{"version":"1.0.0","segments":[{"speaker":"Charles Goldfarb","startTime":10.8,"endTime":13.62,"body":"Welcome to the"},{"speaker":"Charles Goldfarb","startTime":10.8,"endTime":13.62,"body":"upper hand where Chuck and Chris"},{"speaker":"Charles Goldfarb","startTime":13.62,"endTime":14.49,"body":"talk hand surgery."},{"speaker":"Chris Dy","startTime":14.7,"endTime":16.56,"body":"We are two hand"},{"speaker":"Chris Dy","startTime":14.7,"endTime":16.56,"body":"surgeons at Washington"},{"speaker":"Chris Dy","startTime":16.56,"endTime":19.65,"body":"University in St. Louis here to"},{"speaker":"Chris Dy","startTime":16.56,"endTime":19.65,"body":"talk about all aspects of hand"},{"speaker":"Chris Dy","startTime":19.65,"endTime":21.48,"body":"surgery from technical to"},{"speaker":"Chris Dy","startTime":19.65,"endTime":21.48,"body":"personal."},{"speaker":"Charles Goldfarb","startTime":22.05,"endTime":24.33,"body":"Thank you for"},{"speaker":"Charles Goldfarb","startTime":22.05,"endTime":24.33,"body":"subscribing. Wherever you get"},{"speaker":"Charles Goldfarb","startTime":24.33,"endTime":25.23,"body":"your podcasts."},{"speaker":"Chris Dy","startTime":25.44,"endTime":27.66,"body":"And be sure to leave a"},{"speaker":"Chris Dy","startTime":25.44,"endTime":27.66,"body":"review that helps us get the"},{"speaker":"Chris Dy","startTime":27.66,"endTime":28.14,"body":"word out."},{"speaker":"Charles Goldfarb","startTime":28.29,"endTime":29.22,"body":"Oh hey Chris."},{"speaker":"Chris Dy","startTime":29.34,"endTime":30.48,"body":"Hey, Chuck, how are"},{"speaker":"Chris Dy","startTime":29.34,"endTime":30.48,"body":"you?"},{"speaker":"Charles Goldfarb","startTime":30.69,"endTime":32.58,"body":"I'm doing"},{"speaker":"Charles Goldfarb","startTime":30.69,"endTime":32.58,"body":"really well. What about you?"},{"speaker":"Chris Dy","startTime":33.0,"endTime":35.4,"body":"I'm doing pretty well."},{"speaker":"Chris Dy","startTime":33.0,"endTime":35.4,"body":"It sounds like you've got a"},{"speaker":"Chris Dy","startTime":35.4,"endTime":37.35,"body":"pretty exciting trip coming up."},{"speaker":"Chris Dy","startTime":35.4,"endTime":37.35,"body":"Is that right?"},{"speaker":"Charles Goldfarb","startTime":37.59,"endTime":39.96,"body":"Well, you"},{"speaker":"Charles Goldfarb","startTime":37.59,"endTime":39.96,"body":"know, it's sort of weird because"},{"speaker":"Charles Goldfarb","startTime":39.96,"endTime":43.56,"body":"I'm a little nervous. I haven't"},{"speaker":"Charles Goldfarb","startTime":39.96,"endTime":43.56,"body":"been on an airplane or traveled."},{"speaker":"Charles Goldfarb","startTime":43.56,"endTime":45.93,"body":"I've traveled with the family by"},{"speaker":"Charles Goldfarb","startTime":43.56,"endTime":45.93,"body":"car. But I haven't been on an"},{"speaker":"Charles Goldfarb","startTime":45.93,"endTime":49.8,"body":"airplane and I want to say like"},{"speaker":"Charles Goldfarb","startTime":45.93,"endTime":49.8,"body":"18 months or I don't know. So"},{"speaker":"Charles Goldfarb","startTime":49.8,"endTime":54.93,"body":"yes, I'm going for a fellowship"},{"speaker":"Charles Goldfarb","startTime":49.8,"endTime":54.93,"body":"reunion. I did my fellowship in"},{"speaker":"Charles Goldfarb","startTime":54.93,"endTime":60.36,"body":"a bygone era in Cincinnati, and"},{"speaker":"Charles Goldfarb","startTime":54.93,"endTime":60.36,"body":"Dr. Stern is having one of his"},{"speaker":"Charles Goldfarb","startTime":60.54,"endTime":63.69,"body":"fellowship reunions in Jackson"},{"speaker":"Charles Goldfarb","startTime":60.54,"endTime":63.69,"body":"Hole, Wyoming. And this might be"},{"speaker":"Charles Goldfarb","startTime":63.69,"endTime":65.94,"body":"the last one. So I thought it"},{"speaker":"Charles Goldfarb","startTime":63.69,"endTime":65.94,"body":"was important to attend that I'm"},{"speaker":"Charles Goldfarb","startTime":65.94,"endTime":68.73,"body":"taking my eldest son who's pre"},{"speaker":"Charles Goldfarb","startTime":65.94,"endTime":68.73,"body":"med and so we're looking forward"},{"speaker":"Charles Goldfarb","startTime":68.73,"endTime":69.03,"body":"to it."},{"speaker":"Chris Dy","startTime":69.51,"endTime":72.78,"body":"That sounds pretty"},{"speaker":"Chris Dy","startTime":69.51,"endTime":72.78,"body":"exciting. Hopefully, a relaxing"},{"speaker":"Chris Dy","startTime":72.78,"endTime":74.82,"body":"schedule is nothing too crazy,"},{"speaker":"Chris Dy","startTime":72.78,"endTime":74.82,"body":"I'm sure."},{"speaker":"Charles Goldfarb","startTime":75.02,"endTime":78.65,"body":"Yeah, morning."},{"speaker":"Charles Goldfarb","startTime":75.02,"endTime":78.65,"body":"conference, you know, with"},{"speaker":"Charles Goldfarb","startTime":79.01,"endTime":81.89,"body":"presentations, and it's really"},{"speaker":"Charles Goldfarb","startTime":79.01,"endTime":81.89,"body":"nice, because there is some good"},{"speaker":"Charles Goldfarb","startTime":81.89,"endTime":85.04,"body":"science. And there's also some"},{"speaker":"Charles Goldfarb","startTime":81.89,"endTime":85.04,"body":"people with a really good sense"},{"speaker":"Charles Goldfarb","startTime":85.04,"endTime":88.67,"body":"of humor. So it, I really do"},{"speaker":"Charles Goldfarb","startTime":85.04,"endTime":88.67,"body":"enjoy it and then the afternoons"},{"speaker":"Charles Goldfarb","startTime":88.67,"endTime":92.27,"body":"we'll hang out, we'll hike. You"},{"speaker":"Charles Goldfarb","startTime":88.67,"endTime":92.27,"body":"know, it'll be great."},{"speaker":"Chris Dy","startTime":92.69,"endTime":94.28,"body":"There's something"},{"speaker":"Chris Dy","startTime":92.69,"endTime":94.28,"body":"about a meeting like that, where"},{"speaker":"Chris Dy","startTime":94.28,"endTime":96.86,"body":"you actually get what people"},{"speaker":"Chris Dy","startTime":94.28,"endTime":96.86,"body":"really think as opposed to what"},{"speaker":"Chris Dy","startTime":96.86,"endTime":98.06,"body":"they feel like they should say."},{"speaker":"Charles Goldfarb","startTime":98.66,"endTime":101.21,"body":"There is no"},{"speaker":"Charles Goldfarb","startTime":98.66,"endTime":101.21,"body":"doubt there's no formality."},{"speaker":"Charles Goldfarb","startTime":101.21,"endTime":104.78,"body":"There's no expectations. One of"},{"speaker":"Charles Goldfarb","startTime":101.21,"endTime":104.78,"body":"the stories that I'll never"},{"speaker":"Charles Goldfarb","startTime":104.78,"endTime":107.51,"body":"forget is you know, Peter Stern"},{"speaker":"Charles Goldfarb","startTime":104.78,"endTime":107.51,"body":"is known for the proximal row"},{"speaker":"Charles Goldfarb","startTime":107.51,"endTime":112.58,"body":"carpectomy, the PRC and I fellow"},{"speaker":"Charles Goldfarb","startTime":107.51,"endTime":112.58,"body":"showed a case where, sorry,"},{"speaker":"Charles Goldfarb","startTime":112.58,"endTime":118.67,"body":"where, where he had done what he"},{"speaker":"Charles Goldfarb","startTime":112.58,"endTime":118.67,"body":"called the DRC. And he had"},{"speaker":"Charles Goldfarb","startTime":118.67,"endTime":121.61,"body":"removed the trapezium in the"},{"speaker":"Charles Goldfarb","startTime":118.67,"endTime":121.61,"body":"trapezoid for severe arthritis."},{"speaker":"Charles Goldfarb","startTime":121.61,"endTime":125.72,"body":"And that was the first time I've"},{"speaker":"Charles Goldfarb","startTime":121.61,"endTime":125.72,"body":"seen a distal row carpectomy."},{"speaker":"Chris Dy","startTime":127.52,"endTime":128.96,"body":"There you go. You"},{"speaker":"Chris Dy","startTime":127.52,"endTime":128.96,"body":"never know what's going to come"},{"speaker":"Chris Dy","startTime":128.96,"endTime":129.8,"body":"out of Cincinnati."},{"speaker":"Charles Goldfarb","startTime":130.28,"endTime":132.98,"body":"Exactly."},{"speaker":"Charles Goldfarb","startTime":130.28,"endTime":132.98,"body":"Exactly. So what about you any"},{"speaker":"Charles Goldfarb","startTime":132.98,"endTime":134.33,"body":"any good cases?"},{"speaker":"Chris Dy","startTime":134.9,"endTime":137.45,"body":"You know I had a"},{"speaker":"Chris Dy","startTime":134.9,"endTime":137.45,"body":"really interesting case. I had"},{"speaker":"Chris Dy","startTime":137.45,"endTime":142.19,"body":"one where a patient came in with"},{"speaker":"Chris Dy","startTime":137.45,"endTime":142.19,"body":"just incredibly bad superficial"},{"speaker":"Chris Dy","startTime":142.19,"endTime":147.65,"body":"radial nerve distribution, nerve"},{"speaker":"Chris Dy","startTime":142.19,"endTime":147.65,"body":"related pain neuritis. And it"},{"speaker":"Chris Dy","startTime":147.65,"endTime":153.44,"body":"was odd because 15 years prior,"},{"speaker":"Chris Dy","startTime":147.65,"endTime":153.44,"body":"she had had a first compartment"},{"speaker":"Chris Dy","startTime":153.44,"endTime":156.89,"body":"released through a dorsal or"},{"speaker":"Chris Dy","startTime":153.44,"endTime":156.89,"body":"excuse me through a transverse"},{"speaker":"Chris Dy","startTime":156.89,"endTime":160.52,"body":"incision. So I was like, Oh, for"},{"speaker":"Chris Dy","startTime":156.89,"endTime":160.52,"body":"sure that's the answer. Somebody"},{"speaker":"Chris Dy","startTime":160.52,"endTime":164.18,"body":"buggered her nerve, but what was"},{"speaker":"Chris Dy","startTime":160.52,"endTime":164.18,"body":"weird is that it was 15 years"},{"speaker":"Chris Dy","startTime":164.21,"endTime":168.62,"body":"right? So, you know, I kind of"},{"speaker":"Chris Dy","startTime":164.21,"endTime":168.62,"body":"you know, tried to slow roll it"},{"speaker":"Chris Dy","startTime":168.62,"endTime":172.49,"body":"and go conservative route and"},{"speaker":"Chris Dy","startTime":168.62,"endTime":172.49,"body":"you know, finally, you know, we"},{"speaker":"Chris Dy","startTime":172.49,"endTime":177.17,"body":"put her through a diagnostic"},{"speaker":"Chris Dy","startTime":172.49,"endTime":177.17,"body":"injection for her SRN provided"},{"speaker":"Chris Dy","startTime":177.17,"endTime":180.62,"body":"wonderful relief, she felt good,"},{"speaker":"Chris Dy","startTime":177.17,"endTime":180.62,"body":"I felt good. I said, Alright,"},{"speaker":"Chris Dy","startTime":180.62,"endTime":183.32,"body":"let's explore the nerve and I"},{"speaker":"Chris Dy","startTime":180.62,"endTime":183.32,"body":"signed her up for my normal kind"},{"speaker":"Chris Dy","startTime":183.32,"endTime":186.41,"body":"of might have to graft it might"},{"speaker":"Chris Dy","startTime":183.32,"endTime":186.41,"body":"have to bury it might have to do"},{"speaker":"Chris Dy","startTime":186.41,"endTime":191.45,"body":"both, you know, that kind of"},{"speaker":"Chris Dy","startTime":186.41,"endTime":191.45,"body":"thing. And so we get to the or"},{"speaker":"Chris Dy","startTime":191.45,"endTime":196.01,"body":"we do our exploration and while"},{"speaker":"Chris Dy","startTime":191.45,"endTime":196.01,"body":"her her SRN branches look a"},{"speaker":"Chris Dy","startTime":196.01,"endTime":199.73,"body":"little, you know, odd and a"},{"speaker":"Chris Dy","startTime":196.01,"endTime":199.73,"body":"little thickened, she had this"},{"speaker":"Chris Dy","startTime":199.73,"endTime":204.98,"body":"really firm, bulbous mass coming"},{"speaker":"Chris Dy","startTime":199.73,"endTime":204.98,"body":"from a radiocarpal joint, and it"},{"speaker":"Chris Dy","startTime":204.98,"endTime":208.64,"body":"was a cyst. So it's kind of a"},{"speaker":"Chris Dy","startTime":204.98,"endTime":208.64,"body":"variant of a radiocarpal"},{"speaker":"Chris Dy","startTime":208.64,"endTime":213.11,"body":"ganglion cyst more radial than"},{"speaker":"Chris Dy","startTime":208.64,"endTime":213.11,"body":"dorsal and certainly not a volar"},{"speaker":"Chris Dy","startTime":213.11,"endTime":216.53,"body":"cyst. So I just thought was"},{"speaker":"Chris Dy","startTime":213.11,"endTime":216.53,"body":"interesting. It was clearly what"},{"speaker":"Chris Dy","startTime":216.53,"endTime":220.85,"body":"could drive her symptoms, so we"},{"speaker":"Chris Dy","startTime":216.53,"endTime":220.85,"body":"excise the cyst. I also released"},{"speaker":"Chris Dy","startTime":221.06,"endTime":225.59,"body":"the SRN approximately at the"},{"speaker":"Chris Dy","startTime":221.06,"endTime":225.59,"body":"brachioradialis exit, but I"},{"speaker":"Chris Dy","startTime":225.59,"endTime":227.27,"body":"found it to be very interesting."},{"speaker":"Chris Dy","startTime":225.59,"endTime":227.27,"body":"I don't know if you've"},{"speaker":"Chris Dy","startTime":227.27,"endTime":228.2,"body":"encountered that before."},{"speaker":"Charles Goldfarb","startTime":229.01,"endTime":231.65,"body":"I haven't it's"},{"speaker":"Charles Goldfarb","startTime":229.01,"endTime":231.65,"body":"sort of makes me think of the"},{"speaker":"Charles Goldfarb","startTime":232.76,"endTime":237.2,"body":"proximal cap-radiocapitellar"},{"speaker":"Charles Goldfarb","startTime":232.76,"endTime":237.2,"body":"joint and assist there which may"},{"speaker":"Charles Goldfarb","startTime":237.2,"endTime":239.45,"body":"affect the post interosseous"},{"speaker":"Charles Goldfarb","startTime":237.2,"endTime":239.45,"body":"nerve now that's super"},{"speaker":"Charles Goldfarb","startTime":239.45,"endTime":241.97,"body":"interesting. And just for the"},{"speaker":"Charles Goldfarb","startTime":239.45,"endTime":241.97,"body":"audience, and I guess my own"},{"speaker":"Charles Goldfarb","startTime":241.97,"endTime":244.67,"body":"personal sake, explain what you"},{"speaker":"Charles Goldfarb","startTime":241.97,"endTime":244.67,"body":"mean by you release the"},{"speaker":"Charles Goldfarb","startTime":244.67,"endTime":248.06,"body":"superficial branch, the radial"},{"speaker":"Charles Goldfarb","startTime":244.67,"endTime":248.06,"body":"nerve proximally what exactly do"},{"speaker":"Charles Goldfarb","startTime":248.06,"endTime":251.84,"body":"you do to the nerve or I should"},{"speaker":"Charles Goldfarb","startTime":248.06,"endTime":251.84,"body":"say to the surrounding tendons"},{"speaker":"Charles Goldfarb","startTime":251.84,"endTime":253.67,"body":"to give the nerve more room?"},{"speaker":"Chris Dy","startTime":254.29,"endTime":256.36,"body":"Yeah, we've talked"},{"speaker":"Chris Dy","startTime":254.29,"endTime":256.36,"body":"about this a little bit, I think"},{"speaker":"Chris Dy","startTime":256.36,"endTime":259.51,"body":"on a prior episode, but you"},{"speaker":"Chris Dy","startTime":256.36,"endTime":259.51,"body":"know, that nerve is going to go"},{"speaker":"Chris Dy","startTime":259.51,"endTime":265.63,"body":"from deep relatively deep to"},{"speaker":"Chris Dy","startTime":259.51,"endTime":265.63,"body":"superficial at the level where"},{"speaker":"Chris Dy","startTime":265.63,"endTime":268.3,"body":"it goes from underneath the"},{"speaker":"Chris Dy","startTime":265.63,"endTime":268.3,"body":"brachioradialis which tends to"},{"speaker":"Chris Dy","startTime":268.3,"endTime":271.27,"body":"be about eight to 10 centimeters"},{"speaker":"Chris Dy","startTime":268.3,"endTime":271.27,"body":"proximal to the radial styloid."},{"speaker":"Chris Dy","startTime":272.29,"endTime":275.77,"body":"So what what you can do there is"},{"speaker":"Chris Dy","startTime":272.29,"endTime":275.77,"body":"perform essentially its anatomy"},{"speaker":"Chris Dy","startTime":275.77,"endTime":279.07,"body":"of the brachioradialis I tend to"},{"speaker":"Chris Dy","startTime":275.77,"endTime":279.07,"body":"do this, you know, under direct"},{"speaker":"Chris Dy","startTime":279.07,"endTime":282.04,"body":"result visualization just distal"},{"speaker":"Chris Dy","startTime":279.07,"endTime":282.04,"body":"to the musculotendinous"},{"speaker":"Chris Dy","startTime":282.04,"endTime":286.18,"body":"Junction. And before releasing"},{"speaker":"Chris Dy","startTime":282.04,"endTime":286.18,"body":"it, making sure that nothing on"},{"speaker":"Chris Dy","startTime":286.18,"endTime":289.75,"body":"the wrist moves, nothing on the"},{"speaker":"Chris Dy","startTime":286.18,"endTime":289.75,"body":"thumb moves, because clearly he"},{"speaker":"Chris Dy","startTime":289.75,"endTime":292.93,"body":"don't want any additional"},{"speaker":"Chris Dy","startTime":289.75,"endTime":292.93,"body":"problems. And you know, they"},{"speaker":"Chris Dy","startTime":292.96,"endTime":295.57,"body":"obviously have to respect the"},{"speaker":"Chris Dy","startTime":292.96,"endTime":295.57,"body":"nearby structures including the"},{"speaker":"Chris Dy","startTime":295.57,"endTime":298.93,"body":"radial artery. It's an automize"},{"speaker":"Chris Dy","startTime":295.57,"endTime":298.93,"body":"that ensure that the muscle"},{"speaker":"Chris Dy","startTime":298.93,"endTime":301.9,"body":"retracts appropriately That the"},{"speaker":"Chris Dy","startTime":298.93,"endTime":301.9,"body":"nerve is happy."},{"speaker":"Charles Goldfarb","startTime":302.56,"endTime":304.24,"body":"Perfect. Love"},{"speaker":"Charles Goldfarb","startTime":302.56,"endTime":304.24,"body":"it. Love it. Thanks for"},{"speaker":"Charles Goldfarb","startTime":304.24,"endTime":308.38,"body":"clarifying. Yeah, it sounds like"},{"speaker":"Charles Goldfarb","startTime":304.24,"endTime":308.38,"body":"an interesting case. I enjoy"},{"speaker":"Charles Goldfarb","startTime":308.38,"endTime":312.67,"body":"that. I would like to jump in if"},{"speaker":"Charles Goldfarb","startTime":308.38,"endTime":312.67,"body":"you're ready for our topic of"},{"speaker":"Charles Goldfarb","startTime":312.67,"endTime":316.54,"body":"the day actually, maybe part one"},{"speaker":"Charles Goldfarb","startTime":312.67,"endTime":316.54,"body":"of a two part topic."},{"speaker":"Chris Dy","startTime":316.84,"endTime":319.78,"body":"I think that this"},{"speaker":"Chris Dy","startTime":316.84,"endTime":319.78,"body":"topic definitely deserves a"},{"speaker":"Chris Dy","startTime":319.78,"endTime":323.89,"body":"guest from one of our, a guest"},{"speaker":"Chris Dy","startTime":319.78,"endTime":323.89,"body":"appearance from a hand therapy"},{"speaker":"Chris Dy","startTime":323.89,"endTime":327.58,"body":"expert such as Macy Stoner. So I"},{"speaker":"Chris Dy","startTime":323.89,"endTime":327.58,"body":"believe for those of you that"},{"speaker":"Chris Dy","startTime":327.58,"endTime":330.58,"body":"tune in for Macy, and I believe"},{"speaker":"Chris Dy","startTime":327.58,"endTime":330.58,"body":"there are more than a few of you"},{"speaker":"Chris Dy","startTime":330.58,"endTime":333.82,"body":"based on the reviews that have"},{"speaker":"Chris Dy","startTime":330.58,"endTime":333.82,"body":"been left. Macy's coming back"},{"speaker":"Chris Dy","startTime":333.82,"endTime":337.3,"body":"for the next episode on this. So"},{"speaker":"Chris Dy","startTime":333.82,"endTime":337.3,"body":"stay tuned. But we'll try to set"},{"speaker":"Chris Dy","startTime":337.3,"endTime":338.47,"body":"the set the stage for her."},{"speaker":"Charles Goldfarb","startTime":338.8,"endTime":340.3,"body":"Yeah, I have"},{"speaker":"Charles Goldfarb","startTime":338.8,"endTime":340.3,"body":"to say Chris and I are a little"},{"speaker":"Charles Goldfarb","startTime":340.3,"endTime":344.11,"body":"sensitive. It seems like the"},{"speaker":"Charles Goldfarb","startTime":340.3,"endTime":344.11,"body":"crowd may prefer Macy to both of"},{"speaker":"Charles Goldfarb","startTime":344.11,"endTime":346.57,"body":"us. But you know, we'll give the"},{"speaker":"Charles Goldfarb","startTime":344.11,"endTime":346.57,"body":"crowd what they want."},{"speaker":"Chris Dy","startTime":347.01,"endTime":348.9,"body":"Well, you know, we're"},{"speaker":"Chris Dy","startTime":347.01,"endTime":348.9,"body":"gonna try to be better about"},{"speaker":"Chris Dy","startTime":348.93,"endTime":352.53,"body":"some structure to our schedule."},{"speaker":"Chris Dy","startTime":348.93,"endTime":352.53,"body":"So don't worry, Macy won't be"},{"speaker":"Chris Dy","startTime":352.53,"endTime":355.11,"body":"disappearing too much. You'll"},{"speaker":"Chris Dy","startTime":352.53,"endTime":355.11,"body":"you'll get your taste every now"},{"speaker":"Chris Dy","startTime":355.11,"endTime":355.5,"body":"and then."},{"speaker":"Charles Goldfarb","startTime":355.78,"endTime":358.42,"body":"Absolutely. So"},{"speaker":"Charles Goldfarb","startTime":355.78,"endTime":358.42,"body":"the topic Chris and I had"},{"speaker":"Charles Goldfarb","startTime":358.42,"endTime":361.96,"body":"decided would be interesting is"},{"speaker":"Charles Goldfarb","startTime":358.42,"endTime":361.96,"body":"the stiff finger. And it"},{"speaker":"Charles Goldfarb","startTime":361.96,"endTime":366.28,"body":"actually lends itself perfectly"},{"speaker":"Charles Goldfarb","startTime":361.96,"endTime":366.28,"body":"to a podcast format, because"},{"speaker":"Charles Goldfarb","startTime":366.28,"endTime":371.14,"body":"there's really not a lot visual"},{"speaker":"Charles Goldfarb","startTime":366.28,"endTime":371.14,"body":"required. And it's principle"},{"speaker":"Charles Goldfarb","startTime":371.14,"endTime":375.1,"body":"based. And so what I'd like to"},{"speaker":"Charles Goldfarb","startTime":371.14,"endTime":375.1,"body":"start with maybe is, you know,"},{"speaker":"Charles Goldfarb","startTime":375.1,"endTime":379.24,"body":"when I think about this, I think"},{"speaker":"Charles Goldfarb","startTime":375.1,"endTime":379.24,"body":"about two fundamental issues"},{"speaker":"Charles Goldfarb","startTime":379.27,"endTime":383.5,"body":"before I even think about why"},{"speaker":"Charles Goldfarb","startTime":379.27,"endTime":383.5,"body":"the finger might be stiff. And"},{"speaker":"Charles Goldfarb","startTime":383.5,"endTime":386.08,"body":"I'd love your thoughts. The two"},{"speaker":"Charles Goldfarb","startTime":383.5,"endTime":386.08,"body":"fundamental fundamental issues"},{"speaker":"Charles Goldfarb","startTime":386.08,"endTime":389.77,"body":"for me are one, has there been"},{"speaker":"Charles Goldfarb","startTime":386.08,"endTime":389.77,"body":"an appropriate bony"},{"speaker":"Charles Goldfarb","startTime":389.77,"endTime":394.12,"body":"reconstruction prior to the"},{"speaker":"Charles Goldfarb","startTime":389.77,"endTime":394.12,"body":"finger getting stiff? And to"},{"speaker":"Charles Goldfarb","startTime":394.54,"endTime":397.57,"body":"what is the soft tissue or"},{"speaker":"Charles Goldfarb","startTime":394.54,"endTime":397.57,"body":"envelope like? So maybe we can"},{"speaker":"Charles Goldfarb","startTime":397.57,"endTime":399.76,"body":"talk through those? But I don't"},{"speaker":"Charles Goldfarb","startTime":397.57,"endTime":399.76,"body":"know if you'd add anything to"},{"speaker":"Charles Goldfarb","startTime":399.76,"endTime":402.07,"body":"that list? Or how do you think"},{"speaker":"Charles Goldfarb","startTime":399.76,"endTime":402.07,"body":"about it?"},{"speaker":"Chris Dy","startTime":402.6,"endTime":405.03,"body":"No, I think those are"},{"speaker":"Chris Dy","startTime":402.6,"endTime":405.03,"body":"the prerequisites. And for those"},{"speaker":"Chris Dy","startTime":405.03,"endTime":408.39,"body":"of you that are listening, and"},{"speaker":"Chris Dy","startTime":405.03,"endTime":408.39,"body":"if you're a trainee, or you just"},{"speaker":"Chris Dy","startTime":408.39,"endTime":411.57,"body":"want to read something really"},{"speaker":"Chris Dy","startTime":408.39,"endTime":411.57,"body":"good. You know, our partner,"},{"speaker":"Chris Dy","startTime":411.57,"endTime":414.57,"body":"Marty Boyer, gives us lecture"},{"speaker":"Chris Dy","startTime":411.57,"endTime":414.57,"body":"every year in the fellowship."},{"speaker":"Chris Dy","startTime":414.84,"endTime":418.35,"body":"And he always points to the"},{"speaker":"Chris Dy","startTime":414.84,"endTime":418.35,"body":"article that you Dr. Goldfarb"},{"speaker":"Chris Dy","startTime":418.44,"endTime":422.55,"body":"wrote along with Marty and Jesse"},{"speaker":"Chris Dy","startTime":418.44,"endTime":422.55,"body":"Jupiter, and it was published as"},{"speaker":"Chris Dy","startTime":422.55,"endTime":426.12,"body":"an ICL in JBJS in 2007, we'll"},{"speaker":"Chris Dy","startTime":422.55,"endTime":426.12,"body":"include that in the show notes."},{"speaker":"Chris Dy","startTime":426.42,"endTime":430.62,"body":"It's a great article, it"},{"speaker":"Chris Dy","startTime":426.42,"endTime":430.62,"body":"outlines a very elegant way of"},{"speaker":"Chris Dy","startTime":430.62,"endTime":435.06,"body":"thinking about this, you know,"},{"speaker":"Chris Dy","startTime":430.62,"endTime":435.06,"body":"and those are the prerequisites,"},{"speaker":"Chris Dy","startTime":435.06,"endTime":438.15,"body":"right, you want to know that the"},{"speaker":"Chris Dy","startTime":435.06,"endTime":438.15,"body":"skeleton has been appropriately"},{"speaker":"Chris Dy","startTime":438.15,"endTime":441.72,"body":"established and is stable, so as"},{"speaker":"Chris Dy","startTime":438.15,"endTime":441.72,"body":"to allow whatever intervention"},{"speaker":"Chris Dy","startTime":441.72,"endTime":445.62,"body":"you are going to perform to"},{"speaker":"Chris Dy","startTime":441.72,"endTime":445.62,"body":"succeed. And soft tissue"},{"speaker":"Chris Dy","startTime":445.62,"endTime":448.38,"body":"coverage being absolutely"},{"speaker":"Chris Dy","startTime":445.62,"endTime":448.38,"body":"necessary as well. So having a"},{"speaker":"Chris Dy","startTime":448.38,"endTime":451.26,"body":"supple soft tissue envelope,"},{"speaker":"Chris Dy","startTime":448.38,"endTime":451.26,"body":"though, yeah, to start with,"},{"speaker":"Chris Dy","startTime":451.26,"endTime":453.21,"body":"that, if you don't have that"},{"speaker":"Chris Dy","startTime":451.26,"endTime":453.21,"body":"you've got work to do before you"},{"speaker":"Chris Dy","startTime":453.21,"endTime":456.63,"body":"can start thinking about"},{"speaker":"Chris Dy","startTime":453.21,"endTime":456.63,"body":"releasing contractures and, you"},{"speaker":"Chris Dy","startTime":456.63,"endTime":457.89,"body":"know, freeing up tendons."},{"speaker":"Charles Goldfarb","startTime":458.56,"endTime":461.29,"body":"I love that."},{"speaker":"Charles Goldfarb","startTime":458.56,"endTime":461.29,"body":"Two comments. One is, I think"},{"speaker":"Charles Goldfarb","startTime":461.29,"endTime":463.93,"body":"you told me you read that when"},{"speaker":"Charles Goldfarb","startTime":461.29,"endTime":463.93,"body":"it was released, but did you"},{"speaker":"Charles Goldfarb","startTime":463.93,"endTime":467.56,"body":"were in high school at the time"},{"speaker":"Charles Goldfarb","startTime":463.93,"endTime":467.56,"body":"of 2007 release, but you were"},{"speaker":"Charles Goldfarb","startTime":467.56,"endTime":469.3,"body":"ahead of the game, I think ahead"},{"speaker":"Charles Goldfarb","startTime":467.56,"endTime":469.3,"body":"of the curve."},{"speaker":"Chris Dy","startTime":469.84,"endTime":471.22,"body":"You know, this is one"},{"speaker":"Chris Dy","startTime":469.84,"endTime":471.22,"body":"of they still, you know,"},{"speaker":"Chris Dy","startTime":471.22,"endTime":474.07,"body":"published journals, and the only"},{"speaker":"Chris Dy","startTime":471.22,"endTime":474.07,"body":"way you can get them was to go"},{"speaker":"Chris Dy","startTime":474.07,"endTime":477.52,"body":"to the library, open up the"},{"speaker":"Chris Dy","startTime":474.07,"endTime":477.52,"body":"leather bound mahogany, you"},{"speaker":"Chris Dy","startTime":477.52,"endTime":481.18,"body":"know, library books, and"},{"speaker":"Chris Dy","startTime":477.52,"endTime":481.18,"body":"perfectly get your nose in"},{"speaker":"Chris Dy","startTime":481.18,"endTime":483.91,"body":"there. I actually don't even"},{"speaker":"Chris Dy","startTime":481.18,"endTime":483.91,"body":"know if this exists in PDF"},{"speaker":"Chris Dy","startTime":483.91,"endTime":486.49,"body":"format, I'm gonna have to scan"},{"speaker":"Chris Dy","startTime":483.91,"endTime":486.49,"body":"it just for the purposes of"},{"speaker":"Chris Dy","startTime":486.49,"endTime":487.99,"body":"providing it to the to the"},{"speaker":"Chris Dy","startTime":486.49,"endTime":487.99,"body":"listeners."},{"speaker":"Charles Goldfarb","startTime":488.02,"endTime":490.21,"body":"Oh, it's a"},{"speaker":"Charles Goldfarb","startTime":488.02,"endTime":490.21,"body":"classic, it's got to be there."},{"speaker":"Charles Goldfarb","startTime":490.21,"endTime":496.0,"body":"So in all seriousness, you know,"},{"speaker":"Charles Goldfarb","startTime":490.21,"endTime":496.0,"body":"I think this principle of bony"},{"speaker":"Charles Goldfarb","startTime":496.03,"endTime":503.86,"body":"reconstruct, or bony appropriate"},{"speaker":"Charles Goldfarb","startTime":496.03,"endTime":503.86,"body":"initial fixation, and gaining"},{"speaker":"Charles Goldfarb","startTime":503.89,"endTime":508.15,"body":"the proper anatomy, together"},{"speaker":"Charles Goldfarb","startTime":503.89,"endTime":508.15,"body":"with creating a soft tissue"},{"speaker":"Charles Goldfarb","startTime":508.15,"endTime":512.92,"body":"envelope that will allow for"},{"speaker":"Charles Goldfarb","startTime":508.15,"endTime":512.92,"body":"future improvement of the finger"},{"speaker":"Charles Goldfarb","startTime":512.92,"endTime":515.53,"body":"or T. And what I mean by that"},{"speaker":"Charles Goldfarb","startTime":512.92,"endTime":515.53,"body":"is, you know, the hand surgeon"},{"speaker":"Charles Goldfarb","startTime":515.56,"endTime":518.98,"body":"is always thinking about"},{"speaker":"Charles Goldfarb","startTime":515.56,"endTime":518.98,"body":"therapy, it's gonna be why it's"},{"speaker":"Charles Goldfarb","startTime":518.98,"endTime":522.46,"body":"so nice to have Macy. But when"},{"speaker":"Charles Goldfarb","startTime":518.98,"endTime":522.46,"body":"anytime I do a case, not only"},{"speaker":"Charles Goldfarb","startTime":522.46,"endTime":524.53,"body":"when I think about how am I"},{"speaker":"Charles Goldfarb","startTime":522.46,"endTime":524.53,"body":"going to take care of the"},{"speaker":"Charles Goldfarb","startTime":524.53,"endTime":528.49,"body":"fracture, or the injury, I'm"},{"speaker":"Charles Goldfarb","startTime":524.53,"endTime":528.49,"body":"already thinking about what will"},{"speaker":"Charles Goldfarb","startTime":528.49,"endTime":532.72,"body":"therapy look like. But sometimes"},{"speaker":"Charles Goldfarb","startTime":528.49,"endTime":532.72,"body":"we we get ahead of ourselves,"},{"speaker":"Charles Goldfarb","startTime":532.72,"endTime":536.59,"body":"because it is really important"},{"speaker":"Charles Goldfarb","startTime":532.72,"endTime":536.59,"body":"in these cases, emphasize that,"},{"speaker":"Charles Goldfarb","startTime":536.8,"endTime":539.98,"body":"if you don't get the bony"},{"speaker":"Charles Goldfarb","startTime":536.8,"endTime":539.98,"body":"fixation or the soft tissue"},{"speaker":"Charles Goldfarb","startTime":539.98,"endTime":544.27,"body":"fixation right the first time,"},{"speaker":"Charles Goldfarb","startTime":539.98,"endTime":544.27,"body":"then you have to go do that"},{"speaker":"Charles Goldfarb","startTime":544.27,"endTime":547.45,"body":"before you can even think about"},{"speaker":"Charles Goldfarb","startTime":544.27,"endTime":547.45,"body":"the stiff finger. So it really"},{"speaker":"Charles Goldfarb","startTime":547.45,"endTime":552.31,"body":"is an interesting, you know, it"},{"speaker":"Charles Goldfarb","startTime":547.45,"endTime":552.31,"body":"stresses the importance of"},{"speaker":"Charles Goldfarb","startTime":552.31,"endTime":556.18,"body":"thinking, always thinking ahead,"},{"speaker":"Charles Goldfarb","startTime":552.31,"endTime":556.18,"body":"but never losing sight of the"},{"speaker":"Charles Goldfarb","startTime":556.18,"endTime":557.41,"body":"critical components."},{"speaker":"Chris Dy","startTime":557.8,"endTime":561.85,"body":"Well, I mean, the,"},{"speaker":"Chris Dy","startTime":557.8,"endTime":561.85,"body":"the, all the structures in the"},{"speaker":"Chris Dy","startTime":561.85,"endTime":565.45,"body":"finger are so jam packed, as"},{"speaker":"Chris Dy","startTime":561.85,"endTime":565.45,"body":"opposed to the forearm, or even,"},{"speaker":"Chris Dy","startTime":565.48,"endTime":568.9,"body":"you know, the brachium or the"},{"speaker":"Chris Dy","startTime":565.48,"endTime":568.9,"body":"thigh I mean, got a lot of"},{"speaker":"Chris Dy","startTime":568.9,"endTime":572.14,"body":"leeway in the other areas, but"},{"speaker":"Chris Dy","startTime":568.9,"endTime":572.14,"body":"everything is so jam packed in"},{"speaker":"Chris Dy","startTime":572.14,"endTime":575.38,"body":"the finger that if you don't"},{"speaker":"Chris Dy","startTime":572.14,"endTime":575.38,"body":"have, you know, if you don't"},{"speaker":"Chris Dy","startTime":575.38,"endTime":578.35,"body":"have the bone appropriately"},{"speaker":"Chris Dy","startTime":575.38,"endTime":578.35,"body":"stable and fixed in reasonable"},{"speaker":"Chris Dy","startTime":578.35,"endTime":582.79,"body":"alignment, you just can't ask"},{"speaker":"Chris Dy","startTime":578.35,"endTime":582.79,"body":"the tendons to work around that."},{"speaker":"Chris Dy","startTime":582.79,"endTime":585.13,"body":"And I think you guys give a good"},{"speaker":"Chris Dy","startTime":582.79,"endTime":585.13,"body":"example in that article talking"},{"speaker":"Chris Dy","startTime":585.13,"endTime":587.59,"body":"about if you have like a small"},{"speaker":"Chris Dy","startTime":585.13,"endTime":587.59,"body":"like sub condylar fragment"},{"speaker":"Chris Dy","startTime":587.59,"endTime":590.44,"body":"that's getting causing"},{"speaker":"Chris Dy","startTime":587.59,"endTime":590.44,"body":"impingement even you know,"},{"speaker":"Chris Dy","startTime":590.44,"endTime":592.93,"body":"that'll stop the joint from"},{"speaker":"Chris Dy","startTime":590.44,"endTime":592.93,"body":"moving properly and it can also"},{"speaker":"Chris Dy","startTime":592.93,"endTime":596.92,"body":"impinge on the tendons. So it's"},{"speaker":"Chris Dy","startTime":592.93,"endTime":596.92,"body":"those small things and I agree"},{"speaker":"Chris Dy","startTime":596.92,"endTime":599.65,"body":"with your point about, you know,"},{"speaker":"Chris Dy","startTime":596.92,"endTime":599.65,"body":"always thinking about the"},{"speaker":"Chris Dy","startTime":599.65,"endTime":602.14,"body":"therapy And that, honestly, is"},{"speaker":"Chris Dy","startTime":599.65,"endTime":602.14,"body":"why we choose some of the"},{"speaker":"Chris Dy","startTime":602.26,"endTime":605.92,"body":"fixation strategies that we"},{"speaker":"Chris Dy","startTime":602.26,"endTime":605.92,"body":"choose is to enable, you know,"},{"speaker":"Chris Dy","startTime":605.95,"endTime":609.64,"body":"therapy. And I honestly, there"},{"speaker":"Chris Dy","startTime":605.95,"endTime":609.64,"body":"are days where I, I wish I had"},{"speaker":"Chris Dy","startTime":609.67,"endTime":612.85,"body":"been able to provide more stable"},{"speaker":"Chris Dy","startTime":609.67,"endTime":612.85,"body":"fixation, but sometimes the"},{"speaker":"Chris Dy","startTime":612.85,"endTime":615.28,"body":"fracture doesn't give you that."},{"speaker":"Chris Dy","startTime":612.85,"endTime":615.28,"body":"And you really have to slow down"},{"speaker":"Chris Dy","startTime":615.28,"endTime":617.86,"body":"your therapy and taper your"},{"speaker":"Chris Dy","startTime":615.28,"endTime":617.86,"body":"expectations from the very"},{"speaker":"Chris Dy","startTime":617.86,"endTime":618.4,"body":"beginning."},{"speaker":"Charles Goldfarb","startTime":618.94,"endTime":621.4,"body":"Right, and"},{"speaker":"Charles Goldfarb","startTime":618.94,"endTime":621.4,"body":"start talking to the family or"},{"speaker":"Charles Goldfarb","startTime":621.4,"endTime":624.73,"body":"the patient at that time. So for"},{"speaker":"Charles Goldfarb","startTime":621.4,"endTime":624.73,"body":"example, had a really"},{"speaker":"Charles Goldfarb","startTime":624.73,"endTime":628.48,"body":"interesting case today of a"},{"speaker":"Charles Goldfarb","startTime":624.73,"endTime":628.48,"body":"younger patient who essentially"},{"speaker":"Charles Goldfarb","startTime":628.48,"endTime":633.64,"body":"sheared off about 40% of the"},{"speaker":"Charles Goldfarb","startTime":628.48,"endTime":633.64,"body":"base of the middle phalanx sort"},{"speaker":"Charles Goldfarb","startTime":633.64,"endTime":636.19,"body":"of a collateral ligament injury,"},{"speaker":"Charles Goldfarb","startTime":633.64,"endTime":636.19,"body":"but it really affected the"},{"speaker":"Charles Goldfarb","startTime":636.19,"endTime":639.31,"body":"articular surface. And it was"},{"speaker":"Charles Goldfarb","startTime":636.19,"endTime":639.31,"body":"such a thin fragment, it was"},{"speaker":"Charles Goldfarb","startTime":639.31,"endTime":642.52,"body":"really tough to deal with. And"},{"speaker":"Charles Goldfarb","startTime":639.31,"endTime":642.52,"body":"in the end, I accepted that I"},{"speaker":"Charles Goldfarb","startTime":642.52,"endTime":647.44,"body":"had to pin the joint. And that's"},{"speaker":"Charles Goldfarb","startTime":642.52,"endTime":647.44,"body":"okay, for this exact reason I"},{"speaker":"Charles Goldfarb","startTime":647.44,"endTime":652.15,"body":"can deal with finger stiffness,"},{"speaker":"Charles Goldfarb","startTime":647.44,"endTime":652.15,"body":"if I can get the alignment and"},{"speaker":"Charles Goldfarb","startTime":652.15,"endTime":655.75,"body":"the bony healing the way it"},{"speaker":"Charles Goldfarb","startTime":652.15,"endTime":655.75,"body":"needs to be in. So it was a"},{"speaker":"Charles Goldfarb","startTime":655.75,"endTime":658.18,"body":"little disappointing that I"},{"speaker":"Charles Goldfarb","startTime":655.75,"endTime":658.18,"body":"couldn't accomplish all my"},{"speaker":"Charles Goldfarb","startTime":658.18,"endTime":661.78,"body":"goals, but I walked away from"},{"speaker":"Charles Goldfarb","startTime":658.18,"endTime":661.78,"body":"they are very happy with what we"},{"speaker":"Charles Goldfarb","startTime":661.78,"endTime":662.53,"body":"accomplished."},{"speaker":"Chris Dy","startTime":662.94,"endTime":665.46,"body":"So you say that we can"},{"speaker":"Chris Dy","startTime":662.94,"endTime":665.46,"body":"handle stiff fingers. So say you"},{"speaker":"Chris Dy","startTime":665.46,"endTime":670.38,"body":"have stable bony fixation and"},{"speaker":"Chris Dy","startTime":665.46,"endTime":670.38,"body":"reasonable alignment. And you've"},{"speaker":"Chris Dy","startTime":670.38,"endTime":673.17,"body":"got a supple soft tissue"},{"speaker":"Chris Dy","startTime":670.38,"endTime":673.17,"body":"envelope either through, you"},{"speaker":"Chris Dy","startTime":673.17,"endTime":678.27,"body":"know, local coverage, rotational"},{"speaker":"Chris Dy","startTime":673.17,"endTime":678.27,"body":"coverage, whatever it is, how do"},{"speaker":"Chris Dy","startTime":678.27,"endTime":681.54,"body":"you start to diagnose what the"},{"speaker":"Chris Dy","startTime":678.27,"endTime":681.54,"body":"issue is."},{"speaker":"Charles Goldfarb","startTime":682.83,"endTime":685.65,"body":"So the first"},{"speaker":"Charles Goldfarb","startTime":682.83,"endTime":685.65,"body":"thing is you do want to be aware"},{"speaker":"Charles Goldfarb","startTime":685.68,"endTime":689.61,"body":"of, you know, as you think about"},{"speaker":"Charles Goldfarb","startTime":685.68,"endTime":689.61,"body":"the stiff finger and think about"},{"speaker":"Charles Goldfarb","startTime":689.61,"endTime":692.58,"body":"the role of therapy and think"},{"speaker":"Charles Goldfarb","startTime":689.61,"endTime":692.58,"body":"about the role of surgery, the"},{"speaker":"Charles Goldfarb","startTime":692.58,"endTime":696.9,"body":"first thing is, is the finger"},{"speaker":"Charles Goldfarb","startTime":692.58,"endTime":696.9,"body":"through the phase of healing,"},{"speaker":"Charles Goldfarb","startTime":697.44,"endTime":702.66,"body":"such that it's not swollen, it's"},{"speaker":"Charles Goldfarb","startTime":697.44,"endTime":702.66,"body":"not sore. Once you kind of check"},{"speaker":"Charles Goldfarb","startTime":702.66,"endTime":707.22,"body":"those boxes and say the fingers"},{"speaker":"Charles Goldfarb","startTime":702.66,"endTime":707.22,"body":"just stiff, then I think in your"},{"speaker":"Charles Goldfarb","startTime":707.22,"endTime":710.64,"body":"mind to the best of your"},{"speaker":"Charles Goldfarb","startTime":707.22,"endTime":710.64,"body":"ability, you were trying to"},{"speaker":"Charles Goldfarb","startTime":710.64,"endTime":715.41,"body":"figure out why it's stiff. And"},{"speaker":"Charles Goldfarb","startTime":710.64,"endTime":715.41,"body":"for me, I think about this is"},{"speaker":"Charles Goldfarb","startTime":715.41,"endTime":719.25,"body":"really simplistic. And this is"},{"speaker":"Charles Goldfarb","startTime":715.41,"endTime":719.25,"body":"not about imaging. It's not"},{"speaker":"Charles Goldfarb","startTime":719.25,"endTime":723.03,"body":"about ultrasound, you know,"},{"speaker":"Charles Goldfarb","startTime":719.25,"endTime":723.03,"body":"there's no MRI, this is purely a"},{"speaker":"Charles Goldfarb","startTime":723.03,"endTime":727.26,"body":"clinical examination, I think"},{"speaker":"Charles Goldfarb","startTime":723.03,"endTime":727.26,"body":"about the extensor tendons, and"},{"speaker":"Charles Goldfarb","startTime":727.26,"endTime":730.77,"body":"the dorsal capsule and"},{"speaker":"Charles Goldfarb","startTime":727.26,"endTime":730.77,"body":"ligaments, I think about flexor"},{"speaker":"Charles Goldfarb","startTime":730.77,"endTime":735.33,"body":"tendons, and the flexor sheath,"},{"speaker":"Charles Goldfarb","startTime":730.77,"endTime":735.33,"body":"and potentially the volar plate."},{"speaker":"Charles Goldfarb","startTime":735.6,"endTime":739.65,"body":"And that's how I initially"},{"speaker":"Charles Goldfarb","startTime":735.6,"endTime":739.65,"body":"categorize things. Is that where"},{"speaker":"Charles Goldfarb","startTime":739.65,"endTime":740.28,"body":"you start?"},{"speaker":"Chris Dy","startTime":741.12,"endTime":745.56,"body":"Yeah. Similarly, I"},{"speaker":"Chris Dy","startTime":741.12,"endTime":745.56,"body":"mean, I think that one of the"},{"speaker":"Chris Dy","startTime":745.59,"endTime":749.01,"body":"principles that you and Marty"},{"speaker":"Chris Dy","startTime":745.59,"endTime":749.01,"body":"have really drilled into us as"},{"speaker":"Chris Dy","startTime":749.01,"endTime":753.48,"body":"your trainees was, you don't"},{"speaker":"Chris Dy","startTime":749.01,"endTime":753.48,"body":"have good passive motion, who"},{"speaker":"Chris Dy","startTime":753.48,"endTime":757.2,"body":"cares about active motion, you"},{"speaker":"Chris Dy","startTime":753.48,"endTime":757.2,"body":"can't even really assess it. So"},{"speaker":"Chris Dy","startTime":757.2,"endTime":759.48,"body":"you clearly you know, at the end"},{"speaker":"Chris Dy","startTime":757.2,"endTime":759.48,"body":"of the day, what you worry about"},{"speaker":"Chris Dy","startTime":759.48,"endTime":761.85,"body":"and what you want to get as good"},{"speaker":"Chris Dy","startTime":759.48,"endTime":761.85,"body":"active motion, but you can't get"},{"speaker":"Chris Dy","startTime":761.85,"endTime":764.43,"body":"that unless you've got good,"},{"speaker":"Chris Dy","startTime":761.85,"endTime":764.43,"body":"passive motion."},{"speaker":"Charles Goldfarb","startTime":765.74,"endTime":768.08,"body":"Exactly. And"},{"speaker":"Charles Goldfarb","startTime":765.74,"endTime":768.08,"body":"so if you have a finger that"},{"speaker":"Charles Goldfarb","startTime":768.08,"endTime":773.51,"body":"neither flexes, nor extends,"},{"speaker":"Charles Goldfarb","startTime":768.08,"endTime":773.51,"body":"it's just stuck, then really,"},{"speaker":"Charles Goldfarb","startTime":773.51,"endTime":777.65,"body":"you don't know anything about"},{"speaker":"Charles Goldfarb","startTime":773.51,"endTime":777.65,"body":"the flexor, or necessarily the"},{"speaker":"Charles Goldfarb","startTime":777.65,"endTime":780.65,"body":"extensor tendon, you just have"},{"speaker":"Charles Goldfarb","startTime":777.65,"endTime":780.65,"body":"the finger doesn't move. And so"},{"speaker":"Charles Goldfarb","startTime":781.1,"endTime":785.48,"body":"in those kind of patients, the"},{"speaker":"Charles Goldfarb","startTime":781.1,"endTime":785.48,"body":"first thing I would say is, and"},{"speaker":"Charles Goldfarb","startTime":785.48,"endTime":788.63,"body":"I'm interested to know, if you"},{"speaker":"Charles Goldfarb","startTime":785.48,"endTime":788.63,"body":"agree, I think you do agree, I"},{"speaker":"Charles Goldfarb","startTime":788.63,"endTime":794.54,"body":"have stopped trying to treat"},{"speaker":"Charles Goldfarb","startTime":788.63,"endTime":794.54,"body":"dorsal and volar pathology at"},{"speaker":"Charles Goldfarb","startTime":794.54,"endTime":797.87,"body":"the same time, instead of the"},{"speaker":"Charles Goldfarb","startTime":794.54,"endTime":797.87,"body":"words, I almost always start"},{"speaker":"Charles Goldfarb","startTime":797.87,"endTime":802.94,"body":"dorsally. If there's evidence of"},{"speaker":"Charles Goldfarb","startTime":797.87,"endTime":802.94,"body":"an extensor, tendon adhesion,"},{"speaker":"Charles Goldfarb","startTime":803.27,"endTime":806.9,"body":"and or a joint contracture, I am"},{"speaker":"Charles Goldfarb","startTime":803.27,"endTime":806.9,"body":"happy with dealing with those"},{"speaker":"Charles Goldfarb","startTime":806.93,"endTime":809.78,"body":"all at the same time, I don't"},{"speaker":"Charles Goldfarb","startTime":806.93,"endTime":809.78,"body":"honestly think it's that big a"},{"speaker":"Charles Goldfarb","startTime":809.78,"endTime":813.62,"body":"deal. And I do not then go"},{"speaker":"Charles Goldfarb","startTime":809.78,"endTime":813.62,"body":"volarly. Because what I have"},{"speaker":"Charles Goldfarb","startTime":813.62,"endTime":817.07,"body":"found, and what Marty has found,"},{"speaker":"Charles Goldfarb","startTime":813.62,"endTime":817.07,"body":"is that it can be too much for"},{"speaker":"Charles Goldfarb","startTime":817.07,"endTime":819.86,"body":"the patient, and then the"},{"speaker":"Charles Goldfarb","startTime":817.07,"endTime":819.86,"body":"patient swells. And then we know"},{"speaker":"Charles Goldfarb","startTime":819.86,"endTime":822.8,"body":"that the edema can lead to"},{"speaker":"Charles Goldfarb","startTime":819.86,"endTime":822.8,"body":"adhesions, and so becomes this"},{"speaker":"Charles Goldfarb","startTime":822.8,"endTime":826.19,"body":"vicious cycle. And so keeping it"},{"speaker":"Charles Goldfarb","startTime":822.8,"endTime":826.19,"body":"simple, minimizing swelling,"},{"speaker":"Charles Goldfarb","startTime":826.31,"endTime":828.44,"body":"addressing one side of the"},{"speaker":"Charles Goldfarb","startTime":826.31,"endTime":828.44,"body":"finger only, and for me, it"},{"speaker":"Charles Goldfarb","startTime":828.44,"endTime":829.91,"body":"always starts dorsal."},{"speaker":"Chris Dy","startTime":830.42,"endTime":833.06,"body":"So the principle here"},{"speaker":"Chris Dy","startTime":830.42,"endTime":833.06,"body":"is that if you have if you're"},{"speaker":"Chris Dy","startTime":833.06,"endTime":836.24,"body":"trying to assess to gain"},{"speaker":"Chris Dy","startTime":833.06,"endTime":836.24,"body":"flexion, right, which usually is"},{"speaker":"Chris Dy","startTime":836.24,"endTime":839.48,"body":"what we're trying to prioritize,"},{"speaker":"Chris Dy","startTime":836.24,"endTime":839.48,"body":"you don't know whether that's a"},{"speaker":"Chris Dy","startTime":839.48,"endTime":843.59,"body":"flexor tendon adhesion, or it's"},{"speaker":"Chris Dy","startTime":839.48,"endTime":843.59,"body":"a dorsal capsular, you know,"},{"speaker":"Chris Dy","startTime":843.62,"endTime":848.63,"body":"dorsal capsular contracture or"},{"speaker":"Chris Dy","startTime":843.62,"endTime":848.63,"body":"unless you've addressed that"},{"speaker":"Chris Dy","startTime":848.63,"endTime":851.69,"body":"dorsal issue. Now, once you free"},{"speaker":"Chris Dy","startTime":848.63,"endTime":851.69,"body":"things up on the dorsal side"},{"speaker":"Chris Dy","startTime":851.69,"endTime":855.32,"body":"through your capsular, release,"},{"speaker":"Chris Dy","startTime":851.69,"endTime":855.32,"body":"extensor tenolysis, then you can"},{"speaker":"Chris Dy","startTime":855.32,"endTime":858.98,"body":"say, Alright, well now is Arma"},{"speaker":"Chris Dy","startTime":855.32,"endTime":858.98,"body":"flexor tendon stuck. But why do"},{"speaker":"Chris Dy","startTime":858.98,"endTime":862.07,"body":"you start dorsally? Why dorsal"},{"speaker":"Chris Dy","startTime":858.98,"endTime":862.07,"body":"as opposed to starting volarly?"},{"speaker":"Charles Goldfarb","startTime":863.08,"endTime":865.54,"body":"Maybe"},{"speaker":"Charles Goldfarb","startTime":863.08,"endTime":865.54,"body":"simplicity, I think that the"},{"speaker":"Charles Goldfarb","startTime":865.57,"endTime":869.35,"body":"expectations for rehabilitation,"},{"speaker":"Charles Goldfarb","startTime":865.57,"endTime":869.35,"body":"the simplicity of the surgery,"},{"speaker":"Charles Goldfarb","startTime":869.56,"endTime":873.22,"body":"the confidence that I can"},{"speaker":"Charles Goldfarb","startTime":869.56,"endTime":873.22,"body":"accomplish my goal with limited"},{"speaker":"Charles Goldfarb","startTime":873.22,"endTime":875.8,"body":"risk. I think all of those"},{"speaker":"Charles Goldfarb","startTime":873.22,"endTime":875.8,"body":"things are true about the dorsal"},{"speaker":"Charles Goldfarb","startTime":875.8,"endTime":879.7,"body":"finger. And so let me let me"},{"speaker":"Charles Goldfarb","startTime":875.8,"endTime":879.7,"body":"link this to a topic that you"},{"speaker":"Charles Goldfarb","startTime":879.7,"endTime":882.28,"body":"and I have talked about more and"},{"speaker":"Charles Goldfarb","startTime":879.7,"endTime":882.28,"body":"more. And that's local only"},{"speaker":"Charles Goldfarb","startTime":882.28,"endTime":885.49,"body":"surgery because traditionally,"},{"speaker":"Charles Goldfarb","startTime":882.28,"endTime":885.49,"body":"when I thought about doing a"},{"speaker":"Charles Goldfarb","startTime":885.49,"endTime":889.72,"body":"dorsal release, maybe it's a"},{"speaker":"Charles Goldfarb","startTime":885.49,"endTime":889.72,"body":"Bier block, maybe it's local"},{"speaker":"Charles Goldfarb","startTime":889.72,"endTime":893.5,"body":"plus MAC, but really, it's just"},{"speaker":"Charles Goldfarb","startTime":889.72,"endTime":893.5,"body":"whatever it takes, and then I"},{"speaker":"Charles Goldfarb","startTime":893.5,"endTime":896.5,"body":"create a dorsal incision. And"},{"speaker":"Charles Goldfarb","startTime":893.5,"endTime":896.5,"body":"usually what you find in these"},{"speaker":"Charles Goldfarb","startTime":896.5,"endTime":899.53,"body":"really traumatized fingers is"},{"speaker":"Charles Goldfarb","startTime":896.5,"endTime":899.53,"body":"you inside the skin and you"},{"speaker":"Charles Goldfarb","startTime":899.53,"endTime":902.62,"body":"encounter scar tissue. So then"},{"speaker":"Charles Goldfarb","startTime":899.53,"endTime":902.62,"body":"you're creating full thickness"},{"speaker":"Charles Goldfarb","startTime":902.62,"endTime":905.56,"body":"flaps off the extensor"},{"speaker":"Charles Goldfarb","startTime":902.62,"endTime":905.56,"body":"mechanism. Maybe that's proximal"},{"speaker":"Charles Goldfarb","startTime":905.56,"endTime":908.38,"body":"phalanx that maybe that's middle"},{"speaker":"Charles Goldfarb","startTime":905.56,"endTime":908.38,"body":"phalanx as well. But you're"},{"speaker":"Charles Goldfarb","startTime":908.38,"endTime":911.74,"body":"creating full thickness flats"},{"speaker":"Charles Goldfarb","startTime":908.38,"endTime":911.74,"body":"off of the tendon. And then"},{"speaker":"Charles Goldfarb","startTime":911.74,"endTime":915.55,"body":"you're separating the tendon"},{"speaker":"Charles Goldfarb","startTime":911.74,"endTime":915.55,"body":"from the bone. And then you are"},{"speaker":"Charles Goldfarb","startTime":915.64,"endTime":918.67,"body":"releasing the dorsal capsule,"},{"speaker":"Charles Goldfarb","startTime":915.64,"endTime":918.67,"body":"and Mesa, maybe the dorsal"},{"speaker":"Charles Goldfarb","startTime":918.91,"endTime":922.54,"body":"aspect of the ligaments until"},{"speaker":"Charles Goldfarb","startTime":918.91,"endTime":922.54,"body":"you can passively flex the"},{"speaker":"Charles Goldfarb","startTime":922.54,"endTime":926.62,"body":"finger. And typically, that"},{"speaker":"Charles Goldfarb","startTime":922.54,"endTime":926.62,"body":"would be it, you wash it out,"},{"speaker":"Charles Goldfarb","startTime":926.65,"endTime":930.01,"body":"you close it up, you start"},{"speaker":"Charles Goldfarb","startTime":926.65,"endTime":930.01,"body":"therapy, and then you figure out"},{"speaker":"Charles Goldfarb","startTime":930.01,"endTime":932.74,"body":"whether the patient can"},{"speaker":"Charles Goldfarb","startTime":930.01,"endTime":932.74,"body":"demonstrate pull through and"},{"speaker":"Charles Goldfarb","startTime":932.74,"endTime":936.46,"body":"active motion. Whereas I know"},{"speaker":"Charles Goldfarb","startTime":932.74,"endTime":936.46,"body":"you've done this, when you think"},{"speaker":"Charles Goldfarb","startTime":936.46,"endTime":940.57,"body":"about a local only procedure, I"},{"speaker":"Charles Goldfarb","startTime":936.46,"endTime":940.57,"body":"would assume that you would then"},{"speaker":"Charles Goldfarb","startTime":940.57,"endTime":942.88,"body":"ask the patient to flex and see"},{"speaker":"Charles Goldfarb","startTime":940.57,"endTime":942.88,"body":"if they can demonstrate active"},{"speaker":"Charles Goldfarb","startTime":942.88,"endTime":943.21,"body":"motion."},{"speaker":"Chris Dy","startTime":944.14,"endTime":946.99,"body":"Yeah, no, I mean, I"},{"speaker":"Chris Dy","startTime":944.14,"endTime":946.99,"body":"think that these are some of the"},{"speaker":"Chris Dy","startTime":946.99,"endTime":949.87,"body":"more challenging ones, for"},{"speaker":"Chris Dy","startTime":946.99,"endTime":949.87,"body":"obvious reasons, but they're"},{"speaker":"Chris Dy","startTime":949.87,"endTime":954.37,"body":"also some of the more gratifying"},{"speaker":"Chris Dy","startTime":949.87,"endTime":954.37,"body":"ones. You know, I wanted to talk"},{"speaker":"Chris Dy","startTime":954.37,"endTime":957.79,"body":"to you about the use of local"},{"speaker":"Chris Dy","startTime":954.37,"endTime":957.79,"body":"only and how that may change"},{"speaker":"Chris Dy","startTime":957.79,"endTime":961.18,"body":"your thought process. But before"},{"speaker":"Chris Dy","startTime":957.79,"endTime":961.18,"body":"we do that, I actually wanted to"},{"speaker":"Chris Dy","startTime":961.18,"endTime":964.6,"body":"know whether you think it's"},{"speaker":"Chris Dy","startTime":961.18,"endTime":964.6,"body":"usually the dorsal capsule,"},{"speaker":"Chris Dy","startTime":964.6,"endTime":967.63,"body":"whether you think it's tightness"},{"speaker":"Chris Dy","startTime":964.6,"endTime":967.63,"body":"or adhesions around the extensor"},{"speaker":"Chris Dy","startTime":967.63,"endTime":971.59,"body":"mechanism, and which one you go"},{"speaker":"Chris Dy","startTime":967.63,"endTime":971.59,"body":"after first? And how extensive"},{"speaker":"Chris Dy","startTime":971.59,"endTime":975.13,"body":"can your tenolysis be before you"},{"speaker":"Chris Dy","startTime":971.59,"endTime":975.13,"body":"start creating more of an issue?"},{"speaker":"Charles Goldfarb","startTime":976.12,"endTime":978.28,"body":"Yeah, again,"},{"speaker":"Charles Goldfarb","startTime":976.12,"endTime":978.28,"body":"let's let's pretend we're"},{"speaker":"Charles Goldfarb","startTime":978.28,"endTime":981.58,"body":"focused on the proximal phalanx"},{"speaker":"Charles Goldfarb","startTime":978.28,"endTime":981.58,"body":"and may have been a bit proximal"},{"speaker":"Charles Goldfarb","startTime":981.58,"endTime":985.87,"body":"phalanx, maybe the PIP joint."},{"speaker":"Charles Goldfarb","startTime":981.58,"endTime":985.87,"body":"First of all, I'd be curious. I"},{"speaker":"Charles Goldfarb","startTime":985.87,"endTime":988.48,"body":"make straight dorsal incisions,"},{"speaker":"Charles Goldfarb","startTime":985.87,"endTime":988.48,"body":"you know, people, some people do"},{"speaker":"Charles Goldfarb","startTime":988.48,"endTime":991.84,"body":"weird things around the dorsal"},{"speaker":"Charles Goldfarb","startTime":988.48,"endTime":991.84,"body":"joint and this is the dorsal"},{"speaker":"Charles Goldfarb","startTime":991.87,"endTime":994.12,"body":"finger is different for me than"},{"speaker":"Charles Goldfarb","startTime":991.87,"endTime":994.12,"body":"the volar finger. So I make a"},{"speaker":"Charles Goldfarb","startTime":994.12,"endTime":998.53,"body":"straight incision. And I will"},{"speaker":"Charles Goldfarb","startTime":994.12,"endTime":998.53,"body":"say that in most cases, it is"},{"speaker":"Charles Goldfarb","startTime":998.53,"endTime":1002.25,"body":"extensor tendon adhesions, which"},{"speaker":"Charles Goldfarb","startTime":998.53,"endTime":1002.25,"body":"are the primary issue, but"},{"speaker":"Charles Goldfarb","startTime":1003.39,"endTime":1007.5,"body":"releasing the PIP or even the"},{"speaker":"Charles Goldfarb","startTime":1003.39,"endTime":1007.5,"body":"DIP joint capsule is such a"},{"speaker":"Charles Goldfarb","startTime":1007.5,"endTime":1011.61,"body":"simplistic thing to do that"},{"speaker":"Charles Goldfarb","startTime":1007.5,"endTime":1011.61,"body":"unless it's just supple as heck,"},{"speaker":"Charles Goldfarb","startTime":1011.64,"endTime":1015.99,"body":"I go ahead and do it, unless I"},{"speaker":"Charles Goldfarb","startTime":1011.64,"endTime":1015.99,"body":"do a tenolysis and there's full"},{"speaker":"Charles Goldfarb","startTime":1015.99,"endTime":1016.92,"body":"passive motion."},{"speaker":"Chris Dy","startTime":1017.16,"endTime":1019.59,"body":"So you would start we"},{"speaker":"Chris Dy","startTime":1017.16,"endTime":1019.59,"body":"would start with the tenolysis."},{"speaker":"Chris Dy","startTime":1019.77,"endTime":1022.77,"body":"And then check your passive"},{"speaker":"Chris Dy","startTime":1019.77,"endTime":1022.77,"body":"motion if they're not awake, and"},{"speaker":"Chris Dy","startTime":1022.77,"endTime":1026.31,"body":"then release the capsule, if"},{"speaker":"Chris Dy","startTime":1022.77,"endTime":1026.31,"body":"they're still, if they're still"},{"speaker":"Chris Dy","startTime":1026.34,"endTime":1028.32,"body":"not able to passively flex."},{"speaker":"Charles Goldfarb","startTime":1028.75,"endTime":1030.61,"body":"Yeah, so check"},{"speaker":"Charles Goldfarb","startTime":1028.75,"endTime":1030.61,"body":"passive motion, whether they're"},{"speaker":"Charles Goldfarb","startTime":1030.61,"endTime":1034.36,"body":"awake or asleep. And then you"},{"speaker":"Charles Goldfarb","startTime":1030.61,"endTime":1034.36,"body":"have released the capsule, if"},{"speaker":"Charles Goldfarb","startTime":1034.36,"endTime":1037.15,"body":"necessary, and release the"},{"speaker":"Charles Goldfarb","startTime":1034.36,"endTime":1037.15,"body":"dorsal aspect of collateral"},{"speaker":"Charles Goldfarb","startTime":1037.15,"endTime":1039.85,"body":"ligaments or even the entire"},{"speaker":"Charles Goldfarb","startTime":1037.15,"endTime":1039.85,"body":"collateral ligaments, if"},{"speaker":"Charles Goldfarb","startTime":1039.85,"endTime":1043.45,"body":"necessary to achieve easy"},{"speaker":"Charles Goldfarb","startTime":1039.85,"endTime":1043.45,"body":"passive motion."},{"speaker":"Chris Dy","startTime":1043.91,"endTime":1046.55,"body":"And you think that's"},{"speaker":"Chris Dy","startTime":1043.91,"endTime":1046.55,"body":"that you can do that because you"},{"speaker":"Chris Dy","startTime":1046.55,"endTime":1048.32,"body":"know, this is a stiff finger."},{"speaker":"Chris Dy","startTime":1046.55,"endTime":1048.32,"body":"It's not one you're worried"},{"speaker":"Chris Dy","startTime":1048.32,"endTime":1050.75,"body":"about collateral ligament"},{"speaker":"Chris Dy","startTime":1048.32,"endTime":1050.75,"body":"instability, that kind of thing."},{"speaker":"Charles Goldfarb","startTime":1051.08,"endTime":1052.94,"body":"Absolutely. No"},{"speaker":"Charles Goldfarb","startTime":1051.08,"endTime":1052.94,"body":"worries about collateral"},{"speaker":"Charles Goldfarb","startTime":1052.94,"endTime":1054.92,"body":"ligament instability whatsoever."},{"speaker":"Chris Dy","startTime":1055.2,"endTime":1057.69,"body":"Now I've heard you, I"},{"speaker":"Chris Dy","startTime":1055.2,"endTime":1057.69,"body":"think it was you maybe it wasn't"},{"speaker":"Chris Dy","startTime":1057.69,"endTime":1060.87,"body":"you, but I've heard others say"},{"speaker":"Chris Dy","startTime":1057.69,"endTime":1060.87,"body":"that from that dorsal approach,"},{"speaker":"Chris Dy","startTime":1060.87,"endTime":1063.36,"body":"you can then kind of sneak a"},{"speaker":"Chris Dy","startTime":1060.87,"endTime":1063.36,"body":"freer in there and get to the"},{"speaker":"Chris Dy","startTime":1063.42,"endTime":1066.81,"body":"release the volar, check rein"},{"speaker":"Chris Dy","startTime":1063.42,"endTime":1066.81,"body":"ligaments, what do you think"},{"speaker":"Chris Dy","startTime":1066.81,"endTime":1067.41,"body":"about that?"},{"speaker":"Charles Goldfarb","startTime":1067.48,"endTime":1070.27,"body":"Yeah, to me,"},{"speaker":"Charles Goldfarb","startTime":1067.48,"endTime":1070.27,"body":"it's kind of a you can do that."},{"speaker":"Charles Goldfarb","startTime":1070.36,"endTime":1074.65,"body":"And again, to me, it's better to"},{"speaker":"Charles Goldfarb","startTime":1070.36,"endTime":1074.65,"body":"try that than to make a separate"},{"speaker":"Charles Goldfarb","startTime":1074.65,"endTime":1077.86,"body":"volar incision, and really try"},{"speaker":"Charles Goldfarb","startTime":1074.65,"endTime":1077.86,"body":"to do an extensive volar"},{"speaker":"Charles Goldfarb","startTime":1077.86,"endTime":1082.21,"body":"release. Sure, you can put a"},{"speaker":"Charles Goldfarb","startTime":1077.86,"endTime":1082.21,"body":"freer in the joint and try to"},{"speaker":"Charles Goldfarb","startTime":1082.21,"endTime":1085.75,"body":"release the volar plate, if that"},{"speaker":"Charles Goldfarb","startTime":1082.21,"endTime":1085.75,"body":"seems to potentially be a"},{"speaker":"Charles Goldfarb","startTime":1085.75,"endTime":1088.96,"body":"problem. But in reality, you're"},{"speaker":"Charles Goldfarb","startTime":1085.75,"endTime":1088.96,"body":"trying to take a shortcut which"},{"speaker":"Charles Goldfarb","startTime":1088.96,"endTime":1093.4,"body":"you might get away with, but the"},{"speaker":"Charles Goldfarb","startTime":1088.96,"endTime":1093.4,"body":"primary principle for me is"},{"speaker":"Charles Goldfarb","startTime":1093.46,"endTime":1096.88,"body":"don't operate on both sides of"},{"speaker":"Charles Goldfarb","startTime":1093.46,"endTime":1096.88,"body":"the finger. And really, if you"},{"speaker":"Charles Goldfarb","startTime":1096.88,"endTime":1100.6,"body":"achieve your goal dorsally and"},{"speaker":"Charles Goldfarb","startTime":1096.88,"endTime":1100.6,"body":"get the patient to therapy, then"},{"speaker":"Charles Goldfarb","startTime":1100.6,"endTime":1101.92,"body":"you you're off to a great start."},{"speaker":"Chris Dy","startTime":1102.25,"endTime":1105.58,"body":"So does the flexor"},{"speaker":"Chris Dy","startTime":1102.25,"endTime":1105.58,"body":"check. So to say where you"},{"speaker":"Chris Dy","startTime":1106.0,"endTime":1110.08,"body":"essentially performing a trigger"},{"speaker":"Chris Dy","startTime":1106.0,"endTime":1110.08,"body":"finger release in the palm, so"},{"speaker":"Chris Dy","startTime":1110.08,"endTime":1113.23,"body":"not in the finger in the palm on"},{"speaker":"Chris Dy","startTime":1110.08,"endTime":1113.23,"body":"the volar side, the flexor side,"},{"speaker":"Chris Dy","startTime":1113.65,"endTime":1117.73,"body":"and do a tenolysis, a traction"},{"speaker":"Chris Dy","startTime":1113.65,"endTime":1117.73,"body":"type of tenolysis along the FDP,"},{"speaker":"Chris Dy","startTime":1117.82,"endTime":1120.01,"body":"does that count a surgery on"},{"speaker":"Chris Dy","startTime":1117.82,"endTime":1120.01,"body":"both sides of the finger?"},{"speaker":"Charles Goldfarb","startTime":1120.61,"endTime":1122.92,"body":"Excellent"},{"speaker":"Charles Goldfarb","startTime":1120.61,"endTime":1122.92,"body":"question. And I guess it only"},{"speaker":"Charles Goldfarb","startTime":1122.92,"endTime":1127.9,"body":"applies if we're not using local"},{"speaker":"Charles Goldfarb","startTime":1122.92,"endTime":1127.9,"body":"only, right because essentially"},{"speaker":"Charles Goldfarb","startTime":1127.9,"endTime":1130.81,"body":"you're trying to replicate"},{"speaker":"Charles Goldfarb","startTime":1127.9,"endTime":1130.81,"body":"finger flexion or maybe do"},{"speaker":"Charles Goldfarb","startTime":1130.81,"endTime":1133.78,"body":"attraction to license I think"},{"speaker":"Charles Goldfarb","startTime":1130.81,"endTime":1133.78,"body":"there is a role for attracting"},{"speaker":"Charles Goldfarb","startTime":1133.78,"endTime":1138.28,"body":"tenolysis. But I do think that's"},{"speaker":"Charles Goldfarb","startTime":1133.78,"endTime":1138.28,"body":"okay to do a traction tenolysis"},{"speaker":"Charles Goldfarb","startTime":1138.31,"endTime":1142.45,"body":"proximal in the palm, ideally"},{"speaker":"Charles Goldfarb","startTime":1138.31,"endTime":1142.45,"body":"just proximal to the one pulley"},{"speaker":"Charles Goldfarb","startTime":1142.63,"endTime":1145.93,"body":"and see if that demonstrates"},{"speaker":"Charles Goldfarb","startTime":1142.63,"endTime":1145.93,"body":"finger flexion or if there are"},{"speaker":"Charles Goldfarb","startTime":1145.93,"endTime":1148.15,"body":"limited adhesion as it may help"},{"speaker":"Charles Goldfarb","startTime":1145.93,"endTime":1148.15,"body":"break them up."},{"speaker":"Chris Dy","startTime":1149.29,"endTime":1152.92,"body":"It looks like it"},{"speaker":"Chris Dy","startTime":1149.29,"endTime":1152.92,"body":"hurts. A traction tenolysis."},{"speaker":"Charles Goldfarb","startTime":1152.98,"endTime":1155.32,"body":"Well, we know"},{"speaker":"Charles Goldfarb","startTime":1152.98,"endTime":1155.32,"body":"it hurts. Here's why we know it"},{"speaker":"Charles Goldfarb","startTime":1155.32,"endTime":1159.04,"body":"hurts. If I do a little bit of a"},{"speaker":"Charles Goldfarb","startTime":1155.32,"endTime":1159.04,"body":"traction tenolysis with the"},{"speaker":"Charles Goldfarb","startTime":1159.04,"endTime":1163.27,"body":"trigger finger release, and I've"},{"speaker":"Charles Goldfarb","startTime":1159.04,"endTime":1163.27,"body":"had I had a patient come back"},{"speaker":"Charles Goldfarb","startTime":1163.27,"endTime":1166.03,"body":"couple weeks ago to say, you"},{"speaker":"Charles Goldfarb","startTime":1163.27,"endTime":1166.03,"body":"know, that was really easy,"},{"speaker":"Charles Goldfarb","startTime":1166.03,"endTime":1169.21,"body":"except there was this pulling"},{"speaker":"Charles Goldfarb","startTime":1166.03,"endTime":1169.21,"body":"sensation in my forearm"},{"speaker":"Chris Dy","startTime":1169.48,"endTime":1171.55,"body":"Were they were they"},{"speaker":"Chris Dy","startTime":1169.48,"endTime":1171.55,"body":"awake, or were they?"},{"speaker":"Charles Goldfarb","startTime":1171.61,"endTime":1173.02,"body":"Oh, yeah,"},{"speaker":"Charles Goldfarb","startTime":1171.61,"endTime":1173.02,"body":"local only, wide awake."},{"speaker":"Chris Dy","startTime":1173.48,"endTime":1176.48,"body":"But why would you."},{"speaker":"Chris Dy","startTime":1173.48,"endTime":1176.48,"body":"Whoa, timeout. I was about to"},{"speaker":"Chris Dy","startTime":1176.48,"endTime":1179.6,"body":"say that. I feel like a traction"},{"speaker":"Chris Dy","startTime":1176.48,"endTime":1179.6,"body":"tenolysis has been obviated and"},{"speaker":"Chris Dy","startTime":1179.6,"endTime":1183.47,"body":"is now antiquated in the setting"},{"speaker":"Chris Dy","startTime":1179.6,"endTime":1183.47,"body":"of local only surgery."},{"speaker":"Charles Goldfarb","startTime":1183.65,"endTime":1185.54,"body":"Oh, no, it's"},{"speaker":"Charles Goldfarb","startTime":1183.65,"endTime":1185.54,"body":"fine. That's the first one who's"},{"speaker":"Charles Goldfarb","startTime":1185.54,"endTime":1186.38,"body":"complained about it."},{"speaker":"Chris Dy","startTime":1186.83,"endTime":1191.69,"body":"Oh, you're so mean"},{"speaker":"Chris Dy","startTime":1186.83,"endTime":1191.69,"body":"pulling on their FDP like that."},{"speaker":"Chris Dy","startTime":1192.68,"endTime":1196.76,"body":"I will say I remember being your"},{"speaker":"Chris Dy","startTime":1192.68,"endTime":1196.76,"body":"fellow and knowing that I had"},{"speaker":"Chris Dy","startTime":1196.79,"endTime":1201.65,"body":"paid sufficient attention when I"},{"speaker":"Chris Dy","startTime":1196.79,"endTime":1201.65,"body":"was able to twirl the small side"},{"speaker":"Chris Dy","startTime":1201.65,"endTime":1205.76,"body":"of the ragnell retractor around"},{"speaker":"Chris Dy","startTime":1201.65,"endTime":1205.76,"body":"the FDP tendon like a baton, to"},{"speaker":"Chris Dy","startTime":1205.76,"endTime":1209.33,"body":"do the traction tenolysis in the"},{"speaker":"Chris Dy","startTime":1205.76,"endTime":1209.33,"body":"way that you do it. Because it's"},{"speaker":"Chris Dy","startTime":1209.33,"endTime":1213.38,"body":"like watching a marching band."},{"speaker":"Chris Dy","startTime":1209.33,"endTime":1213.38,"body":"Somebody in a marching band roll"},{"speaker":"Chris Dy","startTime":1213.38,"endTime":1214.4,"body":"their baton to do that."},{"speaker":"Charles Goldfarb","startTime":1214.49,"endTime":1215.99,"body":"Yeah, well,"},{"speaker":"Charles Goldfarb","startTime":1214.49,"endTime":1215.99,"body":"you got to have skills it's the"},{"speaker":"Charles Goldfarb","startTime":1215.99,"endTime":1219.05,"body":"hand surgeon skill set, you got"},{"speaker":"Charles Goldfarb","startTime":1215.99,"endTime":1219.05,"body":"to be able to get your ragnell"},{"speaker":"Charles Goldfarb","startTime":1219.05,"endTime":1223.22,"body":"retractor around the FDS, pull"},{"speaker":"Charles Goldfarb","startTime":1219.05,"endTime":1223.22,"body":"on the FDP and do your traction"},{"speaker":"Charles Goldfarb","startTime":1223.22,"endTime":1224.45,"body":"tenolysis? Of course you do."},{"speaker":"Chris Dy","startTime":1224.99,"endTime":1227.09,"body":"Until you don't need"},{"speaker":"Chris Dy","startTime":1224.99,"endTime":1227.09,"body":"to anymore because you know,"},{"speaker":"Chris Dy","startTime":1227.66,"endTime":1228.17,"body":"tenolysis in 2021."},{"speaker":"Charles Goldfarb","startTime":1229.34,"endTime":1233.3,"body":"Fair enough,"},{"speaker":"Charles Goldfarb","startTime":1229.34,"endTime":1233.3,"body":"Dr. Dy. Fair enough. So what is"},{"speaker":"Charles Goldfarb","startTime":1233.3,"endTime":1236.63,"body":"your time interval? Let's say"},{"speaker":"Charles Goldfarb","startTime":1233.3,"endTime":1236.63,"body":"you do your dorsal tenolysis and"},{"speaker":"Charles Goldfarb","startTime":1236.63,"endTime":1240.11,"body":"maybe a capsular release, you're"},{"speaker":"Charles Goldfarb","startTime":1236.63,"endTime":1240.11,"body":"really happy with the surgery,"},{"speaker":"Charles Goldfarb","startTime":1240.29,"endTime":1242.93,"body":"the patient happened to be wide"},{"speaker":"Charles Goldfarb","startTime":1240.29,"endTime":1242.93,"body":"awake, and they could not"},{"speaker":"Charles Goldfarb","startTime":1242.96,"endTime":1247.43,"body":"demonstrate active motion. So"},{"speaker":"Charles Goldfarb","startTime":1242.96,"endTime":1247.43,"body":"for me, that means we still"},{"speaker":"Charles Goldfarb","startTime":1247.43,"endTime":1253.49,"body":"don't know if it's a flexor"},{"speaker":"Charles Goldfarb","startTime":1247.43,"endTime":1253.49,"body":"problem, or if it's a PIP, joint"},{"speaker":"Charles Goldfarb","startTime":1253.49,"endTime":1257.42,"body":"contracture problem, or both."},{"speaker":"Charles Goldfarb","startTime":1253.49,"endTime":1257.42,"body":"But I guess my first question"},{"speaker":"Charles Goldfarb","startTime":1257.42,"endTime":1260.15,"body":"is, how long do you send them to"},{"speaker":"Charles Goldfarb","startTime":1257.42,"endTime":1260.15,"body":"therapy? Is there a time average"},{"speaker":"Charles Goldfarb","startTime":1260.15,"endTime":1261.41,"body":"time? Or what do you look for?"},{"speaker":"Chris Dy","startTime":1262.4,"endTime":1265.49,"body":"I probably would do at"},{"speaker":"Chris Dy","startTime":1262.4,"endTime":1265.49,"body":"least a month. And I think it"},{"speaker":"Chris Dy","startTime":1265.49,"endTime":1269.81,"body":"kind of depends on you need to"},{"speaker":"Chris Dy","startTime":1265.49,"endTime":1269.81,"body":"give them enough time to recover"},{"speaker":"Chris Dy","startTime":1269.81,"endTime":1273.02,"body":"from the surgery to truly engage"},{"speaker":"Chris Dy","startTime":1269.81,"endTime":1273.02,"body":"with a therapist for the"},{"speaker":"Chris Dy","startTime":1273.02,"endTime":1278.21,"body":"therapist to try to understand"},{"speaker":"Chris Dy","startTime":1273.02,"endTime":1278.21,"body":"kind of the personality of the"},{"speaker":"Chris Dy","startTime":1278.21,"endTime":1280.76,"body":"finger, so to say, as well as"},{"speaker":"Chris Dy","startTime":1278.21,"endTime":1280.76,"body":"the personality of the patient."},{"speaker":"Chris Dy","startTime":1281.6,"endTime":1284.54,"body":"And you know, really mean"},{"speaker":"Chris Dy","startTime":1281.6,"endTime":1284.54,"body":"honestly, they usually have been"},{"speaker":"Chris Dy","startTime":1284.54,"endTime":1287.42,"body":"treating the patient for a while"},{"speaker":"Chris Dy","startTime":1284.54,"endTime":1287.42,"body":"before surgery to be honest with"},{"speaker":"Chris Dy","startTime":1287.42,"endTime":1290.18,"body":"you. So they have a sense of"},{"speaker":"Chris Dy","startTime":1287.42,"endTime":1290.18,"body":"what's going on. So I'd say at"},{"speaker":"Chris Dy","startTime":1290.18,"endTime":1293.36,"body":"least a month. I guess I knew we"},{"speaker":"Chris Dy","startTime":1290.18,"endTime":1293.36,"body":"could rely, you know, fall back"},{"speaker":"Chris Dy","startTime":1293.36,"endTime":1295.34,"body":"on the orthopedic unit of six"},{"speaker":"Chris Dy","startTime":1293.36,"endTime":1295.34,"body":"weeks. But."},{"speaker":"Charles Goldfarb","startTime":1296.09,"endTime":1297.89,"body":"Yeah, I think"},{"speaker":"Charles Goldfarb","startTime":1296.09,"endTime":1297.89,"body":"that's good advice. And you know"},{"speaker":"Charles Goldfarb","startTime":1297.89,"endTime":1301.28,"body":"what this is where the therapist"},{"speaker":"Charles Goldfarb","startTime":1297.89,"endTime":1301.28,"body":"is key. This is one one example"},{"speaker":"Charles Goldfarb","startTime":1301.28,"endTime":1304.97,"body":"of the many times the therapist"},{"speaker":"Charles Goldfarb","startTime":1301.28,"endTime":1304.97,"body":"is key, I think four weeks, six"},{"speaker":"Charles Goldfarb","startTime":1304.97,"endTime":1307.16,"body":"weeks, sometimes it's three"},{"speaker":"Charles Goldfarb","startTime":1304.97,"endTime":1307.16,"body":"months. But for me, it's not"},{"speaker":"Charles Goldfarb","startTime":1307.16,"endTime":1310.82,"body":"only the time, it's just making"},{"speaker":"Charles Goldfarb","startTime":1307.16,"endTime":1310.82,"body":"sure the finger looks good, the"},{"speaker":"Charles Goldfarb","startTime":1310.82,"endTime":1314.87,"body":"wound is healed, there's no"},{"speaker":"Charles Goldfarb","startTime":1310.82,"endTime":1314.87,"body":"edema, there's no obvious pain,"},{"speaker":"Charles Goldfarb","startTime":1315.11,"endTime":1318.86,"body":"and they've been able to"},{"speaker":"Charles Goldfarb","startTime":1315.11,"endTime":1318.86,"body":"maintain that passive flexion"},{"speaker":"Charles Goldfarb","startTime":1319.49,"endTime":1321.38,"body":"and then we turn our attention"},{"speaker":"Charles Goldfarb","startTime":1319.49,"endTime":1321.38,"body":"volarly."},{"speaker":"Chris Dy","startTime":1322.04,"endTime":1324.95,"body":"So then what do you"},{"speaker":"Chris Dy","startTime":1322.04,"endTime":1324.95,"body":"think the steps are volarly?"},{"speaker":"Chris Dy","startTime":1325.01,"endTime":1329.0,"body":"What are you concerned about in"},{"speaker":"Chris Dy","startTime":1325.01,"endTime":1329.0,"body":"terms of the pathology that is"},{"speaker":"Chris Dy","startTime":1329.0,"endTime":1330.83,"body":"stopping the finger from"},{"speaker":"Chris Dy","startTime":1329.0,"endTime":1330.83,"body":"flexing?"},{"speaker":"Charles Goldfarb","startTime":1331.04,"endTime":1333.35,"body":"I guess the"},{"speaker":"Charles Goldfarb","startTime":1331.04,"endTime":1333.35,"body":"first question is do your"},{"speaker":"Charles Goldfarb","startTime":1333.35,"endTime":1338.06,"body":"radiographs give you any tip off"},{"speaker":"Charles Goldfarb","startTime":1333.35,"endTime":1338.06,"body":"so in other words, if this was a"},{"speaker":"Charles Goldfarb","startTime":1338.27,"endTime":1342.53,"body":"proximal phalanx fracture, and"},{"speaker":"Charles Goldfarb","startTime":1338.27,"endTime":1342.53,"body":"when you went dorsally, you had"},{"speaker":"Charles Goldfarb","startTime":1342.53,"endTime":1347.27,"body":"a lot of adhesion, in scar"},{"speaker":"Charles Goldfarb","startTime":1342.53,"endTime":1347.27,"body":"tissue, dorsal to the proximal"},{"speaker":"Charles Goldfarb","startTime":1347.27,"endTime":1351.53,"body":"phalanx, then what I would be"},{"speaker":"Charles Goldfarb","startTime":1347.27,"endTime":1351.53,"body":"hoping for is a almost a spot"},{"speaker":"Charles Goldfarb","startTime":1351.53,"endTime":1355.61,"body":"weld situation. Volarly where"},{"speaker":"Charles Goldfarb","startTime":1351.53,"endTime":1355.61,"body":"the flexor tendons were adhered"},{"speaker":"Charles Goldfarb","startTime":1355.61,"endTime":1359.36,"body":"to the volar proximal phalanx"},{"speaker":"Charles Goldfarb","startTime":1355.61,"endTime":1359.36,"body":"those kind of situations are"},{"speaker":"Charles Goldfarb","startTime":1359.36,"endTime":1362.84,"body":"what really makes you happy, and"},{"speaker":"Charles Goldfarb","startTime":1359.36,"endTime":1362.84,"body":"makes you feel like this can be"},{"speaker":"Charles Goldfarb","startTime":1362.84,"endTime":1366.68,"body":"a home run. But the reality is,"},{"speaker":"Charles Goldfarb","startTime":1362.84,"endTime":1366.68,"body":"you go where you think the"},{"speaker":"Charles Goldfarb","startTime":1366.68,"endTime":1371.66,"body":"action is. And you do a release,"},{"speaker":"Charles Goldfarb","startTime":1366.68,"endTime":1371.66,"body":"you know, you do a flexor"},{"speaker":"Charles Goldfarb","startTime":1371.66,"endTime":1376.46,"body":"tenolysis. And we can talk about"},{"speaker":"Charles Goldfarb","startTime":1371.66,"endTime":1376.46,"body":"details a bit, plus minus a"},{"speaker":"Charles Goldfarb","startTime":1376.46,"endTime":1382.7,"body":"joint release. And you know, if"},{"speaker":"Charles Goldfarb","startTime":1376.46,"endTime":1382.7,"body":"your finger extends fully, which"},{"speaker":"Charles Goldfarb","startTime":1382.7,"endTime":1385.16,"body":"it may or may not, then you may"},{"speaker":"Charles Goldfarb","startTime":1382.7,"endTime":1385.16,"body":"not be worried about the PIP"},{"speaker":"Charles Goldfarb","startTime":1385.34,"endTime":1388.58,"body":"joint. But if you have a finger"},{"speaker":"Charles Goldfarb","startTime":1385.34,"endTime":1388.58,"body":"in mid flexion, and it can't"},{"speaker":"Charles Goldfarb","startTime":1388.61,"endTime":1392.6,"body":"extend fully and can't actively"},{"speaker":"Charles Goldfarb","startTime":1388.61,"endTime":1392.6,"body":"flex, then you really don't know"},{"speaker":"Charles Goldfarb","startTime":1392.6,"endTime":1395.57,"body":"whether this is a flexor tendon"},{"speaker":"Charles Goldfarb","startTime":1392.6,"endTime":1395.57,"body":"issue, or a PIP joint"},{"speaker":"Charles Goldfarb","startTime":1395.57,"endTime":1396.08,"body":"contracture."},{"speaker":"Chris Dy","startTime":1396.92,"endTime":1399.26,"body":"So how do you know"},{"speaker":"Chris Dy","startTime":1396.92,"endTime":1399.26,"body":"where the action is? Aside from"},{"speaker":"Chris Dy","startTime":1399.26,"endTime":1402.05,"body":"kind of your if you're in a"},{"speaker":"Chris Dy","startTime":1399.26,"endTime":1402.05,"body":"setting where you know, fracture"},{"speaker":"Chris Dy","startTime":1402.05,"endTime":1404.78,"body":"wise, maybe that's where it was,"},{"speaker":"Chris Dy","startTime":1402.05,"endTime":1404.78,"body":"I mean, I've had a couple of"},{"speaker":"Chris Dy","startTime":1404.78,"endTime":1408.29,"body":"cases where an ultrasound has"},{"speaker":"Chris Dy","startTime":1404.78,"endTime":1408.29,"body":"been very useful showing me"},{"speaker":"Chris Dy","startTime":1408.29,"endTime":1410.93,"body":"where the spot weld was. But"},{"speaker":"Chris Dy","startTime":1408.29,"endTime":1410.93,"body":"that's also something that is"},{"speaker":"Chris Dy","startTime":1410.93,"endTime":1413.9,"body":"inconsistent in terms of the"},{"speaker":"Chris Dy","startTime":1410.93,"endTime":1413.9,"body":"person doing the ultrasound,"},{"speaker":"Chris Dy","startTime":1413.9,"endTime":1415.88,"body":"whether they can deliver that"},{"speaker":"Chris Dy","startTime":1413.9,"endTime":1415.88,"body":"level of detail."},{"speaker":"Charles Goldfarb","startTime":1416.6,"endTime":1418.76,"body":"Yeah, I would"},{"speaker":"Charles Goldfarb","startTime":1416.6,"endTime":1418.76,"body":"say with great comfort that I've"},{"speaker":"Charles Goldfarb","startTime":1418.76,"endTime":1422.57,"body":"never used MRI for this, I don't"},{"speaker":"Charles Goldfarb","startTime":1418.76,"endTime":1422.57,"body":"think MRI has a role. I do think"},{"speaker":"Charles Goldfarb","startTime":1422.57,"endTime":1427.1,"body":"it depends on your comfort with"},{"speaker":"Charles Goldfarb","startTime":1422.57,"endTime":1427.1,"body":"your ultrasonographer. It's not"},{"speaker":"Charles Goldfarb","startTime":1427.1,"endTime":1430.49,"body":"been a regular practice of mine"},{"speaker":"Charles Goldfarb","startTime":1427.1,"endTime":1430.49,"body":"to use ultrasonography. But I"},{"speaker":"Charles Goldfarb","startTime":1430.49,"endTime":1433.49,"body":"have no problem with it being"},{"speaker":"Charles Goldfarb","startTime":1430.49,"endTime":1433.49,"body":"done. So you look for secondary"},{"speaker":"Charles Goldfarb","startTime":1433.49,"endTime":1436.55,"body":"signs, you look for scarring"},{"speaker":"Charles Goldfarb","startTime":1433.49,"endTime":1436.55,"body":"that may affect the skin, you"},{"speaker":"Charles Goldfarb","startTime":1436.55,"endTime":1440.33,"body":"look for X ray signs of healing"},{"speaker":"Charles Goldfarb","startTime":1436.55,"endTime":1440.33,"body":"or know where your fracture or"},{"speaker":"Charles Goldfarb","startTime":1440.33,"endTime":1444.23,"body":"crush injury may have been. And"},{"speaker":"Charles Goldfarb","startTime":1440.33,"endTime":1444.23,"body":"then honestly, you go where you"},{"speaker":"Charles Goldfarb","startTime":1444.23,"endTime":1447.44,"body":"think the action is, and open"},{"speaker":"Charles Goldfarb","startTime":1444.23,"endTime":1447.44,"body":"things up and get to work."},{"speaker":"Chris Dy","startTime":1447.77,"endTime":1450.44,"body":"So is this a local"},{"speaker":"Chris Dy","startTime":1447.77,"endTime":1450.44,"body":"only case for you in 2021?"},{"speaker":"Charles Goldfarb","startTime":1451.67,"endTime":1454.34,"body":"I haven't had"},{"speaker":"Charles Goldfarb","startTime":1451.67,"endTime":1454.34,"body":"this situation but I think the"},{"speaker":"Charles Goldfarb","startTime":1454.34,"endTime":1457.79,"body":"answer is yes. With the right"},{"speaker":"Charles Goldfarb","startTime":1454.34,"endTime":1457.79,"body":"patient. I think it is a local"},{"speaker":"Charles Goldfarb","startTime":1457.79,"endTime":1459.08,"body":"only procedure for you?"},{"speaker":"Chris Dy","startTime":1459.86,"endTime":1462.95,"body":"Yeah, I mean, I and"},{"speaker":"Chris Dy","startTime":1459.86,"endTime":1462.95,"body":"I've had maybe less than a"},{"speaker":"Chris Dy","startTime":1462.95,"endTime":1467.99,"body":"handful I think of flexor"},{"speaker":"Chris Dy","startTime":1462.95,"endTime":1467.99,"body":"tenolyses that I performed for"},{"speaker":"Chris Dy","startTime":1467.99,"endTime":1472.64,"body":"various reasons under a local"},{"speaker":"Chris Dy","startTime":1467.99,"endTime":1472.64,"body":"only. And you This is not like"},{"speaker":"Chris Dy","startTime":1472.64,"endTime":1474.8,"body":"local only carpal tunnel like"},{"speaker":"Chris Dy","startTime":1472.64,"endTime":1474.8,"body":"you got to prepare the patient"},{"speaker":"Chris Dy","startTime":1474.8,"endTime":1477.8,"body":"like this is going to be thank"},{"speaker":"Chris Dy","startTime":1474.8,"endTime":1477.8,"body":"you for doing this because it"},{"speaker":"Chris Dy","startTime":1477.8,"endTime":1482.3,"body":"helps me do my job. This is not"},{"speaker":"Chris Dy","startTime":1477.8,"endTime":1482.3,"body":"going to be a short thing. We"},{"speaker":"Chris Dy","startTime":1482.3,"endTime":1484.91,"body":"will make you as comfortable as"},{"speaker":"Chris Dy","startTime":1482.3,"endTime":1484.91,"body":"we can. But I'll be honest with"},{"speaker":"Chris Dy","startTime":1484.91,"endTime":1489.2,"body":"you, you know, whenever you're"},{"speaker":"Chris Dy","startTime":1484.91,"endTime":1489.2,"body":"manipulating tendons and pulling"},{"speaker":"Chris Dy","startTime":1489.2,"endTime":1492.17,"body":"on muscle bellies that's"},{"speaker":"Chris Dy","startTime":1489.2,"endTime":1492.17,"body":"uncomfortable for people in ways"},{"speaker":"Chris Dy","startTime":1492.17,"endTime":1493.13,"body":"that you can't block."},{"speaker":"Charles Goldfarb","startTime":1494.15,"endTime":1496.04,"body":"Yeah, so this"},{"speaker":"Charles Goldfarb","startTime":1494.15,"endTime":1496.04,"body":"is an interesting one for me"},{"speaker":"Charles Goldfarb","startTime":1496.04,"endTime":1498.65,"body":"because one of the most"},{"speaker":"Charles Goldfarb","startTime":1496.04,"endTime":1498.65,"body":"technical procedures that you"},{"speaker":"Charles Goldfarb","startTime":1498.65,"endTime":1503.27,"body":"are I will do it Maybe even more"},{"speaker":"Charles Goldfarb","startTime":1498.65,"endTime":1503.27,"body":"technical than nerve surgery is"},{"speaker":"Charles Goldfarb","startTime":1503.3,"endTime":1507.59,"body":"a flexor tenolysis. And, you"},{"speaker":"Charles Goldfarb","startTime":1503.3,"endTime":1507.59,"body":"know, things can really go"},{"speaker":"Charles Goldfarb","startTime":1507.59,"endTime":1511.67,"body":"wrong, we're trying to protect"},{"speaker":"Charles Goldfarb","startTime":1507.59,"endTime":1511.67,"body":"the pulley system, we're trying"},{"speaker":"Charles Goldfarb","startTime":1511.67,"endTime":1518.39,"body":"to either maintain or recreate a"},{"speaker":"Charles Goldfarb","startTime":1511.67,"endTime":1518.39,"body":"gliding surface between the two"},{"speaker":"Charles Goldfarb","startTime":1518.39,"endTime":1522.2,"body":"tendons, and free the tendons"},{"speaker":"Charles Goldfarb","startTime":1518.39,"endTime":1522.2,"body":"from bony scarring. And it can"},{"speaker":"Charles Goldfarb","startTime":1522.2,"endTime":1524.78,"body":"be really difficult. And"},{"speaker":"Charles Goldfarb","startTime":1522.2,"endTime":1524.78,"body":"honestly, that's why there are"},{"speaker":"Charles Goldfarb","startTime":1524.78,"endTime":1528.62,"body":"specialized tools available. You"},{"speaker":"Charles Goldfarb","startTime":1524.78,"endTime":1528.62,"body":"know, tenolysis knives are a"},{"speaker":"Charles Goldfarb","startTime":1528.62,"endTime":1533.45,"body":"thing. Now, I don't have them, I"},{"speaker":"Charles Goldfarb","startTime":1528.62,"endTime":1533.45,"body":"don't really use them. And I"},{"speaker":"Charles Goldfarb","startTime":1533.45,"endTime":1536.78,"body":"typically am a surgeon that will"},{"speaker":"Charles Goldfarb","startTime":1533.45,"endTime":1536.78,"body":"try to make do with whatever is"},{"speaker":"Charles Goldfarb","startTime":1536.78,"endTime":1540.35,"body":"there. But this is one case"},{"speaker":"Charles Goldfarb","startTime":1536.78,"endTime":1540.35,"body":"where you sometimes need"},{"speaker":"Charles Goldfarb","startTime":1540.35,"endTime":1544.58,"body":"specialized tools like a beaver"},{"speaker":"Charles Goldfarb","startTime":1540.35,"endTime":1544.58,"body":"blade, or like the tenolysis"},{"speaker":"Charles Goldfarb","startTime":1544.58,"endTime":1547.82,"body":"knives. So I think this is one"},{"speaker":"Charles Goldfarb","startTime":1544.58,"endTime":1547.82,"body":"where it does pay to be"},{"speaker":"Charles Goldfarb","startTime":1547.82,"endTime":1550.52,"body":"prepared, because it can really"},{"speaker":"Charles Goldfarb","startTime":1547.82,"endTime":1550.52,"body":"make a difference."},{"speaker":"Chris Dy","startTime":1550.88,"endTime":1553.55,"body":"Yeah, I agree. beaver"},{"speaker":"Chris Dy","startTime":1550.88,"endTime":1553.55,"body":"blade, 11 blade sometimes for"},{"speaker":"Chris Dy","startTime":1553.55,"endTime":1557.45,"body":"me, I don't have the tenolysis"},{"speaker":"Chris Dy","startTime":1553.55,"endTime":1557.45,"body":"knives. It just doesn't come up"},{"speaker":"Chris Dy","startTime":1557.45,"endTime":1560.24,"body":"that often to be honest with you"},{"speaker":"Chris Dy","startTime":1557.45,"endTime":1560.24,"body":"where I've thought like, Oh, I"},{"speaker":"Chris Dy","startTime":1560.24,"endTime":1564.32,"body":"really need to learn how to use"},{"speaker":"Chris Dy","startTime":1560.24,"endTime":1564.32,"body":"a new instrument. But yeah, and"},{"speaker":"Chris Dy","startTime":1564.41,"endTime":1569.36,"body":"I think the stakes are high."},{"speaker":"Chris Dy","startTime":1564.41,"endTime":1569.36,"body":"It's a hard surgery already."},{"speaker":"Chris Dy","startTime":1569.63,"endTime":1572.51,"body":"Having people awake makes it"},{"speaker":"Chris Dy","startTime":1569.63,"endTime":1572.51,"body":"even more challenging to be"},{"speaker":"Chris Dy","startTime":1572.51,"endTime":1575.75,"body":"honest with you, it adds another"},{"speaker":"Chris Dy","startTime":1572.51,"endTime":1575.75,"body":"layer of complexity to the whole"},{"speaker":"Chris Dy","startTime":1575.75,"endTime":1579.56,"body":"situation. So I can see why some"},{"speaker":"Chris Dy","startTime":1575.75,"endTime":1579.56,"body":"would prefer to have patients"},{"speaker":"Chris Dy","startTime":1579.59,"endTime":1582.89,"body":"asleep. But it I think it does"},{"speaker":"Chris Dy","startTime":1579.59,"endTime":1582.89,"body":"help you know, diagnostically"},{"speaker":"Chris Dy","startTime":1582.89,"endTime":1585.53,"body":"and honestly, we talked about"},{"speaker":"Chris Dy","startTime":1582.89,"endTime":1585.53,"body":"this before about local surgery,"},{"speaker":"Chris Dy","startTime":1585.95,"endTime":1589.37,"body":"patients see how hard you're"},{"speaker":"Chris Dy","startTime":1585.95,"endTime":1589.37,"body":"working. And with them being"},{"speaker":"Chris Dy","startTime":1589.37,"endTime":1592.19,"body":"engaged in the process, they're"},{"speaker":"Chris Dy","startTime":1589.37,"endTime":1592.19,"body":"a little more invested too,"},{"speaker":"Chris Dy","startTime":1592.19,"endTime":1594.59,"body":"because, you know, they're"},{"speaker":"Chris Dy","startTime":1592.19,"endTime":1594.59,"body":"telling the therapist, like all"},{"speaker":"Chris Dy","startTime":1594.59,"endTime":1597.23,"body":"we're doing all this, and you"},{"speaker":"Chris Dy","startTime":1594.59,"endTime":1597.23,"body":"know, they're trying to try"},{"speaker":"Chris Dy","startTime":1597.23,"endTime":1599.6,"body":"this, that and the other and I"},{"speaker":"Chris Dy","startTime":1597.23,"endTime":1599.6,"body":"was there the whole time. And"},{"speaker":"Chris Dy","startTime":1599.6,"endTime":1603.92,"body":"you know, it adds something, I"},{"speaker":"Chris Dy","startTime":1599.6,"endTime":1603.92,"body":"think it's hard to quantify. And"},{"speaker":"Chris Dy","startTime":1603.92,"endTime":1605.42,"body":"it's a little squishy, but it"},{"speaker":"Chris Dy","startTime":1603.92,"endTime":1605.42,"body":"adds something."},{"speaker":"Charles Goldfarb","startTime":1605.87,"endTime":1607.67,"body":"Oh, for sure"},{"speaker":"Charles Goldfarb","startTime":1605.87,"endTime":1607.67,"body":"it does. But you're right, it"},{"speaker":"Charles Goldfarb","startTime":1607.67,"endTime":1610.01,"body":"can become awkward if you're"},{"speaker":"Charles Goldfarb","startTime":1607.67,"endTime":1610.01,"body":"really working hard and not"},{"speaker":"Charles Goldfarb","startTime":1610.01,"endTime":1613.67,"body":"seeing the success that you open"},{"speaker":"Charles Goldfarb","startTime":1610.01,"endTime":1613.67,"body":"expect to see. And so let's say"},{"speaker":"Charles Goldfarb","startTime":1613.67,"endTime":1618.23,"body":"you tackle a what you think is a"},{"speaker":"Charles Goldfarb","startTime":1613.67,"endTime":1618.23,"body":"spot weld over the proximal"},{"speaker":"Charles Goldfarb","startTime":1618.23,"endTime":1622.25,"body":"phalanx and you free the tendons"},{"speaker":"Charles Goldfarb","startTime":1618.23,"endTime":1622.25,"body":"and prior to doing that release,"},{"speaker":"Charles Goldfarb","startTime":1622.25,"endTime":1625.13,"body":"you couldn't extend the finger"},{"speaker":"Charles Goldfarb","startTime":1622.25,"endTime":1625.13,"body":"fully, all the sudden, you can"},{"speaker":"Charles Goldfarb","startTime":1625.13,"endTime":1629.87,"body":"now extend the finger fully. But"},{"speaker":"Charles Goldfarb","startTime":1625.13,"endTime":1629.87,"body":"you might perform a traction"},{"speaker":"Charles Goldfarb","startTime":1629.87,"endTime":1633.56,"body":"tenolysis or if the patient's"},{"speaker":"Charles Goldfarb","startTime":1629.87,"endTime":1633.56,"body":"awake, you ask them to flex. And"},{"speaker":"Charles Goldfarb","startTime":1633.56,"endTime":1636.2,"body":"you don't know, at this point,"},{"speaker":"Charles Goldfarb","startTime":1633.56,"endTime":1636.2,"body":"whether you've achieved a full"},{"speaker":"Charles Goldfarb","startTime":1636.2,"endTime":1638.99,"body":"release of all the adhesions. As"},{"speaker":"Charles Goldfarb","startTime":1636.2,"endTime":1638.99,"body":"a you don't know, if there's"},{"speaker":"Charles Goldfarb","startTime":1638.99,"endTime":1642.59,"body":"more work to be done, you're"},{"speaker":"Charles Goldfarb","startTime":1638.99,"endTime":1642.59,"body":"encouraged that you've gained"},{"speaker":"Charles Goldfarb","startTime":1642.68,"endTime":1647.03,"body":"passive extension by releasing"},{"speaker":"Charles Goldfarb","startTime":1642.68,"endTime":1647.03,"body":"whatever is tight volarly. But"},{"speaker":"Charles Goldfarb","startTime":1647.03,"endTime":1650.78,"body":"until you see their active"},{"speaker":"Charles Goldfarb","startTime":1647.03,"endTime":1650.78,"body":"flexion or pulling on the flexor"},{"speaker":"Charles Goldfarb","startTime":1650.78,"endTime":1653.66,"body":"tendons proximately, the palm to"},{"speaker":"Charles Goldfarb","startTime":1650.78,"endTime":1653.66,"body":"demonstrate flexion you don't"},{"speaker":"Charles Goldfarb","startTime":1653.66,"endTime":1655.7,"body":"know that you've been"},{"speaker":"Charles Goldfarb","startTime":1653.66,"endTime":1655.7,"body":"successful. So that's another"},{"speaker":"Charles Goldfarb","startTime":1655.7,"endTime":1658.76,"body":"reason why despite the"},{"speaker":"Charles Goldfarb","startTime":1655.7,"endTime":1658.76,"body":"challenges of local only, it"},{"speaker":"Charles Goldfarb","startTime":1658.76,"endTime":1660.77,"body":"really is nice to have the"},{"speaker":"Charles Goldfarb","startTime":1658.76,"endTime":1660.77,"body":"patient awake."},{"speaker":"Chris Dy","startTime":1662.0,"endTime":1665.03,"body":"Yeah, absolutely. You"},{"speaker":"Chris Dy","startTime":1662.0,"endTime":1665.03,"body":"know, and then so then at that"},{"speaker":"Chris Dy","startTime":1665.03,"endTime":1669.02,"body":"point, you know, what, if you"},{"speaker":"Chris Dy","startTime":1665.03,"endTime":1669.02,"body":"are sure that the tendons are"},{"speaker":"Chris Dy","startTime":1669.02,"endTime":1672.41,"body":"freed up is that when you're"},{"speaker":"Chris Dy","startTime":1669.02,"endTime":1672.41,"body":"going to, you know, do your PIP"},{"speaker":"Chris Dy","startTime":1672.71,"endTime":1675.23,"body":"contracture release to get a"},{"speaker":"Chris Dy","startTime":1672.71,"endTime":1675.23,"body":"little bit more and how do you"},{"speaker":"Chris Dy","startTime":1675.23,"endTime":1676.34,"body":"approach that technically."},{"speaker":"Charles Goldfarb","startTime":1676.61,"endTime":1678.95,"body":"So if you have"},{"speaker":"Charles Goldfarb","startTime":1676.61,"endTime":1678.95,"body":"a patient who cannot passively"},{"speaker":"Charles Goldfarb","startTime":1678.95,"endTime":1683.69,"body":"extend, but you've done a"},{"speaker":"Charles Goldfarb","startTime":1678.95,"endTime":1683.69,"body":"flexor, tenolysis, and the"},{"speaker":"Charles Goldfarb","startTime":1683.69,"endTime":1688.01,"body":"patient can demonstrate active"},{"speaker":"Charles Goldfarb","startTime":1683.69,"endTime":1688.01,"body":"flexion then the next step"},{"speaker":"Charles Goldfarb","startTime":1688.04,"endTime":1692.75,"body":"absolutely is a PIP joint"},{"speaker":"Charles Goldfarb","startTime":1688.04,"endTime":1692.75,"body":"release. And so this is where"},{"speaker":"Charles Goldfarb","startTime":1692.75,"endTime":1695.27,"body":"we, you know, hear the"},{"speaker":"Charles Goldfarb","startTime":1692.75,"endTime":1695.27,"body":"terminology that check rein"},{"speaker":"Charles Goldfarb","startTime":1695.27,"endTime":1700.31,"body":"ligament, or, you know, non"},{"speaker":"Charles Goldfarb","startTime":1695.27,"endTime":1700.31,"body":"pathological state is the check"},{"speaker":"Charles Goldfarb","startTime":1700.31,"endTime":1704.06,"body":"ligament. That's Kirk Watson's"},{"speaker":"Charles Goldfarb","startTime":1700.31,"endTime":1704.06,"body":"terminology. And so basically,"},{"speaker":"Charles Goldfarb","startTime":1704.12,"endTime":1706.31,"body":"you know, you have the volar"},{"speaker":"Charles Goldfarb","startTime":1704.12,"endTime":1706.31,"body":"plate, which will be very"},{"speaker":"Charles Goldfarb","startTime":1706.31,"endTime":1710.36,"body":"thickened, I tend to approach it"},{"speaker":"Charles Goldfarb","startTime":1706.31,"endTime":1710.36,"body":"proximally, I try to maintain"},{"speaker":"Charles Goldfarb","startTime":1710.36,"endTime":1714.05,"body":"the transverse vasculature and"},{"speaker":"Charles Goldfarb","startTime":1710.36,"endTime":1714.05,"body":"release the volar plate"},{"speaker":"Charles Goldfarb","startTime":1714.05,"endTime":1716.39,"body":"proximally, some people will do"},{"speaker":"Charles Goldfarb","startTime":1714.05,"endTime":1716.39,"body":"a distally I prefer doing it"},{"speaker":"Charles Goldfarb","startTime":1716.39,"endTime":1721.58,"body":"proximally and initially is just"},{"speaker":"Charles Goldfarb","startTime":1716.39,"endTime":1721.58,"body":"a transverse division of the"},{"speaker":"Charles Goldfarb","startTime":1721.58,"endTime":1725.21,"body":"volar plate on the neck of the"},{"speaker":"Charles Goldfarb","startTime":1721.58,"endTime":1725.21,"body":"proximal phalanx as the first"},{"speaker":"Charles Goldfarb","startTime":1725.21,"endTime":1729.08,"body":"step. And that allows you to"},{"speaker":"Charles Goldfarb","startTime":1725.21,"endTime":1729.08,"body":"mate to obtain full passive"},{"speaker":"Charles Goldfarb","startTime":1729.08,"endTime":1732.8,"body":"extension, you're done. The next"},{"speaker":"Charles Goldfarb","startTime":1729.08,"endTime":1732.8,"body":"step would be to release the"},{"speaker":"Charles Goldfarb","startTime":1732.8,"endTime":1735.86,"body":"insertion of the accessory"},{"speaker":"Charles Goldfarb","startTime":1732.8,"endTime":1735.86,"body":"collateral ligaments into the"},{"speaker":"Charles Goldfarb","startTime":1735.86,"endTime":1739.25,"body":"volar plate on each side. So"},{"speaker":"Charles Goldfarb","startTime":1735.86,"endTime":1739.25,"body":"you're working back and forth"},{"speaker":"Charles Goldfarb","startTime":1739.37,"endTime":1741.8,"body":"with your tendons to get the"},{"speaker":"Charles Goldfarb","startTime":1739.37,"endTime":1741.8,"body":"exposure that you need while"},{"speaker":"Charles Goldfarb","startTime":1741.8,"endTime":1743.93,"body":"obviously protecting your"},{"speaker":"Charles Goldfarb","startTime":1741.8,"endTime":1743.93,"body":"neurovascular bundles."},{"speaker":"Chris Dy","startTime":1744.199,"endTime":1747.139,"body":"So how do you how do"},{"speaker":"Chris Dy","startTime":1744.199,"endTime":1747.139,"body":"you handle the tendons? Do you,"},{"speaker":"Chris Dy","startTime":1747.439,"endTime":1749.569,"body":"you know, in terms of"},{"speaker":"Chris Dy","startTime":1747.439,"endTime":1749.569,"body":"manipulating them to get where"},{"speaker":"Chris Dy","startTime":1749.569,"endTime":1750.589,"body":"you need to go on the finger."},{"speaker":"Charles Goldfarb","startTime":1751.08,"endTime":1752.43,"body":"Yeah, I think"},{"speaker":"Charles Goldfarb","startTime":1751.08,"endTime":1752.43,"body":"this goes back to when we've"},{"speaker":"Charles Goldfarb","startTime":1752.43,"endTime":1755.37,"body":"talked about flexor tendon"},{"speaker":"Charles Goldfarb","startTime":1752.43,"endTime":1755.37,"body":"repair, you know, typically, or"},{"speaker":"Charles Goldfarb","startTime":1755.37,"endTime":1758.19,"body":"historically, I might just open"},{"speaker":"Charles Goldfarb","startTime":1755.37,"endTime":1758.19,"body":"the flexor sheath between a two"},{"speaker":"Charles Goldfarb","startTime":1758.19,"endTime":1762.3,"body":"and a four. And that's a great"},{"speaker":"Charles Goldfarb","startTime":1758.19,"endTime":1762.3,"body":"way to expose the flexor tendons"},{"speaker":"Charles Goldfarb","startTime":1762.33,"endTime":1765.96,"body":"and to allow them sufficient"},{"speaker":"Charles Goldfarb","startTime":1762.33,"endTime":1765.96,"body":"mobility to get out of the way"},{"speaker":"Charles Goldfarb","startTime":1765.96,"endTime":1769.65,"body":"for exposure of the volar plate."},{"speaker":"Charles Goldfarb","startTime":1765.96,"endTime":1769.65,"body":"But if you've done a tenolysis"},{"speaker":"Charles Goldfarb","startTime":1769.77,"endTime":1772.47,"body":"and you know your sheath may not"},{"speaker":"Charles Goldfarb","startTime":1769.77,"endTime":1772.47,"body":"be what you want it to be, you"},{"speaker":"Charles Goldfarb","startTime":1772.47,"endTime":1776.58,"body":"have to be careful not to over"},{"speaker":"Charles Goldfarb","startTime":1772.47,"endTime":1776.58,"body":"release the pulley system. But"},{"speaker":"Charles Goldfarb","startTime":1776.67,"endTime":1779.13,"body":"let's say that's what you've"},{"speaker":"Charles Goldfarb","startTime":1776.67,"endTime":1779.13,"body":"done. So you have exposure"},{"speaker":"Charles Goldfarb","startTime":1779.13,"endTime":1783.36,"body":"between A two and A four. So if"},{"speaker":"Charles Goldfarb","startTime":1779.13,"endTime":1783.36,"body":"you really C one, A three and C"},{"speaker":"Charles Goldfarb","startTime":1783.36,"endTime":1787.53,"body":"two, you're looking at tendons,"},{"speaker":"Charles Goldfarb","startTime":1783.36,"endTime":1787.53,"body":"they're gliding nicely, and it's"},{"speaker":"Charles Goldfarb","startTime":1787.8,"endTime":1790.74,"body":"for that it's I feel like it's"},{"speaker":"Charles Goldfarb","startTime":1787.8,"endTime":1790.74,"body":"pretty straightforward. You"},{"speaker":"Charles Goldfarb","startTime":1790.74,"endTime":1794.76,"body":"retract the tendons with a"},{"speaker":"Charles Goldfarb","startTime":1790.74,"endTime":1794.76,"body":"ragnell retractor radially or"},{"speaker":"Charles Goldfarb","startTime":1794.79,"endTime":1798.93,"body":"ulnarly, and you expose your"},{"speaker":"Charles Goldfarb","startTime":1794.79,"endTime":1798.93,"body":"volar plate and expose either"},{"speaker":"Charles Goldfarb","startTime":1798.93,"endTime":1802.11,"body":"side of the Secondary collateral"},{"speaker":"Charles Goldfarb","startTime":1798.93,"endTime":1802.11,"body":"insertion into the volar plate."},{"speaker":"Chris Dy","startTime":1802.89,"endTime":1806.01,"body":"So I want to we'll get"},{"speaker":"Chris Dy","startTime":1802.89,"endTime":1806.01,"body":"into some details with Macy on"},{"speaker":"Chris Dy","startTime":1806.01,"endTime":1809.7,"body":"the therapy aspects. But how do"},{"speaker":"Chris Dy","startTime":1806.01,"endTime":1809.7,"body":"you counsel people about what"},{"speaker":"Chris Dy","startTime":1809.76,"endTime":1812.49,"body":"they're going to get at the end"},{"speaker":"Chris Dy","startTime":1809.76,"endTime":1812.49,"body":"of this? I remember, you know,"},{"speaker":"Chris Dy","startTime":1812.49,"endTime":1814.92,"body":"some of our partners when I was"},{"speaker":"Chris Dy","startTime":1812.49,"endTime":1814.92,"body":"training with them kind of"},{"speaker":"Chris Dy","startTime":1814.92,"endTime":1818.25,"body":"telling people, look, we can do"},{"speaker":"Chris Dy","startTime":1814.92,"endTime":1818.25,"body":"all this work. It look great,"},{"speaker":"Chris Dy","startTime":1818.25,"endTime":1821.37,"body":"probably right. After when you"},{"speaker":"Chris Dy","startTime":1818.25,"endTime":1821.37,"body":"leave the OR, but you're not"},{"speaker":"Chris Dy","startTime":1821.37,"endTime":1825.0,"body":"going to keep all of it. How do"},{"speaker":"Chris Dy","startTime":1821.37,"endTime":1825.0,"body":"you navigate that discussion?"},{"speaker":"Charles Goldfarb","startTime":1825.72,"endTime":1828.33,"body":"Yeah, you"},{"speaker":"Charles Goldfarb","startTime":1825.72,"endTime":1828.33,"body":"know, one of one of my lines in"},{"speaker":"Charles Goldfarb","startTime":1828.33,"endTime":1831.78,"body":"clinic meal, we all have our"},{"speaker":"Charles Goldfarb","startTime":1828.33,"endTime":1831.78,"body":"lines. One of my lines is we as"},{"speaker":"Charles Goldfarb","startTime":1831.78,"endTime":1834.27,"body":"surgeons cannot control the"},{"speaker":"Charles Goldfarb","startTime":1831.78,"endTime":1834.27,"body":"production of scar tissue,"},{"speaker":"Charles Goldfarb","startTime":1834.48,"endTime":1837.99,"body":"eventually, we'll be able to, I"},{"speaker":"Charles Goldfarb","startTime":1834.48,"endTime":1837.99,"body":"say, but we can't today. And so"},{"speaker":"Charles Goldfarb","startTime":1837.99,"endTime":1842.7,"body":"our only control is doing a good"},{"speaker":"Charles Goldfarb","startTime":1837.99,"endTime":1842.7,"body":"job in the OR in starting"},{"speaker":"Charles Goldfarb","startTime":1842.7,"endTime":1846.57,"body":"therapy as soon as possible. And"},{"speaker":"Charles Goldfarb","startTime":1842.7,"endTime":1846.57,"body":"so you're right, I don't promise"},{"speaker":"Charles Goldfarb","startTime":1846.63,"endTime":1850.35,"body":"a finger that straightens fully"},{"speaker":"Charles Goldfarb","startTime":1846.63,"endTime":1850.35,"body":"in a DPC or district Palmer"},{"speaker":"Charles Goldfarb","startTime":1850.35,"endTime":1854.25,"body":"crease measurement of zero. But"},{"speaker":"Charles Goldfarb","startTime":1850.35,"endTime":1854.25,"body":"that's what I hope for. So I"},{"speaker":"Charles Goldfarb","startTime":1854.25,"endTime":1857.49,"body":"tell them that I hope to not"},{"speaker":"Charles Goldfarb","startTime":1854.25,"endTime":1857.49,"body":"leave the OR without having full"},{"speaker":"Charles Goldfarb","startTime":1857.49,"endTime":1861.0,"body":"motion. But if you keep most of"},{"speaker":"Charles Goldfarb","startTime":1857.49,"endTime":1861.0,"body":"it, and I'm usually pretty"},{"speaker":"Charles Goldfarb","startTime":1861.0,"endTime":1864.3,"body":"vague, it's certainly more than"},{"speaker":"Charles Goldfarb","startTime":1861.0,"endTime":1864.3,"body":"50%, I would be disappointed if"},{"speaker":"Charles Goldfarb","startTime":1864.3,"endTime":1867.51,"body":"I only keep 50% of the"},{"speaker":"Charles Goldfarb","startTime":1864.3,"endTime":1867.51,"body":"improvement. But I hope for at"},{"speaker":"Charles Goldfarb","startTime":1867.51,"endTime":1870.72,"body":"least 75% improvement to be"},{"speaker":"Charles Goldfarb","startTime":1867.51,"endTime":1870.72,"body":"maintained. And sometimes it's"},{"speaker":"Charles Goldfarb","startTime":1870.72,"endTime":1875.43,"body":"more, it really depends on the"},{"speaker":"Charles Goldfarb","startTime":1870.72,"endTime":1875.43,"body":"nature of the problem. If it"},{"speaker":"Charles Goldfarb","startTime":1875.43,"endTime":1879.06,"body":"truly is a spot weld, this is"},{"speaker":"Charles Goldfarb","startTime":1875.43,"endTime":1879.06,"body":"straightforward released. And I"},{"speaker":"Charles Goldfarb","startTime":1879.06,"endTime":1881.64,"body":"hope they keep it all. And I"},{"speaker":"Charles Goldfarb","startTime":1879.06,"endTime":1881.64,"body":"expect them to keep it all. But"},{"speaker":"Charles Goldfarb","startTime":1881.64,"endTime":1884.37,"body":"often, if it's more complicated,"},{"speaker":"Charles Goldfarb","startTime":1881.64,"endTime":1884.37,"body":"it's not going to be as good."},{"speaker":"Chris Dy","startTime":1885.03,"endTime":1887.19,"body":"So what's your"},{"speaker":"Chris Dy","startTime":1885.03,"endTime":1887.19,"body":"dressing like any or after"},{"speaker":"Chris Dy","startTime":1887.19,"endTime":1889.26,"body":"you've done the procedure you"},{"speaker":"Chris Dy","startTime":1887.19,"endTime":1889.26,"body":"describe?"},{"speaker":"Charles Goldfarb","startTime":1889.92,"endTime":1891.96,"body":"Yeah, it"},{"speaker":"Charles Goldfarb","startTime":1889.92,"endTime":1891.96,"body":"depends a little bit on how hard"},{"speaker":"Charles Goldfarb","startTime":1891.96,"endTime":1895.92,"body":"I work. If I work hard, I"},{"speaker":"Charles Goldfarb","startTime":1891.96,"endTime":1895.92,"body":"typically operate on Wednesdays"},{"speaker":"Charles Goldfarb","startTime":1895.92,"endTime":1899.34,"body":"for cases like this. If I work"},{"speaker":"Charles Goldfarb","startTime":1895.92,"endTime":1899.34,"body":"hard, I'll put them in a resting"},{"speaker":"Charles Goldfarb","startTime":1899.67,"endTime":1905.07,"body":"splint. And let them sit till"},{"speaker":"Charles Goldfarb","startTime":1899.67,"endTime":1905.07,"body":"Friday, maybe Monday. If I don't"},{"speaker":"Charles Goldfarb","startTime":1905.07,"endTime":1907.35,"body":"work hard, it's just a soft"},{"speaker":"Charles Goldfarb","startTime":1905.07,"endTime":1907.35,"body":"dressing and start therapy the"},{"speaker":"Charles Goldfarb","startTime":1907.35,"endTime":1910.77,"body":"next day. And the idea being let"},{"speaker":"Charles Goldfarb","startTime":1907.35,"endTime":1910.77,"body":"things calm down a little bit."},{"speaker":"Charles Goldfarb","startTime":1911.16,"endTime":1914.07,"body":"Before we get them back into"},{"speaker":"Charles Goldfarb","startTime":1911.16,"endTime":1914.07,"body":"therapy. How do you how do you"},{"speaker":"Charles Goldfarb","startTime":1914.07,"endTime":1914.67,"body":"approach that?"},{"speaker":"Chris Dy","startTime":1915.32,"endTime":1918.5,"body":"Yeah, I tend to go off"},{"speaker":"Chris Dy","startTime":1915.32,"endTime":1918.5,"body":"of the all the flexor tendon"},{"speaker":"Chris Dy","startTime":1918.5,"endTime":1921.62,"body":"kind of edema work, and I will"},{"speaker":"Chris Dy","startTime":1918.5,"endTime":1921.62,"body":"typically have them in 48 hours"},{"speaker":"Chris Dy","startTime":1921.62,"endTime":1924.83,"body":"afterwards, you know, at least"},{"speaker":"Chris Dy","startTime":1921.62,"endTime":1924.83,"body":"to get the dressings down and to"},{"speaker":"Chris Dy","startTime":1924.83,"endTime":1928.52,"body":"start the process with therapy."},{"speaker":"Chris Dy","startTime":1924.83,"endTime":1928.52,"body":"I think that that post operative"},{"speaker":"Chris Dy","startTime":1928.55,"endTime":1932.0,"body":"edema doesn't really quite take"},{"speaker":"Chris Dy","startTime":1928.55,"endTime":1932.0,"body":"a turn down until about 72"},{"speaker":"Chris Dy","startTime":1932.0,"endTime":1936.83,"body":"hours. But you know, it really"},{"speaker":"Chris Dy","startTime":1932.0,"endTime":1936.83,"body":"is good to I think start the"},{"speaker":"Chris Dy","startTime":1936.83,"endTime":1940.94,"body":"process of just re familiarizing"},{"speaker":"Chris Dy","startTime":1936.83,"endTime":1940.94,"body":"the patient with their finger."},{"speaker":"Chris Dy","startTime":1941.63,"endTime":1944.72,"body":"So not that dissimilar. I try to"},{"speaker":"Chris Dy","startTime":1941.63,"endTime":1944.72,"body":"do soft dressings when I can if"},{"speaker":"Chris Dy","startTime":1944.72,"endTime":1947.51,"body":"I'm not trying to protect any,"},{"speaker":"Chris Dy","startTime":1944.72,"endTime":1947.51,"body":"you know, because at this point,"},{"speaker":"Chris Dy","startTime":1947.51,"endTime":1949.34,"body":"you're not doing any"},{"speaker":"Chris Dy","startTime":1947.51,"endTime":1949.34,"body":"tenorrhaphies, you're not doing"},{"speaker":"Chris Dy","startTime":1949.34,"endTime":1953.33,"body":"any osteosynthesis. So you're"},{"speaker":"Chris Dy","startTime":1949.34,"endTime":1953.33,"body":"not really needing big bulky"},{"speaker":"Chris Dy","startTime":1953.33,"endTime":1955.61,"body":"splints that can create their"},{"speaker":"Chris Dy","startTime":1953.33,"endTime":1955.61,"body":"own issues."},{"speaker":"Charles Goldfarb","startTime":1956.06,"endTime":1957.41,"body":"Yeah, and"},{"speaker":"Charles Goldfarb","startTime":1956.06,"endTime":1957.41,"body":"let's be clear about one of the"},{"speaker":"Charles Goldfarb","startTime":1957.41,"endTime":1961.25,"body":"things I almost You know, it"},{"speaker":"Charles Goldfarb","startTime":1957.41,"endTime":1961.25,"body":"sounds we used to think about if"},{"speaker":"Charles Goldfarb","startTime":1961.25,"endTime":1964.7,"body":"we had a significant volar play"},{"speaker":"Charles Goldfarb","startTime":1961.25,"endTime":1964.7,"body":"contracture in a finger in a"},{"speaker":"Charles Goldfarb","startTime":1964.7,"endTime":1969.02,"body":"markedly flexed position. Some"},{"speaker":"Charles Goldfarb","startTime":1964.7,"endTime":1969.02,"body":"might have advocated for pinning"},{"speaker":"Charles Goldfarb","startTime":1969.02,"endTime":1972.77,"body":"the finger and extension to let"},{"speaker":"Charles Goldfarb","startTime":1969.02,"endTime":1972.77,"body":"the soft tissues relax for a"},{"speaker":"Charles Goldfarb","startTime":1972.77,"endTime":1976.97,"body":"week or two weeks. And I want to"},{"speaker":"Charles Goldfarb","startTime":1972.77,"endTime":1976.97,"body":"be clear, I do not do that"},{"speaker":"Charles Goldfarb","startTime":1976.97,"endTime":1980.06,"body":"anymore. I do not think it's"},{"speaker":"Charles Goldfarb","startTime":1976.97,"endTime":1980.06,"body":"helpful, I think it might be"},{"speaker":"Charles Goldfarb","startTime":1980.06,"endTime":1983.18,"body":"harmful. And so I personally"},{"speaker":"Charles Goldfarb","startTime":1980.06,"endTime":1983.18,"body":"don't believe in that approach."},{"speaker":"Charles Goldfarb","startTime":1983.18,"endTime":1987.11,"body":"I like to get the finger"},{"speaker":"Charles Goldfarb","startTime":1983.18,"endTime":1987.11,"body":"mobilize, and let my therapy"},{"speaker":"Charles Goldfarb","startTime":1987.11,"endTime":1990.74,"body":"colleagues splint in different"},{"speaker":"Charles Goldfarb","startTime":1987.11,"endTime":1990.74,"body":"positions after those few days,"},{"speaker":"Charles Goldfarb","startTime":1990.86,"endTime":1994.01,"body":"you know, a couple days later,"},{"speaker":"Charles Goldfarb","startTime":1990.86,"endTime":1994.01,"body":"but I don't pin Do you ever? Not"},{"speaker":"Charles Goldfarb","startTime":1994.01,"endTime":1995.81,"body":"ever, but do you regularly pin?"},{"speaker":"Chris Dy","startTime":1996.74,"endTime":1999.53,"body":"You know, I remember"},{"speaker":"Chris Dy","startTime":1996.74,"endTime":1999.53,"body":"starting out in practice, and I"},{"speaker":"Chris Dy","startTime":1999.53,"endTime":2002.92,"body":"pinned a couple of Dupuytren's,"},{"speaker":"Chris Dy","startTime":1999.53,"endTime":2002.92,"body":"you know, that I had released"},{"speaker":"Chris Dy","startTime":2002.92,"endTime":2005.68,"body":"and I don't really think added a"},{"speaker":"Chris Dy","startTime":2002.92,"endTime":2005.68,"body":"whole lot to be honest with you."},{"speaker":"Chris Dy","startTime":2005.68,"endTime":2009.31,"body":"And it just led to stiffness,"},{"speaker":"Chris Dy","startTime":2005.68,"endTime":2009.31,"body":"which was obviously, you know,"},{"speaker":"Chris Dy","startTime":2009.46,"endTime":2013.03,"body":"in that particular setting, not"},{"speaker":"Chris Dy","startTime":2009.46,"endTime":2013.03,"body":"very helpful. You know, do you"},{"speaker":"Chris Dy","startTime":2013.03,"endTime":2016.93,"body":"think it's the trauma from the"},{"speaker":"Chris Dy","startTime":2013.03,"endTime":2016.93,"body":"actual pin? Or do you think it's"},{"speaker":"Chris Dy","startTime":2016.93,"endTime":2020.38,"body":"the fact that they're not moving"},{"speaker":"Chris Dy","startTime":2016.93,"endTime":2020.38,"body":"there, that joint, and it's"},{"speaker":"Chris Dy","startTime":2020.38,"endTime":2024.04,"body":"leading to accumulation of fluid"},{"speaker":"Chris Dy","startTime":2020.38,"endTime":2024.04,"body":"and lack of, you know, you know,"},{"speaker":"Chris Dy","startTime":2024.07,"endTime":2025.84,"body":"the edema being pumped out of"},{"speaker":"Chris Dy","startTime":2024.07,"endTime":2025.84,"body":"the finger?"},{"speaker":"Charles Goldfarb","startTime":2025.99,"endTime":2027.97,"body":"I think it's"},{"speaker":"Charles Goldfarb","startTime":2025.99,"endTime":2027.97,"body":"the latter. I think the earlier"},{"speaker":"Charles Goldfarb","startTime":2027.97,"endTime":2030.58,"body":"you get them moving, the better"},{"speaker":"Charles Goldfarb","startTime":2027.97,"endTime":2030.58,"body":"and just quote unquote, resting"},{"speaker":"Charles Goldfarb","startTime":2030.58,"endTime":2034.0,"body":"the finger is not as effective"},{"speaker":"Charles Goldfarb","startTime":2030.58,"endTime":2034.0,"body":"as getting it moving."},{"speaker":"Chris Dy","startTime":2034.57,"endTime":2036.73,"body":"So you set the stage"},{"speaker":"Chris Dy","startTime":2034.57,"endTime":2036.73,"body":"for Macy to join us."},{"speaker":"Charles Goldfarb","startTime":2037.06,"endTime":2039.49,"body":"Absolutely. So"},{"speaker":"Charles Goldfarb","startTime":2037.06,"endTime":2039.49,"body":"Macy is going to enlighten you"},{"speaker":"Charles Goldfarb","startTime":2039.55,"endTime":2043.84,"body":"and me and all of us about how"},{"speaker":"Charles Goldfarb","startTime":2039.55,"endTime":2043.84,"body":"she approaches the recovery from"},{"speaker":"Charles Goldfarb","startTime":2043.84,"endTime":2045.4,"body":"the stiff finger and I'm really"},{"speaker":"Charles Goldfarb","startTime":2043.84,"endTime":2045.4,"body":"looking forward to it."},{"speaker":"Chris Dy","startTime":2045.88,"endTime":2047.53,"body":"Fantastic. Well I'll"},{"speaker":"Chris Dy","startTime":2045.88,"endTime":2047.53,"body":"see you next time."},{"speaker":"Charles Goldfarb","startTime":2047.83,"endTime":2048.67,"body":"All right."},{"speaker":"Charles Goldfarb","startTime":2047.83,"endTime":2048.67,"body":"Have a great night."},{"speaker":"Chris Dy","startTime":2048.91,"endTime":2049.45,"body":"You too."},{"speaker":"Charles Goldfarb","startTime":2050.17,"endTime":2052.15,"body":"Hey, Chris,"},{"speaker":"Charles Goldfarb","startTime":2050.17,"endTime":2052.15,"body":"that was fun. Let's do it again"},{"speaker":"Charles Goldfarb","startTime":2052.15,"endTime":2052.66,"body":"real soon."},{"speaker":"Chris Dy","startTime":2052.93,"endTime":2055.45,"body":"Sounds good. Well, be"},{"speaker":"Chris Dy","startTime":2052.93,"endTime":2055.45,"body":"sure to check us out on Twitter"},{"speaker":"Chris Dy","startTime":2055.69,"endTime":2057.91,"body":"@Handpodcast. Hey, Chuck, what's"},{"speaker":"Chris Dy","startTime":2055.69,"endTime":2057.91,"body":"your Twitter handle?"},{"speaker":"Charles Goldfarb","startTime":2058.21,"endTime":2061.06,"body":"Mine is"},{"speaker":"Charles Goldfarb","startTime":2058.21,"endTime":2061.06,"body":"@congenitalhand. What about you?"},{"speaker":"Chris Dy","startTime":2061.21,"endTime":2064.6,"body":"Mine is @ChrisDyMD"},{"speaker":"Chris Dy","startTime":2061.21,"endTime":2064.6,"body":"spelled d y. And if you'd like"},{"speaker":"Chris Dy","startTime":2064.6,"endTime":2067.87,"body":"to email us, you can reach us at"},{"speaker":"Chris Dy","startTime":2064.6,"endTime":2067.87,"body":"handpodcast@gmail.com."},{"speaker":"Charles Goldfarb","startTime":2069.01,"endTime":2071.17,"body":"And remember,"},{"speaker":"Charles Goldfarb","startTime":2069.01,"endTime":2071.17,"body":"please subscribe wherever you"},{"speaker":"Charles Goldfarb","startTime":2071.17,"endTime":2072.25,"body":"get your podcast"},{"speaker":"Chris Dy","startTime":2072.28,"endTime":2074.5,"body":"and be sure to leave a"},{"speaker":"Chris Dy","startTime":2072.28,"endTime":2074.5,"body":"review that helps us get the"},{"speaker":"Chris Dy","startTime":2074.5,"endTime":2074.89,"body":"word out."},{"speaker":"Charles Goldfarb","startTime":2075.28,"endTime":2077.59,"body":"Special thanks"},{"speaker":"Charles Goldfarb","startTime":2075.28,"endTime":2077.59,"body":"to Peter Martin for the amazing"},{"speaker":"Charles Goldfarb","startTime":2077.59,"endTime":2081.55,"body":"music. And remember, keep the"},{"speaker":"Charles Goldfarb","startTime":2077.59,"endTime":2081.55,"body":"upper hand. Come back next time."}]}