTime":607.93,"body":"joint's different. But my, my"},{"speaker":"Charles Goldfarb","startTime":601.24,"endTime":607.93,"body":"experience with First of all, I"},{"speaker":"Charles Goldfarb","startTime":607.93,"endTime":610.57,"body":"don't think it's too much"},{"speaker":"Charles Goldfarb","startTime":607.93,"endTime":610.57,"body":"surgery, in my experience with"},{"speaker":"Charles Goldfarb","startTime":610.6,"endTime":613.81,"body":"purely addressing the"},{"speaker":"Charles Goldfarb","startTime":610.6,"endTime":613.81,"body":"Dupuytren's, which again can be"},{"speaker":"Charles Goldfarb","startTime":613.81,"endTime":617.62,"body":"complex, and it's about 100%"},{"speaker":"Charles Goldfarb","startTime":613.81,"endTime":617.62,"body":"Dupuytren's excision across the"},{"speaker":"Charles Goldfarb","startTime":617.62,"endTime":621.13,"body":"joint, and potentially a little"},{"speaker":"Charles Goldfarb","startTime":617.62,"endTime":621.13,"body":"manipulation is that it has been"},{"speaker":"Charles Goldfarb","startTime":621.13,"endTime":623.59,"body":"really effective and the results"},{"speaker":"Charles Goldfarb","startTime":621.13,"endTime":623.59,"body":"are better, I hope to be able to"},{"speaker":"Charles Goldfarb","startTime":623.59,"endTime":627.16,"body":"eventually look back and provide"},{"speaker":"Charles Goldfarb","startTime":623.59,"endTime":627.16,"body":"some actual follow up on that."},{"speaker":"Charles Goldfarb","startTime":627.31,"endTime":628.6,"body":"But that's my early sense."},{"speaker":"Chris Dy","startTime":629.47,"endTime":632.59,"body":"So if you get that"},{"speaker":"Chris Dy","startTime":629.47,"endTime":632.59,"body":"much correction, what's your"},{"speaker":"Chris Dy","startTime":632.59,"endTime":636.46,"body":"preferred way of dealing with,"},{"speaker":"Chris Dy","startTime":632.59,"endTime":636.46,"body":"you know, any skin voids or soft"},{"speaker":"Chris Dy","startTime":636.46,"endTime":639.55,"body":"tissue defects from the skin"},{"speaker":"Chris Dy","startTime":636.46,"endTime":639.55,"body":"being contracted for so long?"},{"speaker":"Chris Dy","startTime":639.55,"endTime":642.16,"body":"Are you the kind of person that"},{"speaker":"Chris Dy","startTime":639.55,"endTime":642.16,"body":"likes a full thickness skin"},{"speaker":"Chris Dy","startTime":642.16,"endTime":646.42,"body":"graft? Do you like to leave it"},{"speaker":"Chris Dy","startTime":642.16,"endTime":646.42,"body":"open? You know, I remember doing"},{"speaker":"Chris Dy","startTime":646.42,"endTime":649.81,"body":"a modified McCash procedure"},{"speaker":"Chris Dy","startTime":646.42,"endTime":649.81,"body":"during my fellowship with Dr."},{"speaker":"Chris Dy","startTime":649.84,"endTime":652.72,"body":"Gelberman. And that seemed to be"},{"speaker":"Chris Dy","startTime":649.84,"endTime":652.72,"body":"quite labor intensive for the"},{"speaker":"Chris Dy","startTime":652.72,"endTime":654.25,"body":"post operative follow up."},{"speaker":"Charles Goldfarb","startTime":654.69,"endTime":657.54,"body":"Yeah, that"},{"speaker":"Charles Goldfarb","startTime":654.69,"endTime":657.54,"body":"that, thankfully, is not in my"},{"speaker":"Charles Goldfarb","startTime":657.54,"endTime":660.96,"body":"armamentarium. Although it is"},{"speaker":"Charles Goldfarb","startTime":657.54,"endTime":660.96,"body":"good to have seen that because"},{"speaker":"Charles Goldfarb","startTime":660.96,"endTime":665.25,"body":"you never know when you might"},{"speaker":"Charles Goldfarb","startTime":660.96,"endTime":665.25,"body":"need it. And for me, those type"},{"speaker":"Charles Goldfarb","startTime":665.25,"endTime":669.42,"body":"of considerations are about"},{"speaker":"Charles Goldfarb","startTime":665.25,"endTime":669.42,"body":"revisions of previous open"},{"speaker":"Charles Goldfarb","startTime":669.42,"endTime":673.08,"body":"surgeries. And so I for my"},{"speaker":"Charles Goldfarb","startTime":669.42,"endTime":673.08,"body":"camptodactylies is not to bring"},{"speaker":"Charles Goldfarb","startTime":673.08,"endTime":676.59,"body":"it all back to congenital but"},{"speaker":"Charles Goldfarb","startTime":673.08,"endTime":676.59,"body":"for me, that's a that's a key"},{"speaker":"Charles Goldfarb","startTime":676.62,"endTime":680.13,"body":"point, I use a rotation flap off"},{"speaker":"Charles Goldfarb","startTime":676.62,"endTime":680.13,"body":"the side of the finger. And so"},{"speaker":"Charles Goldfarb","startTime":680.13,"endTime":683.97,"body":"that's a great option for me,"},{"speaker":"Charles Goldfarb","startTime":680.13,"endTime":683.97,"body":"especially if that PIP joint if"},{"speaker":"Charles Goldfarb","startTime":683.97,"endTime":687.03,"body":"we're really dealing with skin"},{"speaker":"Charles Goldfarb","startTime":683.97,"endTime":687.03,"body":"that that may not have support"},{"speaker":"Charles Goldfarb","startTime":687.03,"endTime":689.49,"body":"beneath it for healing. And so a"},{"speaker":"Charles Goldfarb","startTime":687.03,"endTime":689.49,"body":"rotation flap can be very"},{"speaker":"Charles Goldfarb","startTime":689.49,"endTime":689.82,"body":"helpful."},{"speaker":"Chris Dy","startTime":691.28,"endTime":694.19,"body":"Okay, that's a great"},{"speaker":"Chris Dy","startTime":691.28,"endTime":694.19,"body":"discussion. It's a nice follow"},{"speaker":"Chris Dy","startTime":694.19,"endTime":696.77,"body":"up, almost part four of"},{"speaker":"Chris Dy","startTime":694.19,"endTime":696.77,"body":"Dupuytren's disease there."},{"speaker":"Charles Goldfarb","startTime":697.08,"endTime":700.35,"body":"Yes. So so I"},{"speaker":"Charles Goldfarb","startTime":697.08,"endTime":700.35,"body":"want to briefly and I think"},{"speaker":"Charles Goldfarb","startTime":700.35,"endTime":704.37,"body":"we're all feeling a little"},{"speaker":"Charles Goldfarb","startTime":700.35,"endTime":704.37,"body":"optimism about COVID. I think,"},{"speaker":"Charles Goldfarb","startTime":704.61,"endTime":706.74,"body":"here in St. Louis, the numbers"},{"speaker":"Charles Goldfarb","startTime":704.61,"endTime":706.74,"body":"are good, actually, across the"},{"speaker":"Charles Goldfarb","startTime":706.74,"endTime":709.17,"body":"country, the numbers it is, we"},{"speaker":"Charles Goldfarb","startTime":706.74,"endTime":709.17,"body":"gotta be careful to say the"},{"speaker":"Charles Goldfarb","startTime":709.17,"endTime":711.15,"body":"numbers are good, the numbers"},{"speaker":"Charles Goldfarb","startTime":709.17,"endTime":711.15,"body":"are heading in the right"},{"speaker":"Charles Goldfarb","startTime":711.15,"endTime":713.91,"body":"direction, there are still far"},{"speaker":"Charles Goldfarb","startTime":711.15,"endTime":713.91,"body":"too many deaths and infections"},{"speaker":"Charles Goldfarb","startTime":713.91,"endTime":719.37,"body":"on a daily basis. I actually am"},{"speaker":"Charles Goldfarb","startTime":713.91,"endTime":719.37,"body":"a little worried about these"},{"speaker":"Charles Goldfarb","startTime":719.49,"endTime":722.37,"body":"variant strains. There was a"},{"speaker":"Charles Goldfarb","startTime":719.49,"endTime":722.37,"body":"really interesting article in"},{"speaker":"Charles Goldfarb","startTime":722.37,"endTime":727.38,"body":"The Atlantic magazine, written"},{"speaker":"Charles Goldfarb","startTime":722.37,"endTime":727.38,"body":"by a Yale public health expert,"},{"speaker":"Charles Goldfarb","startTime":727.68,"endTime":731.7,"body":"and it talked about a city city"},{"speaker":"Charles Goldfarb","startTime":727.68,"endTime":731.7,"body":"called Manny- Manaus, I think"},{"speaker":"Charles Goldfarb","startTime":731.73,"endTime":735.9,"body":"Manaus in Brazil. And it's"},{"speaker":"Charles Goldfarb","startTime":731.73,"endTime":735.9,"body":"really fascinating. This city"},{"speaker":"Charles Goldfarb","startTime":736.11,"endTime":740.85,"body":"was overrun with COVID, early to"},{"speaker":"Charles Goldfarb","startTime":736.11,"endTime":740.85,"body":"the extent that all the public"},{"speaker":"Charles Goldfarb","startTime":740.85,"endTime":745.08,"body":"health folks thought the city"},{"speaker":"Charles Goldfarb","startTime":740.85,"endTime":745.08,"body":"had achieved herd immunity. You"},{"speaker":"Charles Goldfarb","startTime":745.08,"endTime":748.35,"body":"know, typically people say"},{"speaker":"Charles Goldfarb","startTime":745.08,"endTime":748.35,"body":"70-75%, infection rates are"},{"speaker":"Charles Goldfarb","startTime":748.35,"endTime":751.71,"body":"required or immunizations are"},{"speaker":"Charles Goldfarb","startTime":748.35,"endTime":751.71,"body":"required for herd immunity. And"},{"speaker":"Charles Goldfarb","startTime":751.71,"endTime":754.5,"body":"that was what everyone thought"},{"speaker":"Charles Goldfarb","startTime":751.71,"endTime":754.5,"body":"had been achieved in this city."},{"speaker":"Charles Goldfarb","startTime":754.68,"endTime":759.24,"body":"And that was, you know, late"},{"speaker":"Charles Goldfarb","startTime":754.68,"endTime":759.24,"body":"spring, early summer. And the"},{"speaker":"Charles Goldfarb","startTime":759.24,"endTime":764.64,"body":"really concerning thing is that"},{"speaker":"Charles Goldfarb","startTime":759.24,"endTime":764.64,"body":"they are now overrun with a new"},{"speaker":"Charles Goldfarb","startTime":764.64,"endTime":768.0,"body":"Brazilian variant, and people"},{"speaker":"Charles Goldfarb","startTime":764.64,"endTime":768.0,"body":"are sick and people are dying."},{"speaker":"Charles Goldfarb","startTime":768.27,"endTime":773.88,"body":"And it's just it's just a"},{"speaker":"Charles Goldfarb","startTime":768.27,"endTime":773.88,"body":"worrisome example of the fact"},{"speaker":"Charles Goldfarb","startTime":773.88,"endTime":776.28,"body":"that we we are not out of this"},{"speaker":"Charles Goldfarb","startTime":773.88,"endTime":776.28,"body":"yet at all."},{"speaker":"Chris Dy","startTime":777.27,"endTime":780.27,"body":"Yeah, it's it's way"},{"speaker":"Chris Dy","startTime":777.27,"endTime":780.27,"body":"too early to, to do any"},{"speaker":"Chris Dy","startTime":780.27,"endTime":783.84,"body":"celebrating, and certainly way"},{"speaker":"Chris Dy","startTime":780.27,"endTime":783.84,"body":"too early to let down, let down"},{"speaker":"Chris Dy","startTime":783.84,"endTime":788.88,"body":"our guard. It's been a long"},{"speaker":"Chris Dy","startTime":783.84,"endTime":788.88,"body":"time. You know, it's honestly,"},{"speaker":"Chris Dy","startTime":788.88,"endTime":791.76,"body":"it's been 11 months now, since"},{"speaker":"Chris Dy","startTime":788.88,"endTime":791.76,"body":"this whole thing started in"},{"speaker":"Chris Dy","startTime":791.76,"endTime":795.96,"body":"earnest. And probably it's been"},{"speaker":"Chris Dy","startTime":791.76,"endTime":795.96,"body":"here for about a year. So it,"},{"speaker":"Chris Dy","startTime":796.11,"endTime":798.45,"body":"that's tough. And I'm just"},{"speaker":"Chris Dy","startTime":796.11,"endTime":798.45,"body":"surprised you have time to read"},{"speaker":"Chris Dy","startTime":798.45,"endTime":800.13,"body":"the Atlantic. I'm so impressed."},{"speaker":"Charles Goldfarb","startTime":800.66,"endTime":804.68,"body":"I, I thank you"},{"speaker":"Charles Goldfarb","startTime":800.66,"endTime":804.68,"body":"for saying that. I try, I try to"},{"speaker":"Charles Goldfarb","startTime":804.68,"endTime":808.37,"body":"read outside of work. And this"},{"speaker":"Charles Goldfarb","startTime":804.68,"endTime":808.37,"body":"is work related. But yeah, these"},{"speaker":"Charles Goldfarb","startTime":808.37,"endTime":811.67,"body":"kind of I don't know, I like"},{"speaker":"Charles Goldfarb","startTime":808.37,"endTime":811.67,"body":"we've talked about all the ways"},{"speaker":"Charles Goldfarb","startTime":811.67,"endTime":816.65,"body":"we can fight burnout, and fight"},{"speaker":"Charles Goldfarb","startTime":811.67,"endTime":816.65,"body":"the stress that every single one"},{"speaker":"Charles Goldfarb","startTime":816.65,"endTime":819.77,"body":"of us and all of you listening"},{"speaker":"Charles Goldfarb","startTime":816.65,"endTime":819.77,"body":"are experiencing, these are such"},{"speaker":"Charles Goldfarb","startTime":819.83,"endTime":824.72,"body":"abnormal times, that whatever,"},{"speaker":"Charles Goldfarb","startTime":819.83,"endTime":824.72,"body":"whatever gets you talking to"},{"speaker":"Charles Goldfarb","startTime":824.75,"endTime":828.35,"body":"other people, whatever kind of"},{"speaker":"Charles Goldfarb","startTime":824.75,"endTime":828.35,"body":"just makes makes you feel"},{"speaker":"Charles Goldfarb","startTime":828.35,"endTime":830.63,"body":"better. And again, reading"},{"speaker":"Charles Goldfarb","startTime":828.35,"endTime":830.63,"body":"pessimistic news may not make me"},{"speaker":"Charles Goldfarb","startTime":830.63,"endTime":833.33,"body":"feel better. But it's reading"},{"speaker":"Charles Goldfarb","startTime":830.63,"endTime":833.33,"body":"outside of medicine, it leads to"},{"speaker":"Charles Goldfarb","startTime":833.33,"endTime":837.44,"body":"conversations in my house. And"},{"speaker":"Charles Goldfarb","startTime":833.33,"endTime":837.44,"body":"so all of those things matter."},{"speaker":"Charles Goldfarb","startTime":837.59,"endTime":840.65,"body":"And so I do think we should, and"},{"speaker":"Charles Goldfarb","startTime":837.59,"endTime":840.65,"body":"people like me, and you"},{"speaker":"Charles Goldfarb","startTime":840.65,"endTime":842.84,"body":"especially need to fight being"},{"speaker":"Charles Goldfarb","startTime":840.65,"endTime":842.84,"body":"one dimensional, if that's a"},{"speaker":"Charles Goldfarb","startTime":842.84,"endTime":845.69,"body":"trip to the zoo. Great. If"},{"speaker":"Charles Goldfarb","startTime":842.84,"endTime":845.69,"body":"that's, you know, going for a"},{"speaker":"Charles Goldfarb","startTime":845.69,"endTime":848.36,"body":"run great, but all of us need to"},{"speaker":"Charles Goldfarb","startTime":845.69,"endTime":848.36,"body":"continue to be aware of mental"},{"speaker":"Charles Goldfarb","startTime":848.36,"endTime":852.2,"body":"health because we know we are"},{"speaker":"Charles Goldfarb","startTime":848.36,"endTime":852.2,"body":"already in an epidemic of mental"},{"speaker":"Charles Goldfarb","startTime":852.2,"endTime":854.33,"body":"health challenges, and that's"},{"speaker":"Charles Goldfarb","startTime":852.2,"endTime":854.33,"body":"not going to get better anytime"},{"speaker":"Charles Goldfarb","startTime":854.33,"endTime":855.11,"body":"soon, either."},{"speaker":"Chris Dy","startTime":855.9,"endTime":860.25,"body":"My current read"},{"speaker":"Chris Dy","startTime":855.9,"endTime":860.25,"body":"outside of medicine is Dave"},{"speaker":"Chris Dy","startTime":860.25,"endTime":865.14,"body":"Chang's memoir called eat a"},{"speaker":"Chris Dy","startTime":860.25,"endTime":865.14,"body":"peach, the founder and you know,"},{"speaker":"Chris Dy","startTime":865.14,"endTime":869.52,"body":"chef at Momofuku in New York"},{"speaker":"Chris Dy","startTime":865.14,"endTime":869.52,"body":"City initially, and he's"},{"speaker":"Chris Dy","startTime":869.52,"endTime":873.15,"body":"probably one of my favorite"},{"speaker":"Chris Dy","startTime":869.52,"endTime":873.15,"body":"chefs. So the issue with me"},{"speaker":"Chris Dy","startTime":873.15,"endTime":876.39,"body":"reading this book right now is I"},{"speaker":"Chris Dy","startTime":873.15,"endTime":876.39,"body":"get so damn hungry. Every time I"},{"speaker":"Chris Dy","startTime":876.39,"endTime":880.71,"body":"read a chapter and talking about"},{"speaker":"Chris Dy","startTime":876.39,"endTime":880.71,"body":"food, but I agree with you 100%"},{"speaker":"Chris Dy","startTime":881.13,"endTime":884.55,"body":"that we need to read outside of"},{"speaker":"Chris Dy","startTime":881.13,"endTime":884.55,"body":"medicine and I used to read the"},{"speaker":"Chris Dy","startTime":884.55,"endTime":887.13,"body":"Atlantic. I don't know what it"},{"speaker":"Chris Dy","startTime":884.55,"endTime":887.13,"body":"says about my residency. I think"},{"speaker":"Chris Dy","startTime":887.13,"endTime":890.7,"body":"I had time to read in my"},{"speaker":"Chris Dy","startTime":887.13,"endTime":890.7,"body":"residency. But since uh, you"},{"speaker":"Chris Dy","startTime":890.7,"endTime":893.88,"body":"know, parenting and attending"},{"speaker":"Chris Dy","startTime":890.7,"endTime":893.88,"body":"hood started have not found the"},{"speaker":"Chris Dy","startTime":893.88,"endTime":894.24,"body":"time."},{"speaker":"Charles Goldfarb","startTime":894.96,"endTime":897.33,"body":"Well, we"},{"speaker":"Charles Goldfarb","startTime":894.96,"endTime":897.33,"body":"should briefly and I'll tell you"},{"speaker":"Charles Goldfarb","startTime":897.33,"endTime":899.1,"body":"what I'm reading. I may have"},{"speaker":"Charles Goldfarb","startTime":897.33,"endTime":899.1,"body":"mentioned this before. I'm"},{"speaker":"Charles Goldfarb","startTime":899.1,"endTime":902.01,"body":"getting near the end. I read"},{"speaker":"Charles Goldfarb","startTime":899.1,"endTime":902.01,"body":"multiple books at a time. I'm"},{"speaker":"Charles Goldfarb","startTime":902.01,"endTime":906.3,"body":"reading the splendid and the"},{"speaker":"Charles Goldfarb","startTime":902.01,"endTime":906.3,"body":"vile, which is a book that Eric"},{"speaker":"Charles Goldfarb","startTime":906.3,"endTime":909.12,"body":"Larson, who's one of my favorite"},{"speaker":"Charles Goldfarb","startTime":906.3,"endTime":909.12,"body":"kind of historically,"},{"speaker":"Charles Goldfarb","startTime":909.18,"endTime":913.89,"body":"historical, it's true history."},{"speaker":"Charles Goldfarb","startTime":909.18,"endTime":913.89,"body":"But he almost makes it an easy"},{"speaker":"Charles Goldfarb","startTime":913.89,"endTime":918.54,"body":"read. This is about London,"},{"speaker":"Charles Goldfarb","startTime":913.89,"endTime":918.54,"body":"about Winston Churchill, about"},{"speaker":"Charles Goldfarb","startTime":918.54,"endTime":923.58,"body":"leadership, and about World War"},{"speaker":"Charles Goldfarb","startTime":918.54,"endTime":923.58,"body":"Two before the United States"},{"speaker":"Charles Goldfarb","startTime":923.58,"endTime":927.24,"body":"joined in the bombings, it is"},{"speaker":"Charles Goldfarb","startTime":923.58,"endTime":927.24,"body":"incredible. I'm almost done."},{"speaker":"Charles Goldfarb","startTime":927.27,"endTime":930.15,"body":"It's not a book. It's not an"},{"speaker":"Charles Goldfarb","startTime":927.27,"endTime":930.15,"body":"easy read."},{"speaker":"Chris Dy","startTime":930.18,"endTime":931.2,"body":"Sounds like a light"},{"speaker":"Chris Dy","startTime":930.18,"endTime":931.2,"body":"read."},{"speaker":"Charles Goldfarb","startTime":931.0,"endTime":933.73,"body":"Yeah. Well,"},{"speaker":"Charles Goldfarb","startTime":931.0,"endTime":933.73,"body":"the other book we should talk"},{"speaker":"Charles Goldfarb","startTime":933.73,"endTime":943.36,"body":"about is a book called f blank"},{"speaker":"Charles Goldfarb","startTime":933.73,"endTime":943.36,"body":"ck your formula. Why following"},{"speaker":"Charles Goldfarb","startTime":943.36,"endTime":947.29,"body":"rules is the worst marketing"},{"speaker":"Charles Goldfarb","startTime":943.36,"endTime":947.29,"body":"decision you'll ever make. It's"},{"speaker":"Charles Goldfarb","startTime":947.29,"endTime":951.82,"body":"by a few different people, Brian"},{"speaker":"Charles Goldfarb","startTime":947.29,"endTime":951.82,"body":"Krause, and Aaron Perlit. And"},{"speaker":"Charles Goldfarb","startTime":951.82,"endTime":956.11,"body":"the reason I bring this book up,"},{"speaker":"Charles Goldfarb","startTime":951.82,"endTime":956.11,"body":"it's about marketing. And Aaron"},{"speaker":"Charles Goldfarb","startTime":956.11,"endTime":958.66,"body":"is going to be our guest on the"},{"speaker":"Charles Goldfarb","startTime":956.11,"endTime":958.66,"body":"next episode."},{"speaker":"Chris Dy","startTime":959.47,"endTime":962.44,"body":"That's fantastic. I"},{"speaker":"Chris Dy","startTime":959.47,"endTime":962.44,"body":"can't wait to hear what Aaron"},{"speaker":"Chris Dy","startTime":962.44,"endTime":965.05,"body":"has to say. I think it'll be a"},{"speaker":"Chris Dy","startTime":962.44,"endTime":965.05,"body":"nice follow up to the prior"},{"speaker":"Chris Dy","startTime":965.05,"endTime":968.8,"body":"week's episode on marketing and"},{"speaker":"Chris Dy","startTime":965.05,"endTime":968.8,"body":"practice development. And I"},{"speaker":"Chris Dy","startTime":968.8,"endTime":971.05,"body":"think at some point, we're going"},{"speaker":"Chris Dy","startTime":968.8,"endTime":971.05,"body":"to round out that series by"},{"speaker":"Chris Dy","startTime":971.05,"endTime":974.59,"body":"having another surgeon come on"},{"speaker":"Chris Dy","startTime":971.05,"endTime":974.59,"body":"the show who has a different"},{"speaker":"Chris Dy","startTime":974.59,"endTime":977.26,"body":"perspective, perhaps from"},{"speaker":"Chris Dy","startTime":974.59,"endTime":977.26,"body":"private practice. So thank you"},{"speaker":"Chris Dy","startTime":977.26,"endTime":980.23,"body":"in advance to Aaron for joining"},{"speaker":"Chris Dy","startTime":977.26,"endTime":980.23,"body":"us and we look forward to"},{"speaker":"Chris Dy","startTime":980.23,"endTime":981.01,"body":"hearing from him."},{"speaker":"Charles Goldfarb","startTime":981.45,"endTime":984.15,"body":"Perfect. Let's"},{"speaker":"Charles Goldfarb","startTime":981.45,"endTime":984.15,"body":"jump into we thought we had been"},{"speaker":"Charles Goldfarb","startTime":984.15,"endTime":987.81,"body":"neglecting the clinical content"},{"speaker":"Charles Goldfarb","startTime":984.15,"endTime":987.81,"body":"world. So we wanted to break up"},{"speaker":"Charles Goldfarb","startTime":987.81,"endTime":991.26,"body":"the marketing discussion with a"},{"speaker":"Charles Goldfarb","startTime":987.81,"endTime":991.26,"body":"key clinical topic. And you"},{"speaker":"Charles Goldfarb","startTime":991.26,"endTime":993.72,"body":"know, what Chris came up with,"},{"speaker":"Charles Goldfarb","startTime":991.26,"endTime":993.72,"body":"we can only come up with one"},{"speaker":"Charles Goldfarb","startTime":993.72,"endTime":997.5,"body":"dimensional topics. So Chris,"},{"speaker":"Charles Goldfarb","startTime":993.72,"endTime":997.5,"body":"tell us what our topic is."},{"speaker":"Chris Dy","startTime":997.63,"endTime":1000.84,"body":"The topic is pronator"},{"speaker":"Chris Dy","startTime":997.63,"endTime":1000.84,"body":"syndrome, or whatever it's"},{"speaker":"Chris Dy","startTime":1000.84,"endTime":1005.91,"body":"called nowadays. You know, I"},{"speaker":"Chris Dy","startTime":1000.84,"endTime":1005.91,"body":"think that it's challenging,"},{"speaker":"Chris Dy","startTime":1006.21,"endTime":1009.36,"body":"because this is a syndrome that"},{"speaker":"Chris Dy","startTime":1006.21,"endTime":1009.36,"body":"has changed names quite a few"},{"speaker":"Chris Dy","startTime":1009.36,"endTime":1011.67,"body":"times. If you talk to some"},{"speaker":"Chris Dy","startTime":1009.36,"endTime":1011.67,"body":"people, they will call it"},{"speaker":"Chris Dy","startTime":1011.67,"endTime":1014.97,"body":"Lacertus syndrome now. So what"},{"speaker":"Chris Dy","startTime":1011.67,"endTime":1014.97,"body":"are your thoughts, Chuck?"},{"speaker":"Charles Goldfarb","startTime":1016.98,"endTime":1019.29,"body":"For me, it's"},{"speaker":"Charles Goldfarb","startTime":1016.98,"endTime":1019.29,"body":"still called Pronator Syndrome."},{"speaker":"Charles Goldfarb","startTime":1020.28,"endTime":1025.44,"body":"And it is something that is"},{"speaker":"Charles Goldfarb","startTime":1020.28,"endTime":1025.44,"body":"infrequently diagnosed, but when"},{"speaker":"Charles Goldfarb","startTime":1025.44,"endTime":1031.17,"body":"diagnosed, can be a really"},{"speaker":"Charles Goldfarb","startTime":1025.44,"endTime":1031.17,"body":"important step for the patient."},{"speaker":"Chris Dy","startTime":1032.32,"endTime":1037.3,"body":"So in your mind, what"},{"speaker":"Chris Dy","startTime":1032.32,"endTime":1037.3,"body":"is pronator syndrome? I know"},{"speaker":"Chris Dy","startTime":1037.3,"endTime":1039.64,"body":"that there are a number of"},{"speaker":"Chris Dy","startTime":1037.3,"endTime":1039.64,"body":"different definitions out there,"},{"speaker":"Chris Dy","startTime":1039.67,"endTime":1044.14,"body":"I actually pulled out my Dr."},{"speaker":"Chris Dy","startTime":1039.67,"endTime":1044.14,"body":"Gelberman Blue Book, to look up"},{"speaker":"Chris Dy","startTime":1044.14,"endTime":1048.46,"body":"the definition. But I'll read to"},{"speaker":"Chris Dy","startTime":1044.14,"endTime":1048.46,"body":"you that this was first"},{"speaker":"Chris Dy","startTime":1048.46,"endTime":1052.42,"body":"described by Seaforth in 1951,"},{"speaker":"Chris Dy","startTime":1048.46,"endTime":1052.42,"body":"who proposed that the median"},{"speaker":"Chris Dy","startTime":1052.42,"endTime":1055.15,"body":"nerve was compressed between the"},{"speaker":"Chris Dy","startTime":1052.42,"endTime":1055.15,"body":"two heads of the pronator teres"},{"speaker":"Chris Dy","startTime":1055.15,"endTime":1059.65,"body":"muscle or by the FDS arch. Is"},{"speaker":"Chris Dy","startTime":1055.15,"endTime":1059.65,"body":"that still your understanding of"},{"speaker":"Chris Dy","startTime":1059.65,"endTime":1063.61,"body":"it in 2021, which, you know,"},{"speaker":"Chris Dy","startTime":1059.65,"endTime":1063.61,"body":"compared to 1951, it's been"},{"speaker":"Chris Dy","startTime":1063.61,"endTime":1064.3,"body":"quite some time?"},{"speaker":"Charles Goldfarb","startTime":1064.66,"endTime":1067.75,"body":"So, you know,"},{"speaker":"Charles Goldfarb","startTime":1064.66,"endTime":1067.75,"body":"at washu, we have been very"},{"speaker":"Charles Goldfarb","startTime":1067.75,"endTime":1072.79,"body":"fortunate to have a great"},{"speaker":"Charles Goldfarb","startTime":1067.75,"endTime":1072.79,"body":"anatomy series. And some of"},{"speaker":"Charles Goldfarb","startTime":1072.79,"endTime":1075.97,"body":"those anatomy discussions have"},{"speaker":"Charles Goldfarb","startTime":1072.79,"endTime":1075.97,"body":"been remarkably impactful for"},{"speaker":"Charles Goldfarb","startTime":1075.97,"endTime":1079.99,"body":"me. And I remember as a"},{"speaker":"Charles Goldfarb","startTime":1075.97,"endTime":1079.99,"body":"resident, having these"},{"speaker":"Charles Goldfarb","startTime":1079.99,"endTime":1085.6,"body":"discussions, in which we talked"},{"speaker":"Charles Goldfarb","startTime":1079.99,"endTime":1085.6,"body":"about the anatomical reasons for"},{"speaker":"Charles Goldfarb","startTime":1085.6,"endTime":1089.89,"body":"pronator syndrome. And so we"},{"speaker":"Charles Goldfarb","startTime":1085.6,"endTime":1089.89,"body":"talk about the supracondylar"},{"speaker":"Charles Goldfarb","startTime":1089.89,"endTime":1097.27,"body":"process. We talk about the"},{"speaker":"Charles Goldfarb","startTime":1089.89,"endTime":1097.27,"body":"ligament of Struthers. We talk"},{"speaker":"Charles Goldfarb","startTime":1097.27,"endTime":1100.51,"body":"about the lacertus fibrosis, we"},{"speaker":"Charles Goldfarb","startTime":1097.27,"endTime":1100.51,"body":"talked about the pronator. And"},{"speaker":"Charles Goldfarb","startTime":1100.51,"endTime":1104.2,"body":"we talked about the FDS arch and"},{"speaker":"Charles Goldfarb","startTime":1100.51,"endTime":1104.2,"body":"I will never forget Paul Mansky"},{"speaker":"Charles Goldfarb","startTime":1104.2,"endTime":1108.31,"body":"saying, I buy it, I buy all of"},{"speaker":"Charles Goldfarb","startTime":1104.2,"endTime":1108.31,"body":"those as possible explanations"},{"speaker":"Charles Goldfarb","startTime":1108.55,"endTime":1113.71,"body":"for nerve compression, except"},{"speaker":"Charles Goldfarb","startTime":1108.55,"endTime":1113.71,"body":"the lacertus. And I think he's"},{"speaker":"Charles Goldfarb","startTime":1113.71,"endTime":1116.95,"body":"right. And we always release the"},{"speaker":"Charles Goldfarb","startTime":1113.71,"endTime":1116.95,"body":"lacertus. But I think the other"},{"speaker":"Charles Goldfarb","startTime":1116.95,"endTime":1120.85,"body":"is really only three because"},{"speaker":"Charles Goldfarb","startTime":1116.95,"endTime":1120.85,"body":"supracondylar process slash"},{"speaker":"Charles Goldfarb","startTime":1120.85,"endTime":1123.1,"body":"ligament of Struthers, I think"},{"speaker":"Charles Goldfarb","startTime":1120.85,"endTime":1123.1,"body":"is one potential compression"},{"speaker":"Charles Goldfarb","startTime":1123.1,"endTime":1126.19,"body":"point. And I think that two"},{"speaker":"Charles Goldfarb","startTime":1123.1,"endTime":1126.19,"body":"heads of the pronator. And I"},{"speaker":"Charles Goldfarb","startTime":1126.19,"endTime":1129.64,"body":"think that FDS arch can be can"},{"speaker":"Charles Goldfarb","startTime":1126.19,"endTime":1129.64,"body":"be real constriction points, but"},{"speaker":"Charles Goldfarb","startTime":1129.64,"endTime":1133.3,"body":"it's just amazing what sticks"},{"speaker":"Charles Goldfarb","startTime":1129.64,"endTime":1133.3,"body":"with you over time. And I'll"},{"speaker":"Charles Goldfarb","startTime":1133.3,"endTime":1134.74,"body":"never forget those discussions."},{"speaker":"Chris Dy","startTime":1135.43,"endTime":1138.76,"body":"So let's before we"},{"speaker":"Chris Dy","startTime":1135.43,"endTime":1138.76,"body":"dive into the more distal points"},{"speaker":"Chris Dy","startTime":1138.76,"endTime":1141.37,"body":"of entrapment, let's talk a"},{"speaker":"Chris Dy","startTime":1138.76,"endTime":1141.37,"body":"little bit about that"},{"speaker":"Chris Dy","startTime":1141.37,"endTime":1144.04,"body":"supracondylar process and the"},{"speaker":"Chris Dy","startTime":1141.37,"endTime":1144.04,"body":"ligament of Struthers. Have you"},{"speaker":"Chris Dy","startTime":1144.04,"endTime":1145.06,"body":"ever seen one?"},{"speaker":"Charles Goldfarb","startTime":1145.54,"endTime":1147.25,"body":"Yes,"},{"speaker":"Charles Goldfarb","startTime":1145.54,"endTime":1147.25,"body":"absolutely."},{"speaker":"Chris Dy","startTime":1147.79,"endTime":1148.96,"body":"And was it"},{"speaker":"Chris Dy","startTime":1147.79,"endTime":1148.96,"body":"compressive."},{"speaker":"Charles Goldfarb","startTime":1149.08,"endTime":1152.68,"body":"I have seen"},{"speaker":"Charles Goldfarb","startTime":1149.08,"endTime":1152.68,"body":"one. No, I've seen a couple. And"},{"speaker":"Charles Goldfarb","startTime":1152.68,"endTime":1155.65,"body":"yes, I have seen it be"},{"speaker":"Charles Goldfarb","startTime":1152.68,"endTime":1155.65,"body":"compressive. But you are"},{"speaker":"Charles Goldfarb","startTime":1155.65,"endTime":1159.79,"body":"correct. I mean, this is a"},{"speaker":"Charles Goldfarb","startTime":1155.65,"endTime":1159.79,"body":"zebra. The question becomes if"},{"speaker":"Charles Goldfarb","startTime":1159.79,"endTime":1162.34,"body":"you have a patient, and we"},{"speaker":"Charles Goldfarb","startTime":1159.79,"endTime":1162.34,"body":"obviously will get to the"},{"speaker":"Charles Goldfarb","startTime":1162.34,"endTime":1165.43,"body":"diagnosis part. But if you have"},{"speaker":"Charles Goldfarb","startTime":1162.34,"endTime":1165.43,"body":"a patient where you think there"},{"speaker":"Charles Goldfarb","startTime":1165.43,"endTime":1168.55,"body":"is a compression of the median"},{"speaker":"Charles Goldfarb","startTime":1165.43,"endTime":1168.55,"body":"nerve at the elbow, does that"},{"speaker":"Charles Goldfarb","startTime":1168.55,"endTime":1169.75,"body":"require an X ray?"},{"speaker":"Chris Dy","startTime":1171.22,"endTime":1175.18,"body":"Well, I will, I will"},{"speaker":"Chris Dy","startTime":1171.22,"endTime":1175.18,"body":"admit when I see a patient who"},{"speaker":"Chris Dy","startTime":1175.18,"endTime":1178.09,"body":"has had and we'll get into this"},{"speaker":"Chris Dy","startTime":1175.18,"endTime":1178.09,"body":"a little bit I think has not"},{"speaker":"Chris Dy","startTime":1178.09,"endTime":1181.93,"body":"done well after a carpal tunnel"},{"speaker":"Chris Dy","startTime":1178.09,"endTime":1181.93,"body":"release. You know, usually these"},{"speaker":"Chris Dy","startTime":1181.93,"endTime":1184.24,"body":"these folks come in they've had"},{"speaker":"Chris Dy","startTime":1181.93,"endTime":1184.24,"body":"the release done elsewhere."},{"speaker":"Chris Dy","startTime":1184.24,"endTime":1187.96,"body":"They're having persistent pain."},{"speaker":"Chris Dy","startTime":1184.24,"endTime":1187.96,"body":"I usually end up working them up"},{"speaker":"Chris Dy","startTime":1187.96,"endTime":1190.27,"body":"in terms of physical exam, as"},{"speaker":"Chris Dy","startTime":1187.96,"endTime":1190.27,"body":"we'll talk about earlier, a"},{"speaker":"Chris Dy","startTime":1190.27,"endTime":1192.58,"body":"nerve study and then on the way"},{"speaker":"Chris Dy","startTime":1190.27,"endTime":1192.58,"body":"out, I will send them with an X"},{"speaker":"Chris Dy","startTime":1192.58,"endTime":1194.68,"body":"ray of the elbow mainly for"},{"speaker":"Chris Dy","startTime":1192.58,"endTime":1194.68,"body":"completion sake."},{"speaker":"Charles Goldfarb","startTime":1196.01,"endTime":1200.48,"body":"Yeah. I try to"},{"speaker":"Charles Goldfarb","startTime":1196.01,"endTime":1200.48,"body":"get an X ray. I try to palpate"},{"speaker":"Charles Goldfarb","startTime":1200.48,"endTime":1203.39,"body":"and you know, etc, I don't know,"},{"speaker":"Charles Goldfarb","startTime":1200.48,"endTime":1203.39,"body":"I wouldn't be critical of"},{"speaker":"Charles Goldfarb","startTime":1203.39,"endTime":1206.54,"body":"someone for not getting an X"},{"speaker":"Charles Goldfarb","startTime":1203.39,"endTime":1206.54,"body":"ray. But I do think it feels"},{"speaker":"Charles Goldfarb","startTime":1206.54,"endTime":1210.59,"body":"like the complete evaluation. If"},{"speaker":"Charles Goldfarb","startTime":1206.54,"endTime":1210.59,"body":"I'm really truly concerned about"},{"speaker":"Charles Goldfarb","startTime":1210.59,"endTime":1211.4,"body":"that diagnosis."},{"speaker":"Chris Dy","startTime":1211.58,"endTime":1214.22,"body":"I think the psychology"},{"speaker":"Chris Dy","startTime":1211.58,"endTime":1214.22,"body":"of the visit is different though"},{"speaker":"Chris Dy","startTime":1214.25,"endTime":1217.55,"body":"they've come in with a failed"},{"speaker":"Chris Dy","startTime":1214.25,"endTime":1217.55,"body":"surgery or persistent symptoms."},{"speaker":"Chris Dy","startTime":1218.45,"endTime":1221.21,"body":"They are in the mindstate where,"},{"speaker":"Chris Dy","startTime":1218.45,"endTime":1221.21,"body":"and I am to where I want to make"},{"speaker":"Chris Dy","startTime":1221.21,"endTime":1224.39,"body":"sure there's nothing missed. As"},{"speaker":"Chris Dy","startTime":1221.21,"endTime":1224.39,"body":"opposed to the patient who's"},{"speaker":"Chris Dy","startTime":1224.39,"endTime":1227.87,"body":"coming in with a new complaint,"},{"speaker":"Chris Dy","startTime":1224.39,"endTime":1227.87,"body":"a new diagnosis has not had"},{"speaker":"Chris Dy","startTime":1227.87,"endTime":1230.9,"body":"surgery in the past, I will"},{"speaker":"Chris Dy","startTime":1227.87,"endTime":1230.9,"body":"evaluate the median nerve in the"},{"speaker":"Chris Dy","startTime":1230.9,"endTime":1234.35,"body":"proximal forearm, in addition to"},{"speaker":"Chris Dy","startTime":1230.9,"endTime":1234.35,"body":"the carpal tunnel, but I won't"},{"speaker":"Chris Dy","startTime":1234.35,"endTime":1238.52,"body":"get an X ray of the elbow,"},{"speaker":"Chris Dy","startTime":1234.35,"endTime":1238.52,"body":"because I think that, again, it"},{"speaker":"Chris Dy","startTime":1238.52,"endTime":1242.27,"body":"is so rare that the odds of me"},{"speaker":"Chris Dy","startTime":1238.52,"endTime":1242.27,"body":"finding something the pretest"},{"speaker":"Chris Dy","startTime":1242.27,"endTime":1244.64,"body":"probability, so to say, is"},{"speaker":"Chris Dy","startTime":1242.27,"endTime":1244.64,"body":"incredibly low."},{"speaker":"Charles Goldfarb","startTime":1245.39,"endTime":1249.29,"body":"So let me I'm"},{"speaker":"Charles Goldfarb","startTime":1245.39,"endTime":1249.29,"body":"gonna bring up three different"},{"speaker":"Charles Goldfarb","startTime":1249.29,"endTime":1254.69,"body":"diagnoses. And I want you to"},{"speaker":"Charles Goldfarb","startTime":1249.29,"endTime":1254.69,"body":"tell me which one for you has"},{"speaker":"Charles Goldfarb","startTime":1254.69,"endTime":1259.46,"body":"provided a more satisfactory"},{"speaker":"Charles Goldfarb","startTime":1254.69,"endTime":1259.46,"body":"surgical release. So of these"},{"speaker":"Charles Goldfarb","startTime":1259.46,"endTime":1262.64,"body":"three diagnoses, when you end up"},{"speaker":"Charles Goldfarb","startTime":1259.46,"endTime":1262.64,"body":"doing surgery, which might be"},{"speaker":"Charles Goldfarb","startTime":1262.67,"endTime":1266.72,"body":"uncommon, which of these have"},{"speaker":"Charles Goldfarb","startTime":1262.67,"endTime":1266.72,"body":"you been most impressed with the"},{"speaker":"Charles Goldfarb","startTime":1266.72,"endTime":1271.13,"body":"compression of the nerve, you"},{"speaker":"Charles Goldfarb","startTime":1266.72,"endTime":1271.13,"body":"know, in discussion. So I would"},{"speaker":"Charles Goldfarb","startTime":1271.13,"endTime":1277.79,"body":"say, radial tunnel, pronator"},{"speaker":"Charles Goldfarb","startTime":1271.13,"endTime":1277.79,"body":"syndrome, and distal ulnar"},{"speaker":"Charles Goldfarb","startTime":1277.79,"endTime":1280.97,"body":"tunnel compressive syndrome."},{"speaker":"Charles Goldfarb","startTime":1277.79,"endTime":1280.97,"body":"Which of those three has led to"},{"speaker":"Charles Goldfarb","startTime":1280.97,"endTime":1284.21,"body":"the most to the most impressive"},{"speaker":"Charles Goldfarb","startTime":1280.97,"endTime":1284.21,"body":"clinical findings at the time of"},{"speaker":"Charles Goldfarb","startTime":1284.21,"endTime":1285.2,"body":"surgical decompression?"},{"speaker":"Chris Dy","startTime":1286.35,"endTime":1290.79,"body":"In order, pronator by"},{"speaker":"Chris Dy","startTime":1286.35,"endTime":1290.79,"body":"far, and then I think it's"},{"speaker":"Chris Dy","startTime":1290.79,"endTime":1296.37,"body":"probably a tie but I think ulnar"},{"speaker":"Chris Dy","startTime":1290.79,"endTime":1296.37,"body":"motor Guyon canal, distal ulnar"},{"speaker":"Chris Dy","startTime":1296.37,"endTime":1301.05,"body":"tunnel, and followed by the"},{"speaker":"Chris Dy","startTime":1296.37,"endTime":1301.05,"body":"radial tunnel. And that's not to"},{"speaker":"Chris Dy","startTime":1301.05,"endTime":1305.31,"body":"say that those surgeries are not"},{"speaker":"Chris Dy","startTime":1301.05,"endTime":1305.31,"body":"useful and effective. I think"},{"speaker":"Chris Dy","startTime":1305.31,"endTime":1307.62,"body":"those last few surgeries are"},{"speaker":"Chris Dy","startTime":1305.31,"endTime":1307.62,"body":"effective, but in terms of"},{"speaker":"Chris Dy","startTime":1307.68,"endTime":1312.96,"body":"visually being impressed by the"},{"speaker":"Chris Dy","startTime":1307.68,"endTime":1312.96,"body":"compression, a tight FDS arch so"},{"speaker":"Chris Dy","startTime":1312.96,"endTime":1316.35,"body":"not necessarily the lacertus I"},{"speaker":"Chris Dy","startTime":1312.96,"endTime":1316.35,"body":"agree with with with Dr. Mansky"},{"speaker":"Chris Dy","startTime":1316.35,"endTime":1320.91,"body":"on that, a tight FDS arch is"},{"speaker":"Chris Dy","startTime":1316.35,"endTime":1320.91,"body":"visually and audibly satisfying"},{"speaker":"Chris Dy","startTime":1320.91,"endTime":1322.47,"body":"to release. What about you?"},{"speaker":"Charles Goldfarb","startTime":1323.11,"endTime":1327.88,"body":"Totally agree."},{"speaker":"Charles Goldfarb","startTime":1323.11,"endTime":1327.88,"body":"Although, I don't know if this"},{"speaker":"Charles Goldfarb","startTime":1327.88,"endTime":1331.39,"body":"will resonate with listeners, I"},{"speaker":"Charles Goldfarb","startTime":1327.88,"endTime":1331.39,"body":"don't do many distal ulnar"},{"speaker":"Charles Goldfarb","startTime":1331.39,"endTime":1335.47,"body":"tunnel or Guyon's Canal"},{"speaker":"Charles Goldfarb","startTime":1331.39,"endTime":1335.47,"body":"decompressions. We talk about"},{"speaker":"Charles Goldfarb","startTime":1335.47,"endTime":1337.39,"body":"ganglions. And this could be a"},{"speaker":"Charles Goldfarb","startTime":1335.47,"endTime":1337.39,"body":"whole nother topic and I don't"},{"speaker":"Charles Goldfarb","startTime":1337.39,"endTime":1341.38,"body":"want to belabor it, but I am"},{"speaker":"Charles Goldfarb","startTime":1337.39,"endTime":1341.38,"body":"never satisfied with that"},{"speaker":"Charles Goldfarb","startTime":1341.38,"endTime":1344.32,"body":"surgery. I never walk out of the"},{"speaker":"Charles Goldfarb","startTime":1341.38,"endTime":1344.32,"body":"operating room thinking and I"},{"speaker":"Charles Goldfarb","startTime":1344.32,"endTime":1347.41,"body":"did one yesterday actually"},{"speaker":"Charles Goldfarb","startTime":1344.32,"endTime":1347.41,"body":"because of a remarkable Tinel's"},{"speaker":"Charles Goldfarb","startTime":1347.41,"endTime":1351.16,"body":"at the elbow and at the wrist"},{"speaker":"Charles Goldfarb","startTime":1347.41,"endTime":1351.16,"body":"and and suggestion on nerve"},{"speaker":"Charles Goldfarb","startTime":1351.16,"endTime":1355.0,"body":"studies. I never see anything. I"},{"speaker":"Charles Goldfarb","startTime":1351.16,"endTime":1355.0,"body":"just never walk away thinking"},{"speaker":"Charles Goldfarb","startTime":1355.0,"endTime":1357.28,"body":"wow, I really helped this"},{"speaker":"Charles Goldfarb","startTime":1355.0,"endTime":1357.28,"body":"patient even though I might have"},{"speaker":"Charles Goldfarb","startTime":1357.58,"endTime":1359.71,"body":"I never walk out of the"},{"speaker":"Charles Goldfarb","startTime":1357.58,"endTime":1359.71,"body":"operating room thinking that was"},{"speaker":"Charles Goldfarb","startTime":1359.71,"endTime":1360.52,"body":"really satisfying."},{"speaker":"Chris Dy","startTime":1361.11,"endTime":1363.96,"body":"Yeah, the the"},{"speaker":"Chris Dy","startTime":1361.11,"endTime":1363.96,"body":"variability in how that surgery"},{"speaker":"Chris Dy","startTime":1363.96,"endTime":1366.69,"body":"is used is incredible. You know,"},{"speaker":"Chris Dy","startTime":1363.96,"endTime":1366.69,"body":"there are some surgeons who"},{"speaker":"Chris Dy","startTime":1366.69,"endTime":1370.02,"body":"release it every time they do an"},{"speaker":"Chris Dy","startTime":1366.69,"endTime":1370.02,"body":"ulnar nerve surgery at the"},{"speaker":"Chris Dy","startTime":1370.02,"endTime":1373.53,"body":"elbow. There are some that do it"},{"speaker":"Chris Dy","startTime":1370.02,"endTime":1373.53,"body":"many times and others that do it"},{"speaker":"Chris Dy","startTime":1373.53,"endTime":1378.9,"body":"very rarely. And it's while that"},{"speaker":"Chris Dy","startTime":1373.53,"endTime":1378.9,"body":"point where the nerve, the ulnar"},{"speaker":"Chris Dy","startTime":1378.9,"endTime":1381.9,"body":"nerve dives deep to the"},{"speaker":"Chris Dy","startTime":1378.9,"endTime":1381.9,"body":"hypothenar fascia is impressive."},{"speaker":"Chris Dy","startTime":1382.2,"endTime":1387.03,"body":"It never feels particularly"},{"speaker":"Chris Dy","startTime":1382.2,"endTime":1387.03,"body":"tight or synotic. Almost like,"},{"speaker":"Chris Dy","startTime":1388.02,"endTime":1391.35,"body":"for example, the median nerve at"},{"speaker":"Chris Dy","startTime":1388.02,"endTime":1391.35,"body":"the FDS arch in that subset of"},{"speaker":"Chris Dy","startTime":1391.35,"endTime":1395.94,"body":"population has got a really"},{"speaker":"Chris Dy","startTime":1391.35,"endTime":1395.94,"body":"tight band. You know, I think"},{"speaker":"Chris Dy","startTime":1395.94,"endTime":1398.64,"body":"that one thing that we're trying"},{"speaker":"Chris Dy","startTime":1395.94,"endTime":1398.64,"body":"to study in a project that we're"},{"speaker":"Chris Dy","startTime":1398.64,"endTime":1403.14,"body":"doing here is that theory that a"},{"speaker":"Chris Dy","startTime":1398.64,"endTime":1403.14,"body":"nerve that is recovering from an"},{"speaker":"Chris Dy","startTime":1403.14,"endTime":1406.26,"body":"injury or from compressive"},{"speaker":"Chris Dy","startTime":1403.14,"endTime":1406.26,"body":"neuropathy that's been released"},{"speaker":"Chris Dy","startTime":1406.26,"endTime":1411.18,"body":"will actually swell downstream."},{"speaker":"Chris Dy","startTime":1406.26,"endTime":1411.18,"body":"That's an almost dogmatic thing"},{"speaker":"Chris Dy","startTime":1411.18,"endTime":1414.36,"body":"that's held over from lab work."},{"speaker":"Chris Dy","startTime":1411.18,"endTime":1414.36,"body":"And not to say that that"},{"speaker":"Chris Dy","startTime":1414.36,"endTime":1417.72,"body":"translation can't be made. But"},{"speaker":"Chris Dy","startTime":1414.36,"endTime":1417.72,"body":"it has yet to be truly"},{"speaker":"Chris Dy","startTime":1417.72,"endTime":1421.92,"body":"demonstrated in in any sort of"},{"speaker":"Chris Dy","startTime":1417.72,"endTime":1421.92,"body":"clinical studies. There are a"},{"speaker":"Chris Dy","startTime":1421.92,"endTime":1424.77,"body":"couple of case series in which"},{"speaker":"Chris Dy","startTime":1421.92,"endTime":1424.77,"body":"they've released nerves that"},{"speaker":"Chris Dy","startTime":1424.77,"endTime":1428.31,"body":"were that didn't recover"},{"speaker":"Chris Dy","startTime":1424.77,"endTime":1428.31,"body":"completely and gotten some"},{"speaker":"Chris Dy","startTime":1428.31,"endTime":1430.35,"body":"relief, but that's kind of an"},{"speaker":"Chris Dy","startTime":1428.31,"endTime":1430.35,"body":"indirect conclusion."},{"speaker":"Charles Goldfarb","startTime":1431.26,"endTime":1434.77,"body":"But what's"},{"speaker":"Charles Goldfarb","startTime":1431.26,"endTime":1434.77,"body":"your current state of practice"},{"speaker":"Charles Goldfarb","startTime":1434.77,"endTime":1439.09,"body":"and we are way off topic. What's"},{"speaker":"Charles Goldfarb","startTime":1434.77,"endTime":1439.09,"body":"your what's your current state"},{"speaker":"Charles Goldfarb","startTime":1439.09,"endTime":1443.26,"body":"of practice, if you have a"},{"speaker":"Charles Goldfarb","startTime":1439.09,"endTime":1443.26,"body":"severe cubital Tunnel Syndrome,"},{"speaker":"Charles Goldfarb","startTime":1443.59,"endTime":1445.84,"body":"with or without, you know,"},{"speaker":"Charles Goldfarb","startTime":1443.59,"endTime":1445.84,"body":"throwing in a supercharge or"},{"speaker":"Charles Goldfarb","startTime":1445.84,"endTime":1449.08,"body":"anything like that? Do you feel"},{"speaker":"Charles Goldfarb","startTime":1445.84,"endTime":1449.08,"body":"you need to decompress the"},{"speaker":"Charles Goldfarb","startTime":1449.08,"endTime":1452.11,"body":"distal ulnar tunnel to give the"},{"speaker":"Charles Goldfarb","startTime":1449.08,"endTime":1452.11,"body":"nerve the best chance to"},{"speaker":"Charles Goldfarb","startTime":1452.11,"endTime":1452.59,"body":"recover?"},{"speaker":"Chris Dy","startTime":1453.26,"endTime":1456.86,"body":"So I think it depends"},{"speaker":"Chris Dy","startTime":1453.26,"endTime":1456.86,"body":"on the exam. So the patient who"},{"speaker":"Chris Dy","startTime":1457.16,"endTime":1459.62,"body":"it's kind of weird because"},{"speaker":"Chris Dy","startTime":1457.16,"endTime":1459.62,"body":"there's this there's this middle"},{"speaker":"Chris Dy","startTime":1459.62,"endTime":1462.44,"body":"ground where if the patient has"},{"speaker":"Chris Dy","startTime":1459.62,"endTime":1462.44,"body":"severe atrophy or notable"},{"speaker":"Chris Dy","startTime":1462.44,"endTime":1465.74,"body":"atrophy and has decreased CMAP"},{"speaker":"Chris Dy","startTime":1462.44,"endTime":1465.74,"body":"amplitude on the nerve study"},{"speaker":"Chris Dy","startTime":1465.74,"endTime":1468.95,"body":"that patient's probably getting"},{"speaker":"Chris Dy","startTime":1465.74,"endTime":1468.95,"body":"a supercharge anyway because of"},{"speaker":"Chris Dy","startTime":1468.98,"endTime":1471.83,"body":"you know, those findings, so"},{"speaker":"Chris Dy","startTime":1468.98,"endTime":1471.83,"body":"they'll get a Guyon"},{"speaker":"Chris Dy","startTime":1471.83,"endTime":1475.52,"body":"decompression as part of that."},{"speaker":"Chris Dy","startTime":1471.83,"endTime":1475.52,"body":"For the patient that has kind of"},{"speaker":"Chris Dy","startTime":1475.52,"endTime":1479.21,"body":"that moderate loss of CMAP"},{"speaker":"Chris Dy","startTime":1475.52,"endTime":1479.21,"body":"amplitudes has some weakness but"},{"speaker":"Chris Dy","startTime":1479.21,"endTime":1482.54,"body":"doesn't have any frank atrophy"},{"speaker":"Chris Dy","startTime":1479.21,"endTime":1482.54,"body":"and is not getting a supercharge"},{"speaker":"Chris Dy","startTime":1482.54,"endTime":1486.17,"body":"in my practice. I don't love a"},{"speaker":"Chris Dy","startTime":1482.54,"endTime":1486.17,"body":"Tinel's at Guyon's canal because"},{"speaker":"Chris Dy","startTime":1486.17,"endTime":1489.29,"body":"I think you hit the median nerve"},{"speaker":"Chris Dy","startTime":1486.17,"endTime":1489.29,"body":"anyway. So I try to do a Durkan"},{"speaker":"Chris Dy","startTime":1489.29,"endTime":1493.43,"body":"test or just you know, honestly"},{"speaker":"Chris Dy","startTime":1489.29,"endTime":1493.43,"body":"pressing directly over the ulnar"},{"speaker":"Chris Dy","startTime":1493.43,"endTime":1497.51,"body":"nerve just proximal to the"},{"speaker":"Chris Dy","startTime":1493.43,"endTime":1497.51,"body":"pisiform. And if that reproduces"},{"speaker":"Chris Dy","startTime":1497.57,"endTime":1501.32,"body":"a you know the classic"},{"speaker":"Chris Dy","startTime":1497.57,"endTime":1501.32,"body":"paresthesias in the ring and"},{"speaker":"Chris Dy","startTime":1501.32,"endTime":1505.34,"body":"small finger, I will release"},{"speaker":"Chris Dy","startTime":1501.32,"endTime":1505.34,"body":"that nerve. Or if there's any"},{"speaker":"Chris Dy","startTime":1505.34,"endTime":1507.83,"body":"swelling at the wrist on"},{"speaker":"Chris Dy","startTime":1505.34,"endTime":1507.83,"body":"ultrasound, I think the nerve"},{"speaker":"Chris Dy","startTime":1507.83,"endTime":1510.29,"body":"studies are a little less"},{"speaker":"Chris Dy","startTime":1507.83,"endTime":1510.29,"body":"reliable for Guyon's Canal,"},{"speaker":"Chris Dy","startTime":1510.32,"endTime":1513.53,"body":"except if you do side to side"},{"speaker":"Chris Dy","startTime":1510.32,"endTime":1513.53,"body":"comparisons, which we sometimes"},{"speaker":"Chris Dy","startTime":1513.53,"endTime":1516.5,"body":"get, but don't always get. And I"},{"speaker":"Chris Dy","startTime":1513.53,"endTime":1516.5,"body":"get the fact that I'm pushing on"},{"speaker":"Chris Dy","startTime":1516.5,"endTime":1519.02,"body":"a nerve and I'm producing"},{"speaker":"Chris Dy","startTime":1516.5,"endTime":1519.02,"body":"parasthesias and I'm not truly"},{"speaker":"Chris Dy","startTime":1519.02,"endTime":1520.67,"body":"assessing the motor function,"},{"speaker":"Chris Dy","startTime":1519.02,"endTime":1520.67,"body":"but I don't think there's a"},{"speaker":"Chris Dy","startTime":1520.67,"endTime":1521.45,"body":"better way to do it."},{"speaker":"Charles Goldfarb","startTime":1522.83,"endTime":1526.73,"body":"Okay, I would"},{"speaker":"Charles Goldfarb","startTime":1522.83,"endTime":1526.73,"body":"not argue with you a bit. All"},{"speaker":"Charles Goldfarb","startTime":1526.73,"endTime":1527.99,"body":"right, let's refocus."},{"speaker":"Chris Dy","startTime":1528.32,"endTime":1532.46,"body":"Yeah. This this"},{"speaker":"Chris Dy","startTime":1528.32,"endTime":1532.46,"body":"podcast will be entitled, Chuck"},{"speaker":"Chris Dy","startTime":1532.46,"endTime":1535.85,"body":"and Chris's pandemic adventures"},{"speaker":"Chris Dy","startTime":1532.46,"endTime":1535.85,"body":"plus pronator syndrome plus"},{"speaker":"Chris Dy","startTime":1535.85,"endTime":1539.15,"body":"Guyon canal. But anyway, so we"},{"speaker":"Chris Dy","startTime":1535.85,"endTime":1539.15,"body":"talked about the compressive"},{"speaker":"Chris Dy","startTime":1539.15,"endTime":1543.44,"body":"structures. You know, what do"},{"speaker":"Chris Dy","startTime":1539.15,"endTime":1543.44,"body":"you think this really is"},{"speaker":"Chris Dy","startTime":1543.44,"endTime":1547.01,"body":"compression by? Do you, do you"},{"speaker":"Chris Dy","startTime":1543.44,"endTime":1547.01,"body":"think it's still lacertus? I"},{"speaker":"Chris Dy","startTime":1547.01,"endTime":1549.23,"body":"know that Dr. Mansky said it"},{"speaker":"Chris Dy","startTime":1547.01,"endTime":1549.23,"body":"wasn't? Do you think it's the"},{"speaker":"Chris Dy","startTime":1549.23,"endTime":1551.9,"body":"pronator? Some people now"},{"speaker":"Chris Dy","startTime":1549.23,"endTime":1551.9,"body":"believe it's never the pronator?"},{"speaker":"Chris Dy","startTime":1552.2,"endTime":1552.98,"body":"What do you think it is?"},{"speaker":"Charles Goldfarb","startTime":1553.35,"endTime":1556.65,"body":"Which gets to"},{"speaker":"Charles Goldfarb","startTime":1553.35,"endTime":1556.65,"body":"Oh, let's talk about, I'm going"},{"speaker":"Charles Goldfarb","startTime":1556.65,"endTime":1558.87,"body":"to answer your question in a"},{"speaker":"Charles Goldfarb","startTime":1556.65,"endTime":1558.87,"body":"roundabout way. I want to"},{"speaker":"Charles Goldfarb","startTime":1558.87,"endTime":1565.74,"body":"discuss clinical exam. So"},{"speaker":"Charles Goldfarb","startTime":1558.87,"endTime":1565.74,"body":"classically, we talk about, you"},{"speaker":"Charles Goldfarb","startTime":1565.74,"endTime":1569.07,"body":"know, examining the carpal"},{"speaker":"Charles Goldfarb","startTime":1565.74,"endTime":1569.07,"body":"tunnel, examining the median"},{"speaker":"Charles Goldfarb","startTime":1569.07,"endTime":1572.94,"body":"nerve, and I pretty much always"},{"speaker":"Charles Goldfarb","startTime":1569.07,"endTime":1572.94,"body":"assess for a Tinel's at the"},{"speaker":"Charles Goldfarb","startTime":1572.94,"endTime":1576.87,"body":"pronator. And if there's some"},{"speaker":"Charles Goldfarb","startTime":1572.94,"endTime":1576.87,"body":"suggestion of irritability of"},{"speaker":"Charles Goldfarb","startTime":1576.87,"endTime":1579.99,"body":"the nerve there, then I may do"},{"speaker":"Charles Goldfarb","startTime":1576.87,"endTime":1579.99,"body":"some other tests. And so the"},{"speaker":"Charles Goldfarb","startTime":1579.99,"endTime":1585.03,"body":"tests that people talk about are"},{"speaker":"Charles Goldfarb","startTime":1579.99,"endTime":1585.03,"body":"one, extending the elbow and"},{"speaker":"Charles Goldfarb","startTime":1585.03,"endTime":1588.45,"body":"resisted pronation, which assess"},{"speaker":"Charles Goldfarb","startTime":1585.03,"endTime":1588.45,"body":"the role potentially of a"},{"speaker":"Charles Goldfarb","startTime":1588.45,"endTime":1592.86,"body":"pronator compressive point. And"},{"speaker":"Charles Goldfarb","startTime":1588.45,"endTime":1592.86,"body":"then I think people talk about"},{"speaker":"Charles Goldfarb","startTime":1593.25,"endTime":1597.9,"body":"resisted wrist and finger"},{"speaker":"Charles Goldfarb","startTime":1593.25,"endTime":1597.9,"body":"flexion as well, to talk about"},{"speaker":"Charles Goldfarb","startTime":1597.9,"endTime":1604.17,"body":"FDS arch. I I buy it, I think"},{"speaker":"Charles Goldfarb","startTime":1597.9,"endTime":1604.17,"body":"the clinical exam is helpful."},{"speaker":"Charles Goldfarb","startTime":1604.53,"endTime":1608.67,"body":"And I think that the lacert- I"},{"speaker":"Charles Goldfarb","startTime":1604.53,"endTime":1608.67,"body":"do not believe the lacertus is a"},{"speaker":"Charles Goldfarb","startTime":1608.67,"endTime":1611.82,"body":"contributing feature, I think"},{"speaker":"Charles Goldfarb","startTime":1608.67,"endTime":1611.82,"body":"it's either the pronator, or the"},{"speaker":"Charles Goldfarb","startTime":1611.82,"endTime":1613.23,"body":"FDS fibers arch."},{"speaker":"Chris Dy","startTime":1614.17,"endTime":1616.18,"body":"Yeah, and I think"},{"speaker":"Chris Dy","startTime":1614.17,"endTime":1616.18,"body":"that, you know, you're right"},{"speaker":"Chris Dy","startTime":1616.18,"endTime":1620.14,"body":"about the provocative maneuvers,"},{"speaker":"Chris Dy","startTime":1616.18,"endTime":1620.14,"body":"in terms of how it's described."},{"speaker":"Chris Dy","startTime":1620.62,"endTime":1624.1,"body":"And then some people will"},{"speaker":"Chris Dy","startTime":1620.62,"endTime":1624.1,"body":"actually, you know, use resisted"},{"speaker":"Chris Dy","startTime":1624.1,"endTime":1626.41,"body":"elbow flexion as one of them,"},{"speaker":"Chris Dy","startTime":1624.1,"endTime":1626.41,"body":"you know, with the thought that"},{"speaker":"Chris Dy","startTime":1626.41,"endTime":1630.4,"body":"it is the lacertus, I've seen a"},{"speaker":"Chris Dy","startTime":1626.41,"endTime":1630.4,"body":"couple of tight lacertuses. But"},{"speaker":"Chris Dy","startTime":1630.43,"endTime":1635.35,"body":"more, it's not that common to"},{"speaker":"Chris Dy","startTime":1630.43,"endTime":1635.35,"body":"see a really tight lacertus. You"},{"speaker":"Chris Dy","startTime":1635.35,"endTime":1637.96,"body":"know, it is more common, I"},{"speaker":"Chris Dy","startTime":1635.35,"endTime":1637.96,"body":"think, to release a lacertus on"},{"speaker":"Chris Dy","startTime":1637.96,"endTime":1643.09,"body":"the way down to seeing a tight"},{"speaker":"Chris Dy","startTime":1637.96,"endTime":1643.09,"body":"FDS arch. So, you know, I think,"},{"speaker":"Chris Dy","startTime":1643.09,"endTime":1646.81,"body":"to me, the biggest physical exam"},{"speaker":"Chris Dy","startTime":1643.09,"endTime":1646.81,"body":"maneuver that is helpful is"},{"speaker":"Chris Dy","startTime":1646.87,"endTime":1649.15,"body":"again, a more of a Durkan test,"},{"speaker":"Chris Dy","startTime":1646.87,"endTime":1649.15,"body":"because I think a Tinel is a"},{"speaker":"Chris Dy","startTime":1649.15,"endTime":1652.75,"body":"little scattershot in that area"},{"speaker":"Chris Dy","startTime":1649.15,"endTime":1652.75,"body":"personally. So I'd like to feel"},{"speaker":"Chris Dy","startTime":1652.75,"endTime":1657.61,"body":"kind of that midline, lateral"},{"speaker":"Chris Dy","startTime":1652.75,"endTime":1657.61,"body":"ridge of the flexor pronator"},{"speaker":"Chris Dy","startTime":1657.61,"endTime":1662.59,"body":"mass, and kind of fall into that"},{"speaker":"Chris Dy","startTime":1657.61,"endTime":1662.59,"body":"sulcus, where you know, based on"},{"speaker":"Chris Dy","startTime":1662.59,"endTime":1665.08,"body":"the number of ulnar nerve"},{"speaker":"Chris Dy","startTime":1662.59,"endTime":1665.08,"body":"transpositions that I've done"},{"speaker":"Chris Dy","startTime":1665.08,"endTime":1667.06,"body":"and that you've done, you know,"},{"speaker":"Chris Dy","startTime":1665.08,"endTime":1667.06,"body":"where that median nerve is gonna"},{"speaker":"Chris Dy","startTime":1667.06,"endTime":1669.25,"body":"lie, just, you know, on the"},{"speaker":"Chris Dy","startTime":1667.06,"endTime":1669.25,"body":"inside edge of that flexor"},{"speaker":"Chris Dy","startTime":1669.25,"endTime":1673.45,"body":"pronator mass, and push in"},{"speaker":"Chris Dy","startTime":1669.25,"endTime":1673.45,"body":"there. And our our therapists"},{"speaker":"Chris Dy","startTime":1673.45,"endTime":1676.48,"body":"like to, you know, tell me that"},{"speaker":"Chris Dy","startTime":1673.45,"endTime":1676.48,"body":"patients describe my knobby"},{"speaker":"Chris Dy","startTime":1676.48,"endTime":1679.54,"body":"fingers going in there and"},{"speaker":"Chris Dy","startTime":1676.48,"endTime":1679.54,"body":"causing them pain, but if I push"},{"speaker":"Chris Dy","startTime":1679.54,"endTime":1682.15,"body":"in there, I know it's gonna"},{"speaker":"Chris Dy","startTime":1679.54,"endTime":1682.15,"body":"cause some pain, discomfort, but"},{"speaker":"Chris Dy","startTime":1682.15,"endTime":1684.46,"body":"I want to know is if they're"},{"speaker":"Chris Dy","startTime":1682.15,"endTime":1684.46,"body":"having paresthesias, shooting"},{"speaker":"Chris Dy","startTime":1684.46,"endTime":1688.72,"body":"down distally. And if that comes"},{"speaker":"Chris Dy","startTime":1684.46,"endTime":1688.72,"body":"about, then I think this is one"},{"speaker":"Chris Dy","startTime":1688.72,"endTime":1692.35,"body":"I should release proximally as"},{"speaker":"Chris Dy","startTime":1688.72,"endTime":1692.35,"body":"well. Or if I'm doing my Tinel's"},{"speaker":"Chris Dy","startTime":1692.35,"endTime":1695.02,"body":"sign at the carpal tunnel, and"},{"speaker":"Chris Dy","startTime":1692.35,"endTime":1695.02,"body":"the symptoms are radiating"},{"speaker":"Chris Dy","startTime":1695.02,"endTime":1698.32,"body":"proximally that also clues me"},{"speaker":"Chris Dy","startTime":1695.02,"endTime":1698.32,"body":"into a potential other site of"},{"speaker":"Chris Dy","startTime":1698.32,"endTime":1701.86,"body":"compression. And then lastly, I"},{"speaker":"Chris Dy","startTime":1698.32,"endTime":1701.86,"body":"think the physical exam, just"},{"speaker":"Chris Dy","startTime":1701.86,"endTime":1705.55,"body":"doing your standard, you know,"},{"speaker":"Chris Dy","startTime":1701.86,"endTime":1705.55,"body":"extrinsic median nerve motor"},{"speaker":"Chris Dy","startTime":1705.55,"endTime":1708.76,"body":"testing, but with a lot of"},{"speaker":"Chris Dy","startTime":1705.55,"endTime":1708.76,"body":"detail can be incredibly"},{"speaker":"Chris Dy","startTime":1708.76,"endTime":1712.06,"body":"helpful. And for that, you know,"},{"speaker":"Chris Dy","startTime":1708.76,"endTime":1712.06,"body":"it's it's really doing a"},{"speaker":"Chris Dy","startTime":1712.06,"endTime":1716.17,"body":"detailed exam, and you know, I"},{"speaker":"Chris Dy","startTime":1712.06,"endTime":1716.17,"body":"flex the wrist. So I take the"},{"speaker":"Chris Dy","startTime":1716.17,"endTime":1720.61,"body":"tenodesis out of it, and then I"},{"speaker":"Chris Dy","startTime":1716.17,"endTime":1720.61,"body":"will check resisted FPL resisted"},{"speaker":"Chris Dy","startTime":1720.61,"endTime":1723.94,"body":"FDP index. And I think you can"},{"speaker":"Chris Dy","startTime":1720.61,"endTime":1723.94,"body":"get a lot from that, because you"},{"speaker":"Chris Dy","startTime":1723.94,"endTime":1727.72,"body":"should not be able to break"},{"speaker":"Chris Dy","startTime":1723.94,"endTime":1727.72,"body":"somebody who's FPL or FDP index,"},{"speaker":"Chris Dy","startTime":1727.75,"endTime":1730.54,"body":"even what their wrist flexed"},{"speaker":"Chris Dy","startTime":1727.75,"endTime":1730.54,"body":"with one finger. And this is"},{"speaker":"Chris Dy","startTime":1730.54,"endTime":1732.85,"body":"something where you calibrate"},{"speaker":"Chris Dy","startTime":1730.54,"endTime":1732.85,"body":"your exam over, you know,"},{"speaker":"Chris Dy","startTime":1732.85,"endTime":1736.54,"body":"however many people that you see"},{"speaker":"Chris Dy","startTime":1732.85,"endTime":1736.54,"body":"over time, but you shouldn't be"},{"speaker":"Chris Dy","startTime":1736.54,"endTime":1738.37,"body":"able to do that. Just like you"},{"speaker":"Chris Dy","startTime":1736.54,"endTime":1738.37,"body":"shouldn't be able to do that for"},{"speaker":"Chris Dy","startTime":1738.37,"endTime":1741.46,"body":"the ulnar FDPs when you're"},{"speaker":"Chris Dy","startTime":1738.37,"endTime":1741.46,"body":"checking somebody's ulnar nerve."},{"speaker":"Charles Goldfarb","startTime":1742.54,"endTime":1744.43,"body":"Yeah, I like"},{"speaker":"Charles Goldfarb","startTime":1742.54,"endTime":1744.43,"body":"everything you said, I want to"},{"speaker":"Charles Goldfarb","startTime":1744.43,"endTime":1748.33,"body":"emphasize a couple points I if"},{"speaker":"Charles Goldfarb","startTime":1744.43,"endTime":1748.33,"body":"the listeners like me, you guys"},{"speaker":"Charles Goldfarb","startTime":1748.33,"endTime":1751.66,"body":"were all palpating your forearm"},{"speaker":"Charles Goldfarb","startTime":1748.33,"endTime":1751.66,"body":"as Chris described, the-"},{"speaker":"Chris Dy","startTime":1751.69,"endTime":1752.35,"body":"I was too."},{"speaker":"Charles Goldfarb","startTime":1753.83,"endTime":1755.57,"body":"The radial"},{"speaker":"Charles Goldfarb","startTime":1753.83,"endTime":1755.57,"body":"aspect of the flexor pronator"},{"speaker":"Charles Goldfarb","startTime":1755.57,"endTime":1760.13,"body":"mass and you're right for most"},{"speaker":"Charles Goldfarb","startTime":1755.57,"endTime":1760.13,"body":"people, you can really feel that"},{"speaker":"Charles Goldfarb","startTime":1760.13,"endTime":1763.31,"body":"radial aspect, and that's where"},{"speaker":"Charles Goldfarb","startTime":1760.13,"endTime":1763.31,"body":"the nerve is so that's a great"},{"speaker":"Charles Goldfarb","startTime":1763.67,"endTime":1767.48,"body":"anatomical point for exam. The"},{"speaker":"Charles Goldfarb","startTime":1763.67,"endTime":1767.48,"body":"second is one that Dr. Gelberman"},{"speaker":"Charles Goldfarb","startTime":1767.48,"endTime":1770.72,"body":"has always emphasized is if you"},{"speaker":"Charles Goldfarb","startTime":1767.48,"endTime":1770.72,"body":"think about a point two"},{"speaker":"Charles Goldfarb","startTime":1770.72,"endTime":1775.28,"body":"centimeters, proximal and two"},{"speaker":"Charles Goldfarb","startTime":1770.72,"endTime":1775.28,"body":"centimeters, radial to the"},{"speaker":"Charles Goldfarb","startTime":1775.28,"endTime":1780.05,"body":"medial epicondyle. That's"},{"speaker":"Charles Goldfarb","startTime":1775.28,"endTime":1780.05,"body":"another really good anatomical"},{"speaker":"Charles Goldfarb","startTime":1780.14,"endTime":1784.49,"body":"point to consider for the median"},{"speaker":"Charles Goldfarb","startTime":1780.14,"endTime":1784.49,"body":"nerve. So I think everything you"},{"speaker":"Charles Goldfarb","startTime":1784.49,"endTime":1788.12,"body":"said is right on I have to say"},{"speaker":"Charles Goldfarb","startTime":1784.49,"endTime":1788.12,"body":"I'm a little skeptical of"},{"speaker":"Charles Goldfarb","startTime":1788.42,"endTime":1793.43,"body":"proximal radiation during a"},{"speaker":"Charles Goldfarb","startTime":1788.42,"endTime":1793.43,"body":"Tinel's as indicating pronator"},{"speaker":"Charles Goldfarb","startTime":1793.43,"endTime":1797.09,"body":"compression. I don't think it's"},{"speaker":"Charles Goldfarb","startTime":1793.43,"endTime":1797.09,"body":"wrong, but it hasn't set off the"},{"speaker":"Charles Goldfarb","startTime":1797.09,"endTime":1798.5,"body":"same alarm bells for me."},{"speaker":"Chris Dy","startTime":1798.78,"endTime":1800.19,"body":"Yeah and I guess I"},{"speaker":"Chris Dy","startTime":1798.78,"endTime":1800.19,"body":"should clarify. I don't"},{"speaker":"Chris Dy","startTime":1800.19,"endTime":1804.15,"body":"necessarily think that means"},{"speaker":"Chris Dy","startTime":1800.19,"endTime":1804.15,"body":"pronator or proximal forearm"},{"speaker":"Chris Dy","startTime":1804.15,"endTime":1806.4,"body":"compression it to me, it means"},{"speaker":"Chris Dy","startTime":1804.15,"endTime":1806.4,"body":"there's another site of"},{"speaker":"Chris Dy","startTime":1806.4,"endTime":1810.33,"body":"compression. And that could be"},{"speaker":"Chris Dy","startTime":1806.4,"endTime":1810.33,"body":"potentially, you know, the"},{"speaker":"Chris Dy","startTime":1810.33,"endTime":1813.06,"body":"pronator, the lacertus, whatever"},{"speaker":"Chris Dy","startTime":1810.33,"endTime":1813.06,"body":"you want to call this syndrome."},{"speaker":"Chris Dy","startTime":1813.75,"endTime":1818.04,"body":"It could be a supracondylar"},{"speaker":"Chris Dy","startTime":1813.75,"endTime":1818.04,"body":"process, it could be TOS, it"},{"speaker":"Chris Dy","startTime":1818.04,"endTime":1821.4,"body":"could be the C spine, it just"},{"speaker":"Chris Dy","startTime":1818.04,"endTime":1821.4,"body":"clues me in on to look a little"},{"speaker":"Chris Dy","startTime":1821.4,"endTime":1825.27,"body":"harder. Which actually brings us"},{"speaker":"Chris Dy","startTime":1821.4,"endTime":1825.27,"body":"to our next thing, when are you"},{"speaker":"Chris Dy","startTime":1825.27,"endTime":1829.59,"body":"getting any ultrasound or nerve"},{"speaker":"Chris Dy","startTime":1825.27,"endTime":1829.59,"body":"studies for this because this is"},{"speaker":"Chris Dy","startTime":1829.62,"endTime":1831.99,"body":"a condition that is notorious"},{"speaker":"Chris Dy","startTime":1829.62,"endTime":1831.99,"body":"for being a, quote, clinical"},{"speaker":"Chris Dy","startTime":1831.99,"endTime":1832.83,"body":"diagnosis."},{"speaker":"Charles Goldfarb","startTime":1834.37,"endTime":1838.18,"body":"Yeah, you"},{"speaker":"Charles Goldfarb","startTime":1834.37,"endTime":1838.18,"body":"know, the longer I do this, I"},{"speaker":"Charles Goldfarb","startTime":1838.18,"endTime":1840.79,"body":"don't know if I get any wiser,"},{"speaker":"Charles Goldfarb","startTime":1838.18,"endTime":1840.79,"body":"but I become a little more"},{"speaker":"Charles Goldfarb","startTime":1840.79,"endTime":1844.69,"body":"dogmatic in my opinions. And if"},{"speaker":"Charles Goldfarb","startTime":1840.79,"endTime":1844.69,"body":"I'm really thinking that there"},{"speaker":"Charles Goldfarb","startTime":1844.69,"endTime":1849.7,"body":"is a component of median nerve"},{"speaker":"Charles Goldfarb","startTime":1844.69,"endTime":1849.7,"body":"compression at the pronator, I"},{"speaker":"Charles Goldfarb","startTime":1849.7,"endTime":1852.61,"body":"tend to get nerve studies. I"},{"speaker":"Charles Goldfarb","startTime":1849.7,"endTime":1852.61,"body":"don't always do that for carpal"},{"speaker":"Charles Goldfarb","startTime":1852.61,"endTime":1855.34,"body":"tunnel, especially with classic"},{"speaker":"Charles Goldfarb","startTime":1852.61,"endTime":1855.34,"body":"findings. But if I'm thinking"},{"speaker":"Charles Goldfarb","startTime":1855.34,"endTime":1857.65,"body":"there's two sites of"},{"speaker":"Charles Goldfarb","startTime":1855.34,"endTime":1857.65,"body":"compression, I will get the"},{"speaker":"Charles Goldfarb","startTime":1857.65,"endTime":1860.08,"body":"nerve study with or without an"},{"speaker":"Charles Goldfarb","startTime":1857.65,"endTime":1860.08,"body":"ultrasound. I'll leave that up"},{"speaker":"Charles Goldfarb","startTime":1860.08,"endTime":1866.62,"body":"to the to the physical medicine"},{"speaker":"Charles Goldfarb","startTime":1860.08,"endTime":1866.62,"body":"and rehabilitation doctor. The"},{"speaker":"Charles Goldfarb","startTime":1866.62,"endTime":1869.44,"body":"trick, of course, is that they"},{"speaker":"Charles Goldfarb","startTime":1866.62,"endTime":1869.44,"body":"still I still may make the"},{"speaker":"Charles Goldfarb","startTime":1869.44,"endTime":1872.08,"body":"diagnosis of pronator even with"},{"speaker":"Charles Goldfarb","startTime":1869.44,"endTime":1872.08,"body":"a negative nerve study. So then"},{"speaker":"Charles Goldfarb","startTime":1872.08,"endTime":1875.02,"body":"you say, well, what's the point?"},{"speaker":"Charles Goldfarb","startTime":1872.08,"endTime":1875.02,"body":"I think the point is, if it"},{"speaker":"Charles Goldfarb","startTime":1875.02,"endTime":1878.05,"body":"confirms the diagnosis, it's"},{"speaker":"Charles Goldfarb","startTime":1875.02,"endTime":1878.05,"body":"very helpful information for me."},{"speaker":"Chris Dy","startTime":1878.83,"endTime":1880.81,"body":"Yeah, I think it's"},{"speaker":"Chris Dy","startTime":1878.83,"endTime":1880.81,"body":"hard to make the diagnosis on"},{"speaker":"Chris Dy","startTime":1880.81,"endTime":1882.34,"body":"that. I mean, I think if"},{"speaker":"Chris Dy","startTime":1880.81,"endTime":1882.34,"body":"anything, I'll get it for"},{"speaker":"Chris Dy","startTime":1882.34,"endTime":1885.94,"body":"completion sake, and to look at"},{"speaker":"Chris Dy","startTime":1882.34,"endTime":1885.94,"body":"the C spine or the thoracic"},{"speaker":"Chris Dy","startTime":1885.94,"endTime":1890.5,"body":"outlet. But I won't really use"},{"speaker":"Chris Dy","startTime":1885.94,"endTime":1890.5,"body":"it to look at compression in the"},{"speaker":"Chris Dy","startTime":1890.5,"endTime":1893.71,"body":"median nerve, because the"},{"speaker":"Chris Dy","startTime":1890.5,"endTime":1893.71,"body":"thought is, is that this is all"},{"speaker":"Chris Dy","startTime":1893.71,"endTime":1897.76,"body":"theory now that the compression"},{"speaker":"Chris Dy","startTime":1893.71,"endTime":1897.76,"body":"there is not tight enough to"},{"speaker":"Chris Dy","startTime":1897.76,"endTime":1903.94,"body":"actually cause a disruption of"},{"speaker":"Chris Dy","startTime":1897.76,"endTime":1903.94,"body":"conduction. So it's just really"},{"speaker":"Chris Dy","startTime":1903.94,"endTime":1906.85,"body":"hard to find it there. That"},{"speaker":"Chris Dy","startTime":1903.94,"endTime":1906.85,"body":"being said, you know, if I'm"},{"speaker":"Chris Dy","startTime":1906.85,"endTime":1909.1,"body":"concerned about more proximal"},{"speaker":"Chris Dy","startTime":1906.85,"endTime":1909.1,"body":"sites of compressions, I usually"},{"speaker":"Chris Dy","startTime":1909.1,"endTime":1911.56,"body":"will get it. But this is one"},{"speaker":"Chris Dy","startTime":1909.1,"endTime":1911.56,"body":"where I really do rely on my"},{"speaker":"Chris Dy","startTime":1911.56,"endTime":1915.73,"body":"physical exam. You know, I'm"},{"speaker":"Chris Dy","startTime":1911.56,"endTime":1915.73,"body":"reminded of the fact that we're,"},{"speaker":"Chris Dy","startTime":1916.12,"endTime":1919.36,"body":"we're in a very challenging"},{"speaker":"Chris Dy","startTime":1916.12,"endTime":1919.36,"body":"review process right now for a"},{"speaker":"Chris Dy","startTime":1919.36,"endTime":1924.46,"body":"journal article. And we had used"},{"speaker":"Chris Dy","startTime":1919.36,"endTime":1924.46,"body":"the phrase clinical diagnosis"},{"speaker":"Chris Dy","startTime":1924.52,"endTime":1928.51,"body":"and gotten so much pushback from"},{"speaker":"Chris Dy","startTime":1924.52,"endTime":1928.51,"body":"a reviewer because, you know,"},{"speaker":"Chris Dy","startTime":1928.51,"endTime":1931.99,"body":"essentially, that reviewer was"},{"speaker":"Chris Dy","startTime":1928.51,"endTime":1931.99,"body":"very opinionated that whenever"},{"speaker":"Chris Dy","startTime":1931.99,"endTime":1934.63,"body":"they see the words, clinical"},{"speaker":"Chris Dy","startTime":1931.99,"endTime":1934.63,"body":"diagnosis, they feel like it's"},{"speaker":"Chris Dy","startTime":1934.63,"endTime":1937.06,"body":"something that is almost"},{"speaker":"Chris Dy","startTime":1934.63,"endTime":1937.06,"body":"construed by the physician,"},{"speaker":"Chris Dy","startTime":1937.09,"endTime":1941.53,"body":"almost a surgeon induced demand"},{"speaker":"Chris Dy","startTime":1937.09,"endTime":1941.53,"body":"kind of thing. And I guess"},{"speaker":"Chris Dy","startTime":1941.53,"endTime":1944.08,"body":"that's the other side of the"},{"speaker":"Chris Dy","startTime":1941.53,"endTime":1944.08,"body":"pendulum from, you know, this"},{"speaker":"Chris Dy","startTime":1944.08,"endTime":1948.07,"body":"reliance on imaging and"},{"speaker":"Chris Dy","startTime":1944.08,"endTime":1948.07,"body":"objective studies, and taking"},{"speaker":"Chris Dy","startTime":1948.07,"endTime":1949.81,"body":"almost the art out of what we"},{"speaker":"Chris Dy","startTime":1948.07,"endTime":1949.81,"body":"do."},{"speaker":"Charles Goldfarb","startTime":1950.65,"endTime":1952.87,"body":"Yeah, that's"},{"speaker":"Charles Goldfarb","startTime":1950.65,"endTime":1952.87,"body":"super interesting. And it's"},{"speaker":"Charles Goldfarb","startTime":1952.87,"endTime":1956.59,"body":"it's, I guess, from an"},{"speaker":"Charles Goldfarb","startTime":1952.87,"endTime":1956.59,"body":"objectivity standpoint, there's"},{"speaker":"Charles Goldfarb","startTime":1956.59,"endTime":1961.75,"body":"some it's not an unfair comment."},{"speaker":"Charles Goldfarb","startTime":1956.59,"endTime":1961.75,"body":"But it's also not a realistic"},{"speaker":"Charles Goldfarb","startTime":1961.75,"endTime":1965.14,"body":"comment. given some of the"},{"speaker":"Charles Goldfarb","startTime":1961.75,"endTime":1965.14,"body":"diagnoses that we've already"},{"speaker":"Charles Goldfarb","startTime":1965.14,"endTime":1966.79,"body":"talked about today, and others."},{"speaker":"Chris Dy","startTime":1967.15,"endTime":1969.19,"body":"It's a tough one to"},{"speaker":"Chris Dy","startTime":1967.15,"endTime":1969.19,"body":"address in peer review as well."},{"speaker":"Charles Goldfarb","startTime":1969.79,"endTime":1975.01,"body":"Yes, it is."},{"speaker":"Charles Goldfarb","startTime":1969.79,"endTime":1975.01,"body":"So, all right, let's just talk"},{"speaker":"Charles Goldfarb","startTime":1975.01,"endTime":1979.66,"body":"big picture. So what percent of"},{"speaker":"Charles Goldfarb","startTime":1975.01,"endTime":1979.66,"body":"the time when you are performing"},{"speaker":"Charles Goldfarb","startTime":1979.66,"endTime":1984.73,"body":"a primary carpal tunnel release?"},{"speaker":"Charles Goldfarb","startTime":1979.66,"endTime":1984.73,"body":"Do you also perform a pronator"},{"speaker":"Charles Goldfarb","startTime":1984.73,"endTime":1985.45,"body":"decompression?"},{"speaker":"Chris Dy","startTime":1986.38,"endTime":1991.18,"body":"I think now, it's"},{"speaker":"Chris Dy","startTime":1986.38,"endTime":1991.18,"body":"probably 10%. I think that as"},{"speaker":"Chris Dy","startTime":1991.18,"endTime":1993.79,"body":"recently as two or three years"},{"speaker":"Chris Dy","startTime":1991.18,"endTime":1993.79,"body":"ago, it was probably as high as"},{"speaker":"Chris Dy","startTime":1993.79,"endTime":1998.74,"body":"20-25%. And I will say I don't"},{"speaker":"Chris Dy","startTime":1993.79,"endTime":1998.74,"body":"do a pronator decompression, I"},{"speaker":"Chris Dy","startTime":1998.74,"endTime":2001.17,"body":"do a lacertus and an FDS"},{"speaker":"Chris Dy","startTime":1998.74,"endTime":2001.17,"body":"decompression, because I really"},{"speaker":"Chris Dy","startTime":2001.17,"endTime":2003.36,"body":"don't think that it's the"},{"speaker":"Chris Dy","startTime":2001.17,"endTime":2003.36,"body":"pronator that's compressing I"},{"speaker":"Chris Dy","startTime":2003.36,"endTime":2008.22,"body":"know that runs counter to what"},{"speaker":"Chris Dy","startTime":2003.36,"endTime":2008.22,"body":"is described in the textbooks,"},{"speaker":"Chris Dy","startTime":2008.22,"endTime":2012.54,"body":"etc. But I think it's, it's,"},{"speaker":"Chris Dy","startTime":2008.22,"endTime":2012.54,"body":"that's not the compressive"},{"speaker":"Chris Dy","startTime":2012.54,"endTime":2016.44,"body":"point. You know, it's very rare"},{"speaker":"Chris Dy","startTime":2012.54,"endTime":2016.44,"body":"that I will prepare a patient"},{"speaker":"Chris Dy","startTime":2016.44,"endTime":2020.04,"body":"for a full on median nerve"},{"speaker":"Chris Dy","startTime":2016.44,"endTime":2020.04,"body":"decompression to form including"},{"speaker":"Chris Dy","startTime":2020.37,"endTime":2024.96,"body":"takedown of the pronator."},{"speaker":"Chris Dy","startTime":2020.37,"endTime":2024.96,"body":"Because it usually is either the"},{"speaker":"Chris Dy","startTime":2024.99,"endTime":2026.55,"body":"FDS arch or the lacertus."},{"speaker":"Charles Goldfarb","startTime":2027.78,"endTime":2029.49,"body":"I would not"},{"speaker":"Charles Goldfarb","startTime":2027.78,"endTime":2029.49,"body":"argue and I think those who"},{"speaker":"Charles Goldfarb","startTime":2029.49,"endTime":2032.46,"body":"would argue that the pronator is"},{"speaker":"Charles Goldfarb","startTime":2029.49,"endTime":2032.46,"body":"a problem would would make the"},{"speaker":"Charles Goldfarb","startTime":2032.46,"endTime":2038.04,"body":"comment that it is typically a"},{"speaker":"Charles Goldfarb","startTime":2032.46,"endTime":2038.04,"body":"dynamic problem. And bulkier two"},{"speaker":"Charles Goldfarb","startTime":2038.04,"endTime":2040.26,"body":"heads of the pronator, where the"},{"speaker":"Charles Goldfarb","startTime":2038.04,"endTime":2040.26,"body":"median nerve is traveling in"},{"speaker":"Charles Goldfarb","startTime":2040.26,"endTime":2044.43,"body":"between. And for those of you"},{"speaker":"Charles Goldfarb","startTime":2040.26,"endTime":2044.43,"body":"who are residents or medical"},{"speaker":"Charles Goldfarb","startTime":2044.43,"endTime":2047.28,"body":"students who aren't familiar"},{"speaker":"Charles Goldfarb","startTime":2044.43,"endTime":2047.28,"body":"with anatomy, there's nothing"},{"speaker":"Charles Goldfarb","startTime":2047.28,"endTime":2050.64,"body":"quite like the cross sectional"},{"speaker":"Charles Goldfarb","startTime":2047.28,"endTime":2050.64,"body":"anatomy of the elbow, or just"},{"speaker":"Charles Goldfarb","startTime":2050.64,"endTime":2053.76,"body":"distal to the elbow and watching"},{"speaker":"Charles Goldfarb","startTime":2050.64,"endTime":2053.76,"body":"that median nerve travel through"},{"speaker":"Charles Goldfarb","startTime":2053.76,"endTime":2057.21,"body":"the pronator watching a giving"},{"speaker":"Charles Goldfarb","startTime":2053.76,"endTime":2057.21,"body":"off the AIN branch, you know,"},{"speaker":"Charles Goldfarb","startTime":2057.21,"endTime":2059.76,"body":"five centimeters distal to the"},{"speaker":"Charles Goldfarb","startTime":2057.21,"endTime":2059.76,"body":"antecubital is really just"},{"speaker":"Charles Goldfarb","startTime":2059.76,"endTime":2063.15,"body":"fascinating anatomy. But But I"},{"speaker":"Charles Goldfarb","startTime":2059.76,"endTime":2063.15,"body":"agree with you, as far as you"},{"speaker":"Charles Goldfarb","startTime":2063.15,"endTime":2067.02,"body":"know, clear compressive sites,"},{"speaker":"Charles Goldfarb","startTime":2063.15,"endTime":2067.02,"body":"there's no doubt that the- the"},{"speaker":"Charles Goldfarb","startTime":2067.02,"endTime":2069.24,"body":"leading edge of that FDS is much"},{"speaker":"Charles Goldfarb","startTime":2067.02,"endTime":2069.24,"body":"more impressive."},{"speaker":"Chris Dy","startTime":2069.63,"endTime":2071.52,"body":"What's your"},{"speaker":"Chris Dy","startTime":2069.63,"endTime":2071.52,"body":"percentage? You would say?"},{"speaker":"Charles Goldfarb","startTime":2072.12,"endTime":2074.97,"body":"Less for sure."},{"speaker":"Charles Goldfarb","startTime":2072.12,"endTime":2074.97,"body":"And I don't have as heavy a"},{"speaker":"Charles Goldfarb","startTime":2074.97,"endTime":2082.14,"body":"practice as you do. I would say"},{"speaker":"Charles Goldfarb","startTime":2074.97,"endTime":2082.14,"body":"it's it's honestly 2% something"},{"speaker":"Charles Goldfarb","startTime":2082.14,"endTime":2082.32,"body":"like that."},{"speaker":"Chris Dy","startTime":2082.32,"endTime":2085.2,"body":"Yeah. I think that's"},{"speaker":"Chris Dy","startTime":2082.32,"endTime":2085.2,"body":"you know, that's fair. And when"},{"speaker":"Chris Dy","startTime":2085.2,"endTime":2088.08,"body":"we talk I think you maybe said"},{"speaker":"Chris Dy","startTime":2085.2,"endTime":2088.08,"body":"in your training along the way"},{"speaker":"Chris Dy","startTime":2088.08,"endTime":2092.91,"body":"you'd seen some surgeons embrace"},{"speaker":"Chris Dy","startTime":2088.08,"endTime":2092.91,"body":"it and perhaps do too many. You"},{"speaker":"Chris Dy","startTime":2092.91,"endTime":2096.0,"body":"know, and I think that, you"},{"speaker":"Chris Dy","startTime":2092.91,"endTime":2096.0,"body":"know, there's sometimes I'll"},{"speaker":"Chris Dy","startTime":2096.0,"endTime":2098.58,"body":"talk to patients say look, you"},{"speaker":"Chris Dy","startTime":2096.0,"endTime":2098.58,"body":"know, this is a really hard"},{"speaker":"Chris Dy","startTime":2098.58,"endTime":2101.49,"body":"thing to look for objectively"},{"speaker":"Chris Dy","startTime":2098.58,"endTime":2101.49,"body":"Think you have it, we can just"},{"speaker":"Chris Dy","startTime":2101.49,"endTime":2104.19,"body":"do your carpal tunnel release"},{"speaker":"Chris Dy","startTime":2101.49,"endTime":2104.19,"body":"and see how you do. And then if"},{"speaker":"Chris Dy","startTime":2104.19,"endTime":2106.95,"body":"we need to have you come back,"},{"speaker":"Chris Dy","startTime":2104.19,"endTime":2106.95,"body":"we'll come back. Other people, I"},{"speaker":"Chris Dy","startTime":2106.95,"endTime":2109.71,"body":"feel strongly and I kind of"},{"speaker":"Chris Dy","startTime":2106.95,"endTime":2109.71,"body":"honestly influence them one way"},{"speaker":"Chris Dy","startTime":2109.71,"endTime":2112.62,"body":"or another. I think that's what"},{"speaker":"Chris Dy","startTime":2109.71,"endTime":2112.62,"body":"we do as doctors, especially as"},{"speaker":"Chris Dy","startTime":2112.62,"endTime":2116.13,"body":"surgeons, we give them our own"},{"speaker":"Chris Dy","startTime":2112.62,"endTime":2116.13,"body":"our best clinical impression."},{"speaker":"Chris Dy","startTime":2117.33,"endTime":2120.06,"body":"And honestly, I haven't counted"},{"speaker":"Chris Dy","startTime":2117.33,"endTime":2120.06,"body":"I have meant to count before"},{"speaker":"Chris Dy","startTime":2120.09,"endTime":2122.97,"body":"because I knew you're gonna ask"},{"speaker":"Chris Dy","startTime":2120.09,"endTime":2122.97,"body":"me that question. I meant to"},{"speaker":"Chris Dy","startTime":2122.97,"endTime":2125.46,"body":"count before we started, because"},{"speaker":"Chris Dy","startTime":2122.97,"endTime":2125.46,"body":"I did have a patient asked me"},{"speaker":"Chris Dy","startTime":2125.46,"endTime":2128.1,"body":"recently, how many ulnar nerve"},{"speaker":"Chris Dy","startTime":2125.46,"endTime":2128.1,"body":"transpositions I had ever done."},{"speaker":"Chris Dy","startTime":2128.31,"endTime":2131.37,"body":"And I actually looked it up and"},{"speaker":"Chris Dy","startTime":2128.31,"endTime":2131.37,"body":"told him he was like, oh, okay,"},{"speaker":"Chris Dy","startTime":2131.4,"endTime":2132.03,"body":"you can do mine."},{"speaker":"Charles Goldfarb","startTime":2133.62,"endTime":2137.07,"body":"So, alright,"},{"speaker":"Charles Goldfarb","startTime":2133.62,"endTime":2137.07,"body":"and I'm gonna I may, I don't"},{"speaker":"Charles Goldfarb","startTime":2137.07,"endTime":2140.7,"body":"want to anger anybody, but I may"},{"speaker":"Charles Goldfarb","startTime":2137.07,"endTime":2140.7,"body":"anger some people with this"},{"speaker":"Charles Goldfarb","startTime":2140.7,"endTime":2146.43,"body":"question. But do you believe in"},{"speaker":"Charles Goldfarb","startTime":2140.7,"endTime":2146.43,"body":"therapy for pronator syndrome,"},{"speaker":"Charles Goldfarb","startTime":2146.43,"endTime":2149.76,"body":"whatever you want to call it?"},{"speaker":"Charles Goldfarb","startTime":2146.43,"endTime":2149.76,"body":"And do you believe in nerve"},{"speaker":"Charles Goldfarb","startTime":2149.76,"endTime":2153.57,"body":"glides as being an efficacious"},{"speaker":"Charles Goldfarb","startTime":2149.76,"endTime":2153.57,"body":"treatment for nerve pathology?"},{"speaker":"Chris Dy","startTime":2154.86,"endTime":2158.31,"body":"You know, I don't"},{"speaker":"Chris Dy","startTime":2154.86,"endTime":2158.31,"body":"think that it works particularly"},{"speaker":"Chris Dy","startTime":2158.31,"endTime":2161.58,"body":"well for pronator syndrome. If"},{"speaker":"Chris Dy","startTime":2158.31,"endTime":2161.58,"body":"there's something else going on,"},{"speaker":"Chris Dy","startTime":2161.61,"endTime":2165.75,"body":"in terms of thoracic outlet,"},{"speaker":"Chris Dy","startTime":2161.61,"endTime":2165.75,"body":"which clearly can be the case, I"},{"speaker":"Chris Dy","startTime":2165.75,"endTime":2168.45,"body":"think it's really effective"},{"speaker":"Chris Dy","startTime":2165.75,"endTime":2168.45,"body":"there. I think, as you mentioned"},{"speaker":"Chris Dy","startTime":2168.45,"endTime":2172.68,"body":"earlier, it you know, if it is"},{"speaker":"Chris Dy","startTime":2168.45,"endTime":2172.68,"body":"truly the pronator muscle, that"},{"speaker":"Chris Dy","startTime":2172.68,"endTime":2176.34,"body":"is the compressive pathology,"},{"speaker":"Chris Dy","startTime":2172.68,"endTime":2176.34,"body":"then it is a dynamic process and"},{"speaker":"Chris Dy","startTime":2176.34,"endTime":2180.24,"body":"some ergonomic adjustments would"},{"speaker":"Chris Dy","startTime":2176.34,"endTime":2180.24,"body":"be helpful. So I think those"},{"speaker":"Chris Dy","startTime":2180.24,"endTime":2182.43,"body":"ergonomic tips that can be"},{"speaker":"Chris Dy","startTime":2180.24,"endTime":2182.43,"body":"shared by our therapy"},{"speaker":"Chris Dy","startTime":2182.43,"endTime":2184.95,"body":"colleagues, either in a visit"},{"speaker":"Chris Dy","startTime":2182.43,"endTime":2184.95,"body":"with us if they're shadowing the"},{"speaker":"Chris Dy","startTime":2184.95,"endTime":2188.7,"body":"clinic, or with you know, a"},{"speaker":"Chris Dy","startTime":2184.95,"endTime":2188.7,"body":"formal therapy visit can be"},{"speaker":"Chris Dy","startTime":2188.7,"endTime":2192.96,"body":"useful, but I don't put I don't"},{"speaker":"Chris Dy","startTime":2188.7,"endTime":2192.96,"body":"put a lot of stock that that's"},{"speaker":"Chris Dy","startTime":2192.96,"endTime":2196.71,"body":"the thing that's going to stop"},{"speaker":"Chris Dy","startTime":2192.96,"endTime":2196.71,"body":"this process. So I don't"},{"speaker":"Chris Dy","startTime":2196.71,"endTime":2199.2,"body":"routinely send people up just"},{"speaker":"Chris Dy","startTime":2196.71,"endTime":2199.2,"body":"for that. And I think nerve"},{"speaker":"Chris Dy","startTime":2199.2,"endTime":2203.61,"body":"glides do have benefit overall."},{"speaker":"Chris Dy","startTime":2199.2,"endTime":2203.61,"body":"I think some of it is patient"},{"speaker":"Chris Dy","startTime":2203.61,"endTime":2206.16,"body":"empowerment, to be honest with"},{"speaker":"Chris Dy","startTime":2203.61,"endTime":2206.16,"body":"you. And then some of it is"},{"speaker":"Chris Dy","startTime":2206.19,"endTime":2208.32,"body":"ergonomic adjustments that"},{"speaker":"Chris Dy","startTime":2206.19,"endTime":2208.32,"body":"typically come with the"},{"speaker":"Chris Dy","startTime":2208.32,"endTime":2210.57,"body":"instruction of nerve glides."},{"speaker":"Chris Dy","startTime":2208.32,"endTime":2210.57,"body":"What are your thoughts?"},{"speaker":"Charles Goldfarb","startTime":2210.64,"endTime":2213.49,"body":"I think that's"},{"speaker":"Charles Goldfarb","startTime":2210.64,"endTime":2213.49,"body":"well said I've used it more"},{"speaker":"Charles Goldfarb","startTime":2213.49,"endTime":2217.99,"body":"frequently with more success in"},{"speaker":"Charles Goldfarb","startTime":2213.49,"endTime":2217.99,"body":"some mild cubital tunnel and"},{"speaker":"Charles Goldfarb","startTime":2217.99,"endTime":2221.38,"body":"some brachial neuritis, so to"},{"speaker":"Charles Goldfarb","startTime":2217.99,"endTime":2221.38,"body":"speak. And I think it's been"},{"speaker":"Charles Goldfarb","startTime":2221.38,"endTime":2224.65,"body":"helpful in those situations, I"},{"speaker":"Charles Goldfarb","startTime":2221.38,"endTime":2224.65,"body":"have not found much utility for"},{"speaker":"Charles Goldfarb","startTime":2224.65,"endTime":2226.9,"body":"other nerve compression"},{"speaker":"Charles Goldfarb","startTime":2224.65,"endTime":2226.9,"body":"syndromes."},{"speaker":"Chris Dy","startTime":2228.4,"endTime":2231.07,"body":"So what are your if"},{"speaker":"Chris Dy","startTime":2228.4,"endTime":2231.07,"body":"you get if this patient gets to"},{"speaker":"Chris Dy","startTime":2231.07,"endTime":2235.45,"body":"the operating room? What's your"},{"speaker":"Chris Dy","startTime":2231.07,"endTime":2235.45,"body":"preferred anesthetic?"},{"speaker":"Charles Goldfarb","startTime":2235.75,"endTime":2237.31,"body":"I don't think"},{"speaker":"Charles Goldfarb","startTime":2235.75,"endTime":2237.31,"body":"this is one where I would"},{"speaker":"Charles Goldfarb","startTime":2237.31,"endTime":2241.24,"body":"consider a local only technique."},{"speaker":"Charles Goldfarb","startTime":2237.31,"endTime":2241.24,"body":"I think with deeper procedures,"},{"speaker":"Charles Goldfarb","startTime":2241.24,"endTime":2245.08,"body":"more proximal procedures it's"},{"speaker":"Charles Goldfarb","startTime":2241.24,"endTime":2245.08,"body":"more challenging. So for me, it"},{"speaker":"Charles Goldfarb","startTime":2245.08,"endTime":2250.24,"body":"would not be a local only, I"},{"speaker":"Charles Goldfarb","startTime":2245.08,"endTime":2250.24,"body":"would consider a bier block. And"},{"speaker":"Charles Goldfarb","startTime":2250.24,"endTime":2253.12,"body":"because this is not a lengthy"},{"speaker":"Charles Goldfarb","startTime":2250.24,"endTime":2253.12,"body":"procedure, it's not a big"},{"speaker":"Charles Goldfarb","startTime":2253.12,"endTime":2256.48,"body":"incision procedure. But I would"},{"speaker":"Charles Goldfarb","startTime":2253.12,"endTime":2256.48,"body":"consider a bier block I would"},{"speaker":"Charles Goldfarb","startTime":2256.48,"endTime":2261.4,"body":"consider a supraclavicular"},{"speaker":"Charles Goldfarb","startTime":2256.48,"endTime":2261.4,"body":"block, which I use a lot. And I"},{"speaker":"Charles Goldfarb","startTime":2261.4,"endTime":2263.98,"body":"would certainly consider a"},{"speaker":"Charles Goldfarb","startTime":2261.4,"endTime":2263.98,"body":"general but it wouldn't be a"},{"speaker":"Charles Goldfarb","startTime":2263.98,"endTime":2265.54,"body":"local only for me. What about"},{"speaker":"Charles Goldfarb","startTime":2263.98,"endTime":2265.54,"body":"you?"},{"speaker":"Chris Dy","startTime":2266.41,"endTime":2271.09,"body":"So I kind of was clued"},{"speaker":"Chris Dy","startTime":2266.41,"endTime":2271.09,"body":"in on doing more lacertus"},{"speaker":"Chris Dy","startTime":2271.12,"endTime":2274.78,"body":"pronator decompressions when I"},{"speaker":"Chris Dy","startTime":2271.12,"endTime":2274.78,"body":"visited Elizabeth Hagert in I"},{"speaker":"Chris Dy","startTime":2274.78,"endTime":2279.1,"body":"think it was 2016 in Stockholm."},{"speaker":"Chris Dy","startTime":2274.78,"endTime":2279.1,"body":"And you know, she had a practice"},{"speaker":"Chris Dy","startTime":2279.1,"endTime":2281.86,"body":"where she was doing these in"},{"speaker":"Chris Dy","startTime":2279.1,"endTime":2281.86,"body":"essentially a procedure room"},{"speaker":"Chris Dy","startTime":2281.89,"endTime":2286.84,"body":"under local and seeing her"},{"speaker":"Chris Dy","startTime":2281.89,"endTime":2286.84,"body":"results. It was really"},{"speaker":"Chris Dy","startTime":2286.84,"endTime":2289.42,"body":"impressive. You know, we were"},{"speaker":"Chris Dy","startTime":2286.84,"endTime":2289.42,"body":"talking about the resistance,"},{"speaker":"Chris Dy","startTime":2289.45,"endTime":2292.54,"body":"you know, extrinsic median"},{"speaker":"Chris Dy","startTime":2289.45,"endTime":2292.54,"body":"testing, seeing on the table"},{"speaker":"Chris Dy","startTime":2292.54,"endTime":2295.06,"body":"improvement. Now, I don't know"},{"speaker":"Chris Dy","startTime":2292.54,"endTime":2295.06,"body":"how much of that was a parlor"},{"speaker":"Chris Dy","startTime":2295.06,"endTime":2297.52,"body":"trick. And I actually tried to"},{"speaker":"Chris Dy","startTime":2295.06,"endTime":2297.52,"body":"examine them myself. And I think"},{"speaker":"Chris Dy","startTime":2297.52,"endTime":2301.81,"body":"she was right. And I have that I"},{"speaker":"Chris Dy","startTime":2297.52,"endTime":2301.81,"body":"have had, I think there was one"},{"speaker":"Chris Dy","startTime":2301.81,"endTime":2304.3,"body":"trainee, I think it was Sobel,"},{"speaker":"Chris Dy","startTime":2301.81,"endTime":2304.3,"body":"Andrew Sobel, who was with me,"},{"speaker":"Chris Dy","startTime":2304.51,"endTime":2307.06,"body":"and I did this, like we had him"},{"speaker":"Chris Dy","startTime":2304.51,"endTime":2307.06,"body":"test the patient beforehand,"},{"speaker":"Chris Dy","startTime":2307.06,"endTime":2309.82,"body":"test the patient after the FDS"},{"speaker":"Chris Dy","startTime":2307.06,"endTime":2309.82,"body":"arch decompression, and he was"},{"speaker":"Chris Dy","startTime":2309.82,"endTime":2313.84,"body":"blown away like he was sold, or"},{"speaker":"Chris Dy","startTime":2309.82,"endTime":2313.84,"body":"whoever the trainee was, but it"},{"speaker":"Chris Dy","startTime":2313.84,"endTime":2317.44,"body":"doesn't happen like that that"},{"speaker":"Chris Dy","startTime":2313.84,"endTime":2317.44,"body":"often. And I used to do a lot of"},{"speaker":"Chris Dy","startTime":2317.44,"endTime":2322.3,"body":"these under local but what I've"},{"speaker":"Chris Dy","startTime":2317.44,"endTime":2322.3,"body":"realized in our in our patient"},{"speaker":"Chris Dy","startTime":2322.3,"endTime":2325.57,"body":"population who tend to have a"},{"speaker":"Chris Dy","startTime":2322.3,"endTime":2325.57,"body":"healthier subcutaneous envelope,"},{"speaker":"Chris Dy","startTime":2325.69,"endTime":2329.68,"body":"to put it politely, more obese"},{"speaker":"Chris Dy","startTime":2325.69,"endTime":2329.68,"body":"patients. It's challenging to do"},{"speaker":"Chris Dy","startTime":2329.68,"endTime":2331.51,"body":"these under local for the"},{"speaker":"Chris Dy","startTime":2329.68,"endTime":2331.51,"body":"reasons you stated. It's a"},{"speaker":"Chris Dy","startTime":2331.51,"endTime":2335.26,"body":"deeper dissection. And one"},{"speaker":"Chris Dy","startTime":2331.51,"endTime":2335.26,"body":"difference, I think, and maybe"},{"speaker":"Chris Dy","startTime":2335.26,"endTime":2338.14,"body":"I'm misremembering what"},{"speaker":"Chris Dy","startTime":2335.26,"endTime":2338.14,"body":"Elizabeth taught me, but she did"},{"speaker":"Chris Dy","startTime":2338.14,"endTime":2341.29,"body":"not routinely visualize the"},{"speaker":"Chris Dy","startTime":2338.14,"endTime":2341.29,"body":"median nerve every time she"},{"speaker":"Chris Dy","startTime":2341.29,"endTime":2344.02,"body":"would find the lacertus would"},{"speaker":"Chris Dy","startTime":2341.29,"endTime":2344.02,"body":"release the lacertus and call it"},{"speaker":"Chris Dy","startTime":2344.02,"endTime":2347.26,"body":"a day. There were times where"},{"speaker":"Chris Dy","startTime":2344.02,"endTime":2347.26,"body":"she would check them and examine"},{"speaker":"Chris Dy","startTime":2347.26,"endTime":2349.81,"body":"them and then perhaps release"},{"speaker":"Chris Dy","startTime":2347.26,"endTime":2349.81,"body":"the FDS arch if they still had"},{"speaker":"Chris Dy","startTime":2349.81,"endTime":2354.13,"body":"some weakness. But I think my"},{"speaker":"Chris Dy","startTime":2349.81,"endTime":2354.13,"body":"personal philosophy is, you"},{"speaker":"Chris Dy","startTime":2354.13,"endTime":2356.56,"body":"know, I'm there to decompress"},{"speaker":"Chris Dy","startTime":2354.13,"endTime":2356.56,"body":"the median nerve, I want to see"},{"speaker":"Chris Dy","startTime":2356.56,"endTime":2359.41,"body":"the median nerve. And sometimes"},{"speaker":"Chris Dy","startTime":2356.56,"endTime":2359.41,"body":"that can be a little more"},{"speaker":"Chris Dy","startTime":2359.41,"endTime":2362.29,"body":"difficult with patients under"},{"speaker":"Chris Dy","startTime":2359.41,"endTime":2362.29,"body":"local not impossible, but a"},{"speaker":"Chris Dy","startTime":2362.29,"endTime":2363.22,"body":"little more difficult."},{"speaker":"Charles Goldfarb","startTime":2364.02,"endTime":2367.26,"body":"I think that's"},{"speaker":"Charles Goldfarb","startTime":2364.02,"endTime":2367.26,"body":"well said. And for me, just to"},{"speaker":"Charles Goldfarb","startTime":2367.26,"endTime":2370.65,"body":"be blunt, and we have been"},{"speaker":"Charles Goldfarb","startTime":2367.26,"endTime":2370.65,"body":"jabbering on now for quite a"},{"speaker":"Charles Goldfarb","startTime":2370.65,"endTime":2375.93,"body":"while. I make a three ish"},{"speaker":"Charles Goldfarb","startTime":2370.65,"endTime":2375.93,"body":"centimeter incision from the"},{"speaker":"Charles Goldfarb","startTime":2375.93,"endTime":2379.05,"body":"antecubital crease distally I"},{"speaker":"Charles Goldfarb","startTime":2375.93,"endTime":2379.05,"body":"think you can subcutaneously get"},{"speaker":"Charles Goldfarb","startTime":2379.05,"endTime":2382.71,"body":"a great exposure proximally if"},{"speaker":"Charles Goldfarb","startTime":2379.05,"endTime":2382.71,"body":"you need it. I release a"},{"speaker":"Charles Goldfarb","startTime":2382.71,"endTime":2385.8,"body":"lacertus, I examine the nerve as"},{"speaker":"Charles Goldfarb","startTime":2382.71,"endTime":2385.8,"body":"it passes between the two heads"},{"speaker":"Charles Goldfarb","startTime":2385.8,"endTime":2389.61,"body":"of the pronator and I trace it"},{"speaker":"Charles Goldfarb","startTime":2385.8,"endTime":2389.61,"body":"down toward the FDS arch and"},{"speaker":"Charles Goldfarb","startTime":2389.61,"endTime":2394.35,"body":"release that fascicle leading"},{"speaker":"Charles Goldfarb","startTime":2389.61,"endTime":2394.35,"body":"edge as as needed and and it is"},{"speaker":"Charles Goldfarb","startTime":2394.38,"endTime":2397.62,"body":"it is needed every time. And so"},{"speaker":"Charles Goldfarb","startTime":2394.38,"endTime":2397.62,"body":"I do all three of those things"},{"speaker":"Charles Goldfarb","startTime":2397.62,"endTime":2399.78,"body":"even though I don't necessarily"},{"speaker":"Charles Goldfarb","startTime":2397.62,"endTime":2399.78,"body":"believe the lacertus is"},{"speaker":"Charles Goldfarb","startTime":2399.78,"endTime":2402.39,"body":"contributing, but those are the"},{"speaker":"Charles Goldfarb","startTime":2399.78,"endTime":2402.39,"body":"three areas I check for, in"},{"speaker":"Charles Goldfarb","startTime":2402.39,"endTime":2404.1,"body":"addition to palpating more"},{"speaker":"Charles Goldfarb","startTime":2402.39,"endTime":2404.1,"body":"proximally."},{"speaker":"Chris Dy","startTime":2404.78,"endTime":2407.51,"body":"And after, after I"},{"speaker":"Chris Dy","startTime":2404.78,"endTime":2407.51,"body":"release that FDS arch, I will"},{"speaker":"Chris Dy","startTime":2407.51,"endTime":2411.14,"body":"continue to trace the nerve"},{"speaker":"Chris Dy","startTime":2407.51,"endTime":2411.14,"body":"distally. And usually it's with"},{"speaker":"Chris Dy","startTime":2411.59,"endTime":2414.92,"body":"a close tenotomy scissor, and"},{"speaker":"Chris Dy","startTime":2411.59,"endTime":2414.92,"body":"just palpating that course of"},{"speaker":"Chris Dy","startTime":2414.92,"endTime":2417.98,"body":"the nerve and making sure that"},{"speaker":"Chris Dy","startTime":2414.92,"endTime":2417.98,"body":"it's not tight, and I typically"},{"speaker":"Chris Dy","startTime":2417.98,"endTime":2421.04,"body":"am able to put my finger in"},{"speaker":"Chris Dy","startTime":2417.98,"endTime":2421.04,"body":"there. And, you know, make sure"},{"speaker":"Chris Dy","startTime":2421.04,"endTime":2424.22,"body":"that it's not tight as the nerve"},{"speaker":"Chris Dy","startTime":2421.04,"endTime":2424.22,"body":"progresses into the mid portion"},{"speaker":"Chris Dy","startTime":2424.22,"endTime":2427.16,"body":"of the forearm. So even through,"},{"speaker":"Chris Dy","startTime":2424.22,"endTime":2427.16,"body":"you know, a relatively small"},{"speaker":"Chris Dy","startTime":2427.16,"endTime":2430.31,"body":"incision, you can do a lot of"},{"speaker":"Chris Dy","startTime":2427.16,"endTime":2430.31,"body":"work and ensure you know, do it"},{"speaker":"Chris Dy","startTime":2430.31,"endTime":2433.94,"body":"safely, obviously, and ensure"},{"speaker":"Chris Dy","startTime":2430.31,"endTime":2433.94,"body":"that everything is decompressed."},{"speaker":"Chris Dy","startTime":2434.75,"endTime":2438.56,"body":"You know, I'm like you I use a"},{"speaker":"Chris Dy","startTime":2434.75,"endTime":2438.56,"body":"little incision, that's probably"},{"speaker":"Chris Dy","startTime":2438.56,"endTime":2441.2,"body":"you know, is the most proximal"},{"speaker":"Chris Dy","startTime":2438.56,"endTime":2441.2,"body":"part is just distal to the"},{"speaker":"Chris Dy","startTime":2441.2,"endTime":2443.6,"body":"antecubital fossa, it's a little"},{"speaker":"Chris Dy","startTime":2441.2,"endTime":2443.6,"body":"s shaped incision, and kind of"},{"speaker":"Chris Dy","startTime":2443.6,"endTime":2447.56,"body":"matches the course of that"},{"speaker":"Chris Dy","startTime":2443.6,"endTime":2447.56,"body":"flexor pronator radial edge. And"},{"speaker":"Chris Dy","startTime":2447.56,"endTime":2450.14,"body":"this one can sometimes be a"},{"speaker":"Chris Dy","startTime":2447.56,"endTime":2450.14,"body":"little tricky in terms of"},{"speaker":"Chris Dy","startTime":2450.14,"endTime":2452.9,"body":"finding the median nerve,"},{"speaker":"Chris Dy","startTime":2450.14,"endTime":2452.9,"body":"because I find that it's, it's"},{"speaker":"Chris Dy","startTime":2452.9,"endTime":2455.93,"body":"sometimes hiding in plain sight."},{"speaker":"Chris Dy","startTime":2452.9,"endTime":2455.93,"body":"And if you're off just a click"},{"speaker":"Chris Dy","startTime":2455.93,"endTime":2458.24,"body":"with your dissection in terms of"},{"speaker":"Chris Dy","startTime":2455.93,"endTime":2458.24,"body":"the plane that you're coming"},{"speaker":"Chris Dy","startTime":2458.24,"endTime":2460.82,"body":"down, it can be a little harder"},{"speaker":"Chris Dy","startTime":2458.24,"endTime":2460.82,"body":"because it's so weird, because"},{"speaker":"Chris Dy","startTime":2460.82,"endTime":2463.19,"body":"you're so used to looking at it,"},{"speaker":"Chris Dy","startTime":2460.82,"endTime":2463.19,"body":"for example, during an ulnar"},{"speaker":"Chris Dy","startTime":2463.19,"endTime":2465.59,"body":"nerve transposition from the"},{"speaker":"Chris Dy","startTime":2463.19,"endTime":2465.59,"body":"medial side and looking kind of"},{"speaker":"Chris Dy","startTime":2465.59,"endTime":2468.38,"body":"over the top. And it almost"},{"speaker":"Chris Dy","startTime":2465.59,"endTime":2468.38,"body":"shows itself immediately to you."},{"speaker":"Chris Dy","startTime":2468.8,"endTime":2471.35,"body":"This one can kind of be hiding"},{"speaker":"Chris Dy","startTime":2468.8,"endTime":2471.35,"body":"in plain sight. And you know, it"},{"speaker":"Chris Dy","startTime":2471.35,"endTime":2473.36,"body":"just takes a little longer you"},{"speaker":"Chris Dy","startTime":2471.35,"endTime":2473.36,"body":"want to make sure obviously, you"},{"speaker":"Chris Dy","startTime":2473.36,"endTime":2474.71,"body":"see you get it out safely."},{"speaker":"Charles Goldfarb","startTime":2475.34,"endTime":2476.93,"body":"Absolutely."},{"speaker":"Charles Goldfarb","startTime":2475.34,"endTime":2476.93,"body":"And you have to make sure those"},{"speaker":"Charles Goldfarb","startTime":2476.93,"endTime":2479.93,"body":"big veins there are not your"},{"speaker":"Charles Goldfarb","startTime":2476.93,"endTime":2479.93,"body":"Nemesis and they will be your"},{"speaker":"Charles Goldfarb","startTime":2479.93,"endTime":2485.99,"body":"nemesis, likely, but keeping"},{"speaker":"Charles Goldfarb","startTime":2479.93,"endTime":2485.99,"body":"those intact is helpful. I do"},{"speaker":"Charles Goldfarb","startTime":2485.99,"endTime":2488.63,"body":"one thing I do like about this"},{"speaker":"Charles Goldfarb","startTime":2485.99,"endTime":2488.63,"body":"procedure in a way that I also"},{"speaker":"Charles Goldfarb","startTime":2488.63,"endTime":2491.27,"body":"like a radial tunnel"},{"speaker":"Charles Goldfarb","startTime":2488.63,"endTime":2491.27,"body":"decompression is the recovery is"},{"speaker":"Charles Goldfarb","startTime":2491.27,"endTime":2494.45,"body":"remarkably fast. And by"},{"speaker":"Charles Goldfarb","startTime":2491.27,"endTime":2494.45,"body":"recovery, I mean, the recovery"},{"speaker":"Charles Goldfarb","startTime":2494.45,"endTime":2498.14,"body":"from the surgery, patients"},{"speaker":"Charles Goldfarb","startTime":2494.45,"endTime":2498.14,"body":"bounce back really quickly, the"},{"speaker":"Charles Goldfarb","startTime":2498.14,"endTime":2501.5,"body":"wounds heal well. I use a bulky"},{"speaker":"Charles Goldfarb","startTime":2498.14,"endTime":2501.5,"body":"soft dressing, let them start"},{"speaker":"Charles Goldfarb","startTime":2501.5,"endTime":2504.14,"body":"using their hand right away."},{"speaker":"Charles Goldfarb","startTime":2501.5,"endTime":2504.14,"body":"When I see them at two weeks, I"},{"speaker":"Charles Goldfarb","startTime":2504.14,"endTime":2506.33,"body":"often don't see them again,"},{"speaker":"Charles Goldfarb","startTime":2504.14,"endTime":2506.33,"body":"unless we just need another"},{"speaker":"Charles Goldfarb","startTime":2506.33,"endTime":2507.8,"body":"follow up because we need more"},{"speaker":"Charles Goldfarb","startTime":2506.33,"endTime":2507.8,"body":"time."},{"speaker":"Chris Dy","startTime":2508.29,"endTime":2510.72,"body":"Yeah, bulky, soft"},{"speaker":"Chris Dy","startTime":2508.29,"endTime":2510.72,"body":"dressing for me down to five"},{"speaker":"Chris Dy","startTime":2510.72,"endTime":2514.71,"body":"days, sometimes earlier"},{"speaker":"Chris Dy","startTime":2510.72,"endTime":2514.71,"body":"depending on the calendar. And"},{"speaker":"Chris Dy","startTime":2514.71,"endTime":2518.28,"body":"you know, I have had, I think"},{"speaker":"Chris Dy","startTime":2514.71,"endTime":2518.28,"body":"probably one or two hematomas"},{"speaker":"Chris Dy","startTime":2518.94,"endTime":2521.07,"body":"that have come about. So that's"},{"speaker":"Chris Dy","startTime":2518.94,"endTime":2521.07,"body":"one thing that you always got to"},{"speaker":"Chris Dy","startTime":2521.07,"endTime":2523.53,"body":"look out for, especially if you"},{"speaker":"Chris Dy","startTime":2521.07,"endTime":2523.53,"body":"are using a tourniquet if the"},{"speaker":"Chris Dy","startTime":2523.53,"endTime":2527.55,"body":"patient's asleep. But in a"},{"speaker":"Chris Dy","startTime":2523.53,"endTime":2527.55,"body":"slender patient with a low BMI,"},{"speaker":"Chris Dy","startTime":2527.55,"endTime":2530.97,"body":"I will do it awake. You know,"},{"speaker":"Chris Dy","startTime":2527.55,"endTime":2530.97,"body":"just obviously, it's one of"},{"speaker":"Chris Dy","startTime":2530.97,"endTime":2534.75,"body":"those things where you tell the"},{"speaker":"Chris Dy","startTime":2530.97,"endTime":2534.75,"body":"trainee, this is where technique"},{"speaker":"Chris Dy","startTime":2534.75,"endTime":2538.11,"body":"is paramount, because awake"},{"speaker":"Chris Dy","startTime":2534.75,"endTime":2538.11,"body":"surgery can be unforgiving in"},{"speaker":"Chris Dy","startTime":2538.11,"endTime":2540.36,"body":"terms of how the patients"},{"speaker":"Chris Dy","startTime":2538.11,"endTime":2540.36,"body":"perceive things. So this is"},{"speaker":"Chris Dy","startTime":2540.36,"endTime":2543.45,"body":"really minimizing the big"},{"speaker":"Chris Dy","startTime":2540.36,"endTime":2543.45,"body":"spreads being very locked in and"},{"speaker":"Chris Dy","startTime":2543.45,"endTime":2546.06,"body":"technically precise the entire"},{"speaker":"Chris Dy","startTime":2543.45,"endTime":2546.06,"body":"time. Not that you aren't during"},{"speaker":"Chris Dy","startTime":2546.06,"endTime":2548.58,"body":"any of this surgery, but you can"},{"speaker":"Chris Dy","startTime":2546.06,"endTime":2548.58,"body":"get away with bigger spreads"},{"speaker":"Chris Dy","startTime":2548.58,"endTime":2549.48,"body":"when the patient's asleep."},{"speaker":"Charles Goldfarb","startTime":2550.17,"endTime":2553.14,"body":"I think that's"},{"speaker":"Charles Goldfarb","startTime":2550.17,"endTime":2553.14,"body":"an excellent point I did four"},{"speaker":"Charles Goldfarb","startTime":2553.14,"endTime":2556.35,"body":"local only procedures yesterday"},{"speaker":"Charles Goldfarb","startTime":2553.14,"endTime":2556.35,"body":"they were in the OR but four"},{"speaker":"Charles Goldfarb","startTime":2556.35,"endTime":2559.62,"body":"which was a lot for me. And it"},{"speaker":"Charles Goldfarb","startTime":2556.35,"endTime":2559.62,"body":"you're right when you especially"},{"speaker":"Charles Goldfarb","startTime":2559.62,"endTime":2562.26,"body":"when you're working on a nerve,"},{"speaker":"Charles Goldfarb","startTime":2559.62,"endTime":2562.26,"body":"those big spread dissections,"},{"speaker":"Charles Goldfarb","startTime":2562.26,"endTime":2566.46,"body":"which I favor at times are a"},{"speaker":"Charles Goldfarb","startTime":2562.26,"endTime":2566.46,"body":"common no go with a local only"},{"speaker":"Charles Goldfarb","startTime":2566.46,"endTime":2570.03,"body":"because you ding that nerve"},{"speaker":"Charles Goldfarb","startTime":2566.46,"endTime":2570.03,"body":"once. Even if they don't, you"},{"speaker":"Charles Goldfarb","startTime":2570.03,"endTime":2572.73,"body":"know even if they're anesthetic"},{"speaker":"Charles Goldfarb","startTime":2570.03,"endTime":2572.73,"body":"to things, they feel it."},{"speaker":"Chris Dy","startTime":2573.42,"endTime":2575.79,"body":"Yeah, you know, part"},{"speaker":"Chris Dy","startTime":2573.42,"endTime":2575.79,"body":"of part of wide awake, which I"},{"speaker":"Chris Dy","startTime":2575.79,"endTime":2578.7,"body":"think some people don't like is"},{"speaker":"Chris Dy","startTime":2575.79,"endTime":2578.7,"body":"the showmanship aspect of it,"},{"speaker":"Chris Dy","startTime":2578.91,"endTime":2582.78,"body":"you kind of have to be on every"},{"speaker":"Chris Dy","startTime":2578.91,"endTime":2582.78,"body":"cylinder, right? So you've got"},{"speaker":"Chris Dy","startTime":2582.78,"endTime":2585.33,"body":"to lead the OR, you got to do"},{"speaker":"Chris Dy","startTime":2582.78,"endTime":2585.33,"body":"the surgery or take a trainee"},{"speaker":"Chris Dy","startTime":2585.33,"endTime":2587.55,"body":"through the surgery. And you"},{"speaker":"Chris Dy","startTime":2585.33,"endTime":2587.55,"body":"have to essentially entertain"},{"speaker":"Chris Dy","startTime":2587.55,"endTime":2591.36,"body":"the patient, or hope that the"},{"speaker":"Chris Dy","startTime":2587.55,"endTime":2591.36,"body":"person up top who's monitoring"},{"speaker":"Chris Dy","startTime":2591.36,"endTime":2593.76,"body":"the patient, if you have that is"},{"speaker":"Chris Dy","startTime":2591.36,"endTime":2593.76,"body":"also doing it and that's the"},{"speaker":"Chris Dy","startTime":2593.76,"endTime":2596.4,"body":"biggest lesson I took from one"},{"speaker":"Chris Dy","startTime":2593.76,"endTime":2596.4,"body":"of the biggest lessons I took"},{"speaker":"Chris Dy","startTime":2596.4,"endTime":2600.12,"body":"from our brief stint of doing"},{"speaker":"Chris Dy","startTime":2596.4,"endTime":2600.12,"body":"these in the office alone was"},{"speaker":"Chris Dy","startTime":2600.12,"endTime":2603.18,"body":"that I just had to do more. It's"},{"speaker":"Chris Dy","startTime":2600.12,"endTime":2603.18,"body":"like more mental bandwidth to do"},{"speaker":"Chris Dy","startTime":2603.18,"endTime":2604.71,"body":"the entertaining part of it too."},{"speaker":"Charles Goldfarb","startTime":2605.4,"endTime":2606.99,"body":"I think you're"},{"speaker":"Charles Goldfarb","startTime":2605.4,"endTime":2606.99,"body":"right. And we know you're a"},{"speaker":"Charles Goldfarb","startTime":2606.99,"endTime":2614.13,"body":"showman Dr. Dy, but it is, it's"},{"speaker":"Charles Goldfarb","startTime":2606.99,"endTime":2614.13,"body":"harder work for sure. It really"},{"speaker":"Charles Goldfarb","startTime":2614.13,"endTime":2615.54,"body":"is. For sure."},{"speaker":"Chris Dy","startTime":2616.68,"endTime":2619.65,"body":"Well, on that note, I"},{"speaker":"Chris Dy","startTime":2616.68,"endTime":2619.65,"body":"think we have brought pronator"},{"speaker":"Chris Dy","startTime":2619.65,"endTime":2624.39,"body":"syndrome, lacertus syndrome, FDS"},{"speaker":"Chris Dy","startTime":2619.65,"endTime":2624.39,"body":"arch syndrome to a close. We"},{"speaker":"Chris Dy","startTime":2624.39,"endTime":2626.97,"body":"haven't even talked about AIN"},{"speaker":"Chris Dy","startTime":2624.39,"endTime":2626.97,"body":"syndrome, which is an entirely"},{"speaker":"Chris Dy","startTime":2626.97,"endTime":2627.72,"body":"different topic."},{"speaker":"Charles Goldfarb","startTime":2627.75,"endTime":2629.4,"body":"Oh god, I"},{"speaker":"Charles Goldfarb","startTime":2627.75,"endTime":2629.4,"body":"thought we were done."},{"speaker":"Chris Dy","startTime":2630.03,"endTime":2632.16,"body":"We'll leave that for"},{"speaker":"Chris Dy","startTime":2630.03,"endTime":2632.16,"body":"the next nerve related potpourri"},{"speaker":"Chris Dy","startTime":2632.16,"endTime":2632.82,"body":"day, so."},{"speaker":"Charles Goldfarb","startTime":2632.97,"endTime":2633.75,"body":"Fantastic."},{"speaker":"Chris Dy","startTime":2633.87,"endTime":2634.86,"body":"Have a wonderful day,"},{"speaker":"Chris Dy","startTime":2633.87,"endTime":2634.86,"body":"Chuck."},{"speaker":"Charles Goldfarb","startTime":2635.1,"endTime":2636.15,"body":"Good to see"},{"speaker":"Charles Goldfarb","startTime":2635.1,"endTime":2636.15,"body":"you, Chris. Thank you."},{"speaker":"Chris Dy","startTime":2636.39,"endTime":2637.11,"body":"Take care. Bye."},{"speaker":"Charles Goldfarb","startTime":2637.98,"endTime":2639.99,"body":"Hey, Chris."},{"speaker":"Charles Goldfarb","startTime":2637.98,"endTime":2639.99,"body":"That was fun. Let's do it again"},{"speaker":"Charles Goldfarb","startTime":2639.99,"endTime":2640.5,"body":"real soon."},{"speaker":"Chris Dy","startTime":2640.77,"endTime":2643.29,"body":"Sounds good. Well, be"},{"speaker":"Chris Dy","startTime":2640.77,"endTime":2643.29,"body":"sure to check us out on Twitter"},{"speaker":"Chris Dy","startTime":2643.5,"endTime":2645.69,"body":"@handpodcast. Hey, Chuck, what's"},{"speaker":"Chris Dy","startTime":2643.5,"endTime":2645.69,"body":"your Twitter handle?"},{"speaker":"Charles Goldfarb","startTime":2646.05,"endTime":2648.9,"body":"Mine is"},{"speaker":"Charles Goldfarb","startTime":2646.05,"endTime":2648.9,"body":"@congenitalhand. What about you?"},{"speaker":"Chris Dy","startTime":2649.05,"endTime":2652.41,"body":"Mine is @ChrisDyMD"},{"speaker":"Chris Dy","startTime":2649.05,"endTime":2652.41,"body":"spelled d y. And if you'd like"},{"speaker":"Chris Dy","startTime":2652.41,"endTime":2655.71,"body":"to email us, you can reach us at"},{"speaker":"Chris Dy","startTime":2652.41,"endTime":2655.71,"body":"handpodcast@gmail.com."},{"speaker":"Charles Goldfarb","startTime":2656.86,"endTime":2658.99,"body":"And remember,"},{"speaker":"Charles Goldfarb","startTime":2656.86,"endTime":2658.99,"body":"please subscribe wherever you"},{"speaker":"Charles Goldfarb","startTime":2658.99,"endTime":2660.07,"body":"get your podcasts"},{"speaker":"Chris Dy","startTime":2660.13,"endTime":2662.32,"body":"and be sure to leave a"},{"speaker":"Chris Dy","startTime":2660.13,"endTime":2662.32,"body":"review that helps us get the"},{"speaker":"Chris Dy","startTime":2662.32,"endTime":2662.74,"body":"word out."},{"speaker":"Charles Goldfarb","startTime":2663.13,"endTime":2665.41,"body":"Special thanks"},{"speaker":"Charles Goldfarb","startTime":2663.13,"endTime":2665.41,"body":"to Peter Martin for the amazing"},{"speaker":"Charles Goldfarb","startTime":2665.41,"endTime":2669.31,"body":"music. And remember, keep the"},{"speaker":"Charles Goldfarb","startTime":2665.41,"endTime":2669.31,"body":"upper hand come back next"}]}