{"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":21.45,"body":"surgery from technical to"},{"speaker":"Chris Dy","startTime":19.65,"endTime":21.45,"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":28.2,"endTime":29.25,"body":"Oh, hey,"},{"speaker":"Charles Goldfarb","startTime":28.2,"endTime":29.25,"body":"Chris."},{"speaker":"Chris Dy","startTime":29.85,"endTime":30.93,"body":"Hey, Chuck, how are"},{"speaker":"Chris Dy","startTime":29.85,"endTime":30.93,"body":"you?"},{"speaker":"Charles Goldfarb","startTime":31.35,"endTime":33.09,"body":"I'm doing"},{"speaker":"Charles Goldfarb","startTime":31.35,"endTime":33.09,"body":"really well. How are you today?"},{"speaker":"Chris Dy","startTime":33.42,"endTime":37.44,"body":"I am well it is. I'm"},{"speaker":"Chris Dy","startTime":33.42,"endTime":37.44,"body":"visiting family in Houston,"},{"speaker":"Chris Dy","startTime":37.44,"endTime":42.06,"body":"Texas. And it is god awfully"},{"speaker":"Chris Dy","startTime":37.44,"endTime":42.06,"body":"humid here. It is very different"},{"speaker":"Chris Dy","startTime":42.06,"endTime":42.96,"body":"than St. Louis."},{"speaker":"Charles Goldfarb","startTime":43.2,"endTime":45.36,"body":"Summer in"},{"speaker":"Charles Goldfarb","startTime":43.2,"endTime":45.36,"body":"Texas. And people think St."},{"speaker":"Charles Goldfarb","startTime":45.36,"endTime":46.11,"body":"Louis is hot."},{"speaker":"Chris Dy","startTime":47.1,"endTime":49.5,"body":"Yeah, no, but I have"},{"speaker":"Chris Dy","startTime":47.1,"endTime":49.5,"body":"been spending some nice quality"},{"speaker":"Chris Dy","startTime":49.5,"endTime":53.16,"body":"time at the at the pool with the"},{"speaker":"Chris Dy","startTime":49.5,"endTime":53.16,"body":"kids. My son is essentially a"},{"speaker":"Chris Dy","startTime":53.16,"endTime":56.01,"body":"fish now. He can swim on his"},{"speaker":"Chris Dy","startTime":53.16,"endTime":56.01,"body":"own, which as you remember is"},{"speaker":"Chris Dy","startTime":56.01,"endTime":59.1,"body":"very different than last summer."},{"speaker":"Chris Dy","startTime":56.01,"endTime":59.1,"body":"So now I'm working on a three"},{"speaker":"Chris Dy","startTime":59.1,"endTime":59.49,"body":"year old."},{"speaker":"Charles Goldfarb","startTime":60.23,"endTime":62.72,"body":"I love it."},{"speaker":"Charles Goldfarb","startTime":60.23,"endTime":62.72,"body":"Well, we have a really special"},{"speaker":"Charles Goldfarb","startTime":62.72,"endTime":68.36,"body":"guest today who can absolutely"},{"speaker":"Charles Goldfarb","startTime":62.72,"endTime":68.36,"body":"relate to hot because she was"},{"speaker":"Charles Goldfarb","startTime":68.36,"endTime":73.1,"body":"born in the really warm climate."},{"speaker":"Charles Goldfarb","startTime":68.36,"endTime":73.1,"body":"I think she was born in"},{"speaker":"Charles Goldfarb","startTime":73.13,"endTime":77.06,"body":"Birmingham, Alabama. I know she"},{"speaker":"Charles Goldfarb","startTime":73.13,"endTime":77.06,"body":"grew up there. So we are lucky"},{"speaker":"Charles Goldfarb","startTime":77.06,"endTime":79.31,"body":"enough to have Macy Stonner back"},{"speaker":"Charles Goldfarb","startTime":77.06,"endTime":79.31,"body":"with us."},{"speaker":"Chris Dy","startTime":79.76,"endTime":81.11,"body":"By popular demand."},{"speaker":"Charles Goldfarb","startTime":81.26,"endTime":85.22,"body":"By popular"},{"speaker":"Charles Goldfarb","startTime":81.26,"endTime":85.22,"body":"demand for sure. Welcome back."},{"speaker":"Macy Stonner","startTime":85.55,"endTime":87.29,"body":"Thank you so much"},{"speaker":"Macy Stonner","startTime":85.55,"endTime":87.29,"body":"for having me back. It's a"},{"speaker":"Macy Stonner","startTime":87.29,"endTime":87.8,"body":"pleasure."},{"speaker":"Charles Goldfarb","startTime":87.86,"endTime":90.59,"body":"So Macy, for"},{"speaker":"Charles Goldfarb","startTime":87.86,"endTime":90.59,"body":"those of you who maybe have"},{"speaker":"Charles Goldfarb","startTime":90.59,"endTime":94.58,"body":"tuned in and hadn't caught all"},{"speaker":"Charles Goldfarb","startTime":90.59,"endTime":94.58,"body":"the back episodes is a wonderful"},{"speaker":"Charles Goldfarb","startTime":94.58,"endTime":98.33,"body":"occupational therapist. And it"},{"speaker":"Charles Goldfarb","startTime":94.58,"endTime":98.33,"body":"really we should be addressing"},{"speaker":"Charles Goldfarb","startTime":98.33,"endTime":99.98,"body":"her is Dr. Stonner."},{"speaker":"Macy Stonner","startTime":100.07,"endTime":101.48,"body":"That's definitely"},{"speaker":"Macy Stonner","startTime":100.07,"endTime":101.48,"body":"not necessarily."},{"speaker":"Chris Dy","startTime":102.41,"endTime":104.45,"body":"Her parents are"},{"speaker":"Chris Dy","startTime":102.41,"endTime":104.45,"body":"probably like, Yes, of course."},{"speaker":"Chris Dy","startTime":104.45,"endTime":105.71,"body":"Why would you not call her"},{"speaker":"Chris Dy","startTime":104.45,"endTime":105.71,"body":"Doctor."},{"speaker":"Macy Stonner","startTime":105.83,"endTime":107.96,"body":"They actually"},{"speaker":"Macy Stonner","startTime":105.83,"endTime":107.96,"body":"would say that. But no, not for"},{"speaker":"Macy Stonner","startTime":107.96,"endTime":108.26,"body":"me."},{"speaker":"Charles Goldfarb","startTime":108.38,"endTime":110.18,"body":"Oh, Chris"},{"speaker":"Charles Goldfarb","startTime":108.38,"endTime":110.18,"body":"wants me to call him Dr. Dy and"},{"speaker":"Charles Goldfarb","startTime":110.18,"endTime":111.86,"body":"I just had I don't know, I don't"},{"speaker":"Charles Goldfarb","startTime":110.18,"endTime":111.86,"body":"know."},{"speaker":"Chris Dy","startTime":113.48,"endTime":116.21,"body":"Well, Macy thank you"},{"speaker":"Chris Dy","startTime":113.48,"endTime":116.21,"body":"for joining us. We're gonna do a"},{"speaker":"Chris Dy","startTime":116.21,"endTime":119.93,"body":"nice follow up on our prior"},{"speaker":"Chris Dy","startTime":116.21,"endTime":119.93,"body":"stiff finger episode. But before"},{"speaker":"Chris Dy","startTime":119.93,"endTime":123.05,"body":"we get rolling, if you let us"},{"speaker":"Chris Dy","startTime":119.93,"endTime":123.05,"body":"just kind of read a review and"},{"speaker":"Chris Dy","startTime":123.05,"endTime":126.11,"body":"maybe bring up a case"},{"speaker":"Chris Dy","startTime":123.05,"endTime":126.11,"body":"presentation that I think will"},{"speaker":"Chris Dy","startTime":126.11,"endTime":130.91,"body":"start the discussion. So thank"},{"speaker":"Chris Dy","startTime":126.11,"endTime":130.91,"body":"you to BrittMitchOTRL for this"},{"speaker":"Chris Dy","startTime":130.91,"endTime":134.12,"body":"great review that you left five"},{"speaker":"Chris Dy","startTime":130.91,"endTime":134.12,"body":"stars The only way to do it, and"},{"speaker":"Chris Dy","startTime":134.12,"endTime":136.76,"body":"she actually left questions, so"},{"speaker":"Chris Dy","startTime":134.12,"endTime":136.76,"body":"we have to answer them on the"},{"speaker":"Chris Dy","startTime":136.76,"endTime":140.48,"body":"air. But says Chris, and Chuck,"},{"speaker":"Chris Dy","startTime":136.76,"endTime":140.48,"body":"I am an OT who is working in a"},{"speaker":"Chris Dy","startTime":140.48,"endTime":143.33,"body":"hospital based orthopedic hand"},{"speaker":"Chris Dy","startTime":140.48,"endTime":143.33,"body":"clinic, I am two years into my"},{"speaker":"Chris Dy","startTime":143.33,"endTime":147.02,"body":"journey to become a CHD. That's"},{"speaker":"Chris Dy","startTime":143.33,"endTime":147.02,"body":"awesome. Good for you. I've been"},{"speaker":"Chris Dy","startTime":147.02,"endTime":150.23,"body":"a practicing OT for five and a"},{"speaker":"Chris Dy","startTime":147.02,"endTime":150.23,"body":"half years. I want to thank you"},{"speaker":"Chris Dy","startTime":150.23,"endTime":153.23,"body":"all so much for taking the time"},{"speaker":"Chris Dy","startTime":150.23,"endTime":153.23,"body":"to have a podcast dedicated to"},{"speaker":"Chris Dy","startTime":153.23,"endTime":156.74,"body":"hand surgery. I listened to your"},{"speaker":"Chris Dy","startTime":153.23,"endTime":156.74,"body":"podcast every time I'm driving"},{"speaker":"Chris Dy","startTime":156.74,"endTime":159.53,"body":"into work and taking my young"},{"speaker":"Chris Dy","startTime":156.74,"endTime":159.53,"body":"kids to their swim lessons."},{"speaker":"Chris Dy","startTime":159.56,"endTime":162.2,"body":"There you go. I've done that"},{"speaker":"Chris Dy","startTime":159.56,"endTime":162.2,"body":"swim lesson thing many times."},{"speaker":"Chris Dy","startTime":162.2,"endTime":164.21,"body":"Now. Hopefully you're not"},{"speaker":"Chris Dy","startTime":162.2,"endTime":164.21,"body":"getting in the pool like I have"},{"speaker":"Chris Dy","startTime":164.21,"endTime":167.69,"body":"to. I have found it so helpful"},{"speaker":"Chris Dy","startTime":164.21,"endTime":167.69,"body":"for my studies and for"},{"speaker":"Chris Dy","startTime":167.69,"endTime":171.5,"body":"treatment. You are all awesome."},{"speaker":"Chris Dy","startTime":167.69,"endTime":171.5,"body":"I do have a couple questions if"},{"speaker":"Chris Dy","startTime":171.5,"endTime":173.45,"body":"you don't mind answering them."},{"speaker":"Chris Dy","startTime":171.5,"endTime":173.45,"body":"So let's take the first one,"},{"speaker":"Chris Dy","startTime":173.45,"endTime":176.33,"body":"Chuck, how often do you"},{"speaker":"Chris Dy","startTime":173.45,"endTime":176.33,"body":"communicate with your hand"},{"speaker":"Chris Dy","startTime":176.33,"endTime":179.81,"body":"therapists? Do you round with"},{"speaker":"Chris Dy","startTime":176.33,"endTime":179.81,"body":"your hand therapist? If so what"},{"speaker":"Chris Dy","startTime":179.81,"endTime":182.87,"body":"do you recommend on how to"},{"speaker":"Chris Dy","startTime":179.81,"endTime":182.87,"body":"implement rounding and or more"},{"speaker":"Chris Dy","startTime":182.87,"endTime":185.96,"body":"frequent communication? I find"},{"speaker":"Chris Dy","startTime":182.87,"endTime":185.96,"body":"it difficult to speak with the"},{"speaker":"Chris Dy","startTime":185.96,"endTime":189.35,"body":"hand surgeon I work with due to"},{"speaker":"Chris Dy","startTime":185.96,"endTime":189.35,"body":"them being so incredibly busy."},{"speaker":"Chris Dy","startTime":189.68,"endTime":190.49,"body":"Let's start with that."},{"speaker":"Charles Goldfarb","startTime":191.21,"endTime":192.92,"body":"Well, first of"},{"speaker":"Charles Goldfarb","startTime":191.21,"endTime":192.92,"body":"all, I'm not sure what this"},{"speaker":"Charles Goldfarb","startTime":192.92,"endTime":196.94,"body":"rounding thing is. I believe"},{"speaker":"Charles Goldfarb","startTime":192.92,"endTime":196.94,"body":"that's a reference to the"},{"speaker":"Charles Goldfarb","startTime":196.94,"endTime":201.5,"body":"hospital which I try to stay out"},{"speaker":"Charles Goldfarb","startTime":196.94,"endTime":201.5,"body":"of. But seriously, it is a"},{"speaker":"Charles Goldfarb","startTime":201.5,"endTime":206.06,"body":"really good question. So I am"},{"speaker":"Charles Goldfarb","startTime":201.5,"endTime":206.06,"body":"fortunate enough to a couple"},{"speaker":"Charles Goldfarb","startTime":206.06,"endTime":210.41,"body":"times a month work with Macy."},{"speaker":"Charles Goldfarb","startTime":206.06,"endTime":210.41,"body":"And weekly I work with Stacy"},{"speaker":"Charles Goldfarb","startTime":210.41,"endTime":214.4,"body":"Baker. And we obviously"},{"speaker":"Charles Goldfarb","startTime":210.41,"endTime":214.4,"body":"communicate during those times"},{"speaker":"Charles Goldfarb","startTime":214.4,"endTime":219.41,"body":"we are in clinic together. But I"},{"speaker":"Charles Goldfarb","startTime":214.4,"endTime":219.41,"body":"would say honestly, in some form"},{"speaker":"Charles Goldfarb","startTime":219.41,"endTime":221.96,"body":"or fashion, I have communication"},{"speaker":"Charles Goldfarb","startTime":219.41,"endTime":221.96,"body":"with a therapist every day,"},{"speaker":"Charles Goldfarb","startTime":222.65,"endTime":227.72,"body":"whether that's by email, by"},{"speaker":"Charles Goldfarb","startTime":222.65,"endTime":227.72,"body":"phone or in epic, we communicate"},{"speaker":"Charles Goldfarb","startTime":227.72,"endTime":232.13,"body":"and so to me, while I guess some"},{"speaker":"Charles Goldfarb","startTime":227.72,"endTime":232.13,"body":"might consider it an investment"},{"speaker":"Charles Goldfarb","startTime":232.13,"endTime":235.97,"body":"of time, it is a no brainer."},{"speaker":"Charles Goldfarb","startTime":232.13,"endTime":235.97,"body":"Because the therapists are"},{"speaker":"Charles Goldfarb","startTime":236.0,"endTime":239.06,"body":"working towards the same goal"},{"speaker":"Charles Goldfarb","startTime":236.0,"endTime":239.06,"body":"that I am, which is, you know,"},{"speaker":"Charles Goldfarb","startTime":239.09,"endTime":242.27,"body":"outcomes. Is that Is that how"},{"speaker":"Charles Goldfarb","startTime":239.09,"endTime":242.27,"body":"you think about it, Chris or and"},{"speaker":"Charles Goldfarb","startTime":242.27,"endTime":243.5,"body":"then maybe Macy could chime in."},{"speaker":"Chris Dy","startTime":244.55,"endTime":247.82,"body":"Yeah, I mean, I you"},{"speaker":"Chris Dy","startTime":244.55,"endTime":247.82,"body":"know, I don't spend much time in"},{"speaker":"Chris Dy","startTime":247.82,"endTime":250.61,"body":"the hospital with regards to"},{"speaker":"Chris Dy","startTime":247.82,"endTime":250.61,"body":"inpatient care, just by the"},{"speaker":"Chris Dy","startTime":250.61,"endTime":253.13,"body":"nature of the practice. I have,"},{"speaker":"Chris Dy","startTime":250.61,"endTime":253.13,"body":"you know, whenever we do have"},{"speaker":"Chris Dy","startTime":253.13,"endTime":256.61,"body":"somebody either you know,"},{"speaker":"Chris Dy","startTime":253.13,"endTime":256.61,"body":"somebody who's a trauma patient,"},{"speaker":"Chris Dy","startTime":257.69,"endTime":261.86,"body":"or a Plexus post op who stay in"},{"speaker":"Chris Dy","startTime":257.69,"endTime":261.86,"body":"the hospital, we do communicate"},{"speaker":"Chris Dy","startTime":261.86,"endTime":266.69,"body":"with our inpatient occupational"},{"speaker":"Chris Dy","startTime":261.86,"endTime":266.69,"body":"therapists, like Chuck, I work"},{"speaker":"Chris Dy","startTime":266.69,"endTime":270.29,"body":"in a model where I'm fortunate"},{"speaker":"Chris Dy","startTime":266.69,"endTime":270.29,"body":"enough to have had therapists in"},{"speaker":"Chris Dy","startTime":270.29,"endTime":273.71,"body":"our clinics at all times. So"},{"speaker":"Chris Dy","startTime":270.29,"endTime":273.71,"body":"that's been really useful in"},{"speaker":"Chris Dy","startTime":273.71,"endTime":277.16,"body":"terms of not only the expertise"},{"speaker":"Chris Dy","startTime":273.71,"endTime":277.16,"body":"that they bring to the clinic"},{"speaker":"Chris Dy","startTime":277.16,"endTime":282.32,"body":"sessions themselves, but also"},{"speaker":"Chris Dy","startTime":277.16,"endTime":282.32,"body":"the, the communication. It makes"},{"speaker":"Chris Dy","startTime":282.32,"endTime":285.47,"body":"it they're an extension of my"},{"speaker":"Chris Dy","startTime":282.32,"endTime":285.47,"body":"practice, in essence, although"},{"speaker":"Chris Dy","startTime":285.5,"endTime":287.78,"body":"you know, they are they're"},{"speaker":"Chris Dy","startTime":285.5,"endTime":287.78,"body":"definitely a distinct entity on"},{"speaker":"Chris Dy","startTime":287.78,"endTime":291.92,"body":"their own. It makes people think"},{"speaker":"Chris Dy","startTime":287.78,"endTime":291.92,"body":"that we are just this great"},{"speaker":"Chris Dy","startTime":291.92,"endTime":295.43,"body":"team, which we are, but"},{"speaker":"Chris Dy","startTime":291.92,"endTime":295.43,"body":"obviously, the optics of that"},{"speaker":"Chris Dy","startTime":295.43,"endTime":298.31,"body":"are super important. I guess in"},{"speaker":"Chris Dy","startTime":295.43,"endTime":298.31,"body":"terms of advice, you know, what"},{"speaker":"Chris Dy","startTime":298.31,"endTime":301.13,"body":"I on the surgeon side, what I"},{"speaker":"Chris Dy","startTime":298.31,"endTime":301.13,"body":"Tell all of our graduating"},{"speaker":"Chris Dy","startTime":301.13,"endTime":304.76,"body":"fellows is check out the hand"},{"speaker":"Chris Dy","startTime":301.13,"endTime":304.76,"body":"therapy environment where you're"},{"speaker":"Chris Dy","startTime":304.76,"endTime":307.28,"body":"going to start working. And if"},{"speaker":"Chris Dy","startTime":304.76,"endTime":307.28,"body":"you can try to find a way to"},{"speaker":"Chris Dy","startTime":307.28,"endTime":310.07,"body":"have a hand therapist seeing"},{"speaker":"Chris Dy","startTime":307.28,"endTime":310.07,"body":"patients with you in the clinic,"},{"speaker":"Chris Dy","startTime":310.31,"endTime":315.32,"body":"it's obviously an investment on"},{"speaker":"Chris Dy","startTime":310.31,"endTime":315.32,"body":"their end in terms of time that"},{"speaker":"Chris Dy","startTime":315.32,"endTime":318.92,"body":"they're not in the office, so"},{"speaker":"Chris Dy","startTime":315.32,"endTime":318.92,"body":"called opportunity cost. But the"},{"speaker":"Chris Dy","startTime":318.92,"endTime":321.38,"body":"relationships and the referrals"},{"speaker":"Chris Dy","startTime":318.92,"endTime":321.38,"body":"that come out of that I think"},{"speaker":"Chris Dy","startTime":321.38,"endTime":324.35,"body":"are super useful. Macy, what are"},{"speaker":"Chris Dy","startTime":321.38,"endTime":324.35,"body":"your What are your thoughts"},{"speaker":"Chris Dy","startTime":324.35,"endTime":326.03,"body":"about the communication aspect"},{"speaker":"Chris Dy","startTime":324.35,"endTime":326.03,"body":"of it?"},{"speaker":"Macy Stonner","startTime":327.86,"endTime":330.41,"body":"Well, I am"},{"speaker":"Macy Stonner","startTime":327.86,"endTime":330.41,"body":"incredibly spoiled, because the"},{"speaker":"Macy Stonner","startTime":330.41,"endTime":332.66,"body":"only job that I've ever had is"},{"speaker":"Macy Stonner","startTime":330.41,"endTime":332.66,"body":"at the Milliken Hand center"},{"speaker":"Macy Stonner","startTime":332.69,"endTime":335.03,"body":"where we collaborate very"},{"speaker":"Macy Stonner","startTime":332.69,"endTime":335.03,"body":"strongly with the physicians"},{"speaker":"Macy Stonner","startTime":335.03,"endTime":339.08,"body":"next door. And so I have been"},{"speaker":"Macy Stonner","startTime":335.03,"endTime":339.08,"body":"very spoiled with that"},{"speaker":"Macy Stonner","startTime":339.08,"endTime":342.77,"body":"relationship. And I really value"},{"speaker":"Macy Stonner","startTime":339.08,"endTime":342.77,"body":"it. One thing that I really love"},{"speaker":"Macy Stonner","startTime":342.77,"endTime":346.97,"body":"is, as you mentioned, the"},{"speaker":"Macy Stonner","startTime":342.77,"endTime":346.97,"body":"fellows Skye Halverson and Sandy"},{"speaker":"Macy Stonner","startTime":346.97,"endTime":349.79,"body":"Gephardt if you're listening, I"},{"speaker":"Macy Stonner","startTime":346.97,"endTime":349.79,"body":"love it when I get phone calls"},{"speaker":"Macy Stonner","startTime":349.79,"endTime":353.33,"body":"from old fellows to our to our"},{"speaker":"Macy Stonner","startTime":349.79,"endTime":353.33,"body":"hand center, and they're like,"},{"speaker":"Macy Stonner","startTime":353.33,"endTime":357.44,"body":"Hey, we're now have our own"},{"speaker":"Macy Stonner","startTime":353.33,"endTime":357.44,"body":"practice now. And we don't have"},{"speaker":"Macy Stonner","startTime":357.44,"endTime":359.33,"body":"a hand therapists on staff or I"},{"speaker":"Macy Stonner","startTime":357.44,"endTime":359.33,"body":"don't know them very well, can"},{"speaker":"Macy Stonner","startTime":359.33,"endTime":362.51,"body":"you tell me what you do for"},{"speaker":"Macy Stonner","startTime":359.33,"endTime":362.51,"body":"tendon transfers for XYZ or"},{"speaker":"Macy Stonner","startTime":362.51,"endTime":363.98,"body":"whatnot. And so it's just kind"},{"speaker":"Macy Stonner","startTime":362.51,"endTime":363.98,"body":"of fun."},{"speaker":"Chris Dy","startTime":364.16,"endTime":366.38,"body":"So let's go to"},{"speaker":"Chris Dy","startTime":364.16,"endTime":366.38,"body":"question number two. So"},{"speaker":"Chris Dy","startTime":366.38,"endTime":369.41,"body":"regarding the podcast about"},{"speaker":"Chris Dy","startTime":366.38,"endTime":369.41,"body":"nerve reps, what has been your"},{"speaker":"Chris Dy","startTime":369.41,"endTime":372.74,"body":"experience was with placental"},{"speaker":"Chris Dy","startTime":369.41,"endTime":372.74,"body":"graphs for wrapping nerves"},{"speaker":"Chris Dy","startTime":372.77,"endTime":377.3,"body":"successful or not successful in"},{"speaker":"Chris Dy","startTime":372.77,"endTime":377.3,"body":"reducing adhesions? I will say"},{"speaker":"Chris Dy","startTime":377.3,"endTime":381.56,"body":"I've read about this. But I have"},{"speaker":"Chris Dy","startTime":377.3,"endTime":381.56,"body":"not used placental grafts,"},{"speaker":"Chris Dy","startTime":381.56,"endTime":385.22,"body":"mainly, because I think I have"},{"speaker":"Chris Dy","startTime":381.56,"endTime":385.22,"body":"some better options. I typically"},{"speaker":"Chris Dy","startTime":385.22,"endTime":390.53,"body":"in some of these cases will go"},{"speaker":"Chris Dy","startTime":385.22,"endTime":390.53,"body":"with a autologous vein wrap as"},{"speaker":"Chris Dy","startTime":390.53,"endTime":392.87,"body":"opposed to a commercially"},{"speaker":"Chris Dy","startTime":390.53,"endTime":392.87,"body":"available wrap. And I know that"},{"speaker":"Chris Dy","startTime":393.59,"endTime":395.6,"body":"that's going to generate some"},{"speaker":"Chris Dy","startTime":393.59,"endTime":395.6,"body":"controversy, and we have some"},{"speaker":"Chris Dy","startTime":395.6,"endTime":399.59,"body":"sparring partners with regards"},{"speaker":"Chris Dy","startTime":395.6,"endTime":399.59,"body":"to that. But I haven't had to go"},{"speaker":"Chris Dy","startTime":399.59,"endTime":404.0,"body":"to placenta. Yet, as Marty Boyer"},{"speaker":"Chris Dy","startTime":399.59,"endTime":404.0,"body":"says, never say never, never say"},{"speaker":"Chris Dy","startTime":404.0,"endTime":408.14,"body":"always but I don't ever envision"},{"speaker":"Chris Dy","startTime":404.0,"endTime":408.14,"body":"myself using that. Chuck, do you"},{"speaker":"Chris Dy","startTime":408.14,"endTime":409.58,"body":"ever see yourself using"},{"speaker":"Chris Dy","startTime":408.14,"endTime":409.58,"body":"placenta?"},{"speaker":"Charles Goldfarb","startTime":409.94,"endTime":413.42,"body":"Well, I you"},{"speaker":"Charles Goldfarb","startTime":409.94,"endTime":413.42,"body":"know, conceptually, the placenta"},{"speaker":"Charles Goldfarb","startTime":413.42,"endTime":418.04,"body":"is kind of held up. Like some of"},{"speaker":"Charles Goldfarb","startTime":413.42,"endTime":418.04,"body":"the injections are held up as"},{"speaker":"Charles Goldfarb","startTime":418.04,"endTime":422.15,"body":"the cure all for anything and"},{"speaker":"Charles Goldfarb","startTime":418.04,"endTime":422.15,"body":"everything. I obviously have no"},{"speaker":"Charles Goldfarb","startTime":422.15,"endTime":426.32,"body":"experience with that. But you"},{"speaker":"Charles Goldfarb","startTime":422.15,"endTime":426.32,"body":"know, we are we are just at the"},{"speaker":"Charles Goldfarb","startTime":426.32,"endTime":429.62,"body":"beginning of understanding the"},{"speaker":"Charles Goldfarb","startTime":426.32,"endTime":429.62,"body":"processes of scarring and"},{"speaker":"Charles Goldfarb","startTime":429.62,"endTime":432.95,"body":"solutions to scarring. And so I"},{"speaker":"Charles Goldfarb","startTime":429.62,"endTime":432.95,"body":"certainly have an open mind but"},{"speaker":"Charles Goldfarb","startTime":432.95,"endTime":433.76,"body":"no experience."},{"speaker":"Chris Dy","startTime":434.87,"endTime":438.29,"body":"So thank you so much"},{"speaker":"Chris Dy","startTime":434.87,"endTime":438.29,"body":"for that review. We love it. We"},{"speaker":"Chris Dy","startTime":438.29,"endTime":441.68,"body":"love getting questions from"},{"speaker":"Chris Dy","startTime":438.29,"endTime":441.68,"body":"everybody. So please get on to"},{"speaker":"Chris Dy","startTime":441.68,"endTime":445.55,"body":"Apple iTunes. And leave us a"},{"speaker":"Chris Dy","startTime":441.68,"endTime":445.55,"body":"review five star review. If you"},{"speaker":"Chris Dy","startTime":445.55,"endTime":448.28,"body":"feel like it. Well really should"},{"speaker":"Chris Dy","startTime":445.55,"endTime":448.28,"body":"the only option to be a five"},{"speaker":"Chris Dy","startTime":448.28,"endTime":451.01,"body":"star review, and then leave a"},{"speaker":"Chris Dy","startTime":448.28,"endTime":451.01,"body":"question or a comment and we'll"},{"speaker":"Chris Dy","startTime":451.01,"endTime":454.88,"body":"read it on the air. And Chuck,"},{"speaker":"Chris Dy","startTime":451.01,"endTime":454.88,"body":"why don't you set us up for"},{"speaker":"Chris Dy","startTime":454.91,"endTime":455.81,"body":"today's discussion."},{"speaker":"Charles Goldfarb","startTime":456.2,"endTime":458.27,"body":"Perfect,"},{"speaker":"Charles Goldfarb","startTime":456.2,"endTime":458.27,"body":"perfect. So let's present. Maybe"},{"speaker":"Charles Goldfarb","startTime":458.27,"endTime":464.06,"body":"we'll take two case scenarios"},{"speaker":"Charles Goldfarb","startTime":458.27,"endTime":464.06,"body":"and ask Macy's wisdom and her"},{"speaker":"Charles Goldfarb","startTime":464.06,"endTime":467.9,"body":"thoughts on how she handles a"},{"speaker":"Charles Goldfarb","startTime":464.06,"endTime":467.9,"body":"patient like this. So let's just"},{"speaker":"Charles Goldfarb","startTime":467.9,"endTime":476.24,"body":"start with maybe a simplistic 25"},{"speaker":"Charles Goldfarb","startTime":467.9,"endTime":476.24,"body":"year old who has a have. Let's"},{"speaker":"Charles Goldfarb","startTime":476.24,"endTime":480.11,"body":"start with a simplistic 25 year"},{"speaker":"Charles Goldfarb","startTime":476.24,"endTime":480.11,"body":"old who has an oblique fracture"},{"speaker":"Charles Goldfarb","startTime":480.11,"endTime":484.37,"body":"of the proximal phalanx which is"},{"speaker":"Charles Goldfarb","startTime":480.11,"endTime":484.37,"body":"displaced and shortened. The"},{"speaker":"Charles Goldfarb","startTime":484.37,"endTime":487.76,"body":"surgeon takes the patient to the"},{"speaker":"Charles Goldfarb","startTime":484.37,"endTime":487.76,"body":"operating room obtains a near"},{"speaker":"Charles Goldfarb","startTime":487.76,"endTime":494.9,"body":"anatomical close reduction and"},{"speaker":"Charles Goldfarb","startTime":487.76,"endTime":494.9,"body":"places to K wires 0.045 For this"},{"speaker":"Charles Goldfarb","startTime":494.9,"endTime":499.52,"body":"example, so good solid k wires,"},{"speaker":"Charles Goldfarb","startTime":494.9,"endTime":499.52,"body":"caps those K wires, places them"},{"speaker":"Charles Goldfarb","startTime":499.52,"endTime":505.49,"body":"in a splint and sends them to"},{"speaker":"Charles Goldfarb","startTime":499.52,"endTime":505.49,"body":"Macy for care. So the first"},{"speaker":"Charles Goldfarb","startTime":505.49,"endTime":510.56,"body":"question I have may see is when"},{"speaker":"Charles Goldfarb","startTime":505.49,"endTime":510.56,"body":"would you most prefer to see"},{"speaker":"Charles Goldfarb","startTime":510.56,"endTime":512.87,"body":"that patient post op? Do you"},{"speaker":"Charles Goldfarb","startTime":510.56,"endTime":512.87,"body":"want to see him day two? You"},{"speaker":"Charles Goldfarb","startTime":512.87,"endTime":515.69,"body":"want to see him day 10? When"},{"speaker":"Charles Goldfarb","startTime":512.87,"endTime":515.69,"body":"would you like to start?"},{"speaker":"Macy Stonner","startTime":517.4,"endTime":519.35,"body":"I guess this is"},{"speaker":"Macy Stonner","startTime":517.4,"endTime":519.35,"body":"somewhat arbitrary. But I guess"},{"speaker":"Macy Stonner","startTime":519.35,"endTime":522.68,"body":"in my head, I always have five"},{"speaker":"Macy Stonner","startTime":519.35,"endTime":522.68,"body":"to seven days. That's typically"},{"speaker":"Macy Stonner","startTime":522.68,"endTime":528.23,"body":"when I would start moving them"},{"speaker":"Macy Stonner","startTime":522.68,"endTime":528.23,"body":"actively. I feel like a week is"},{"speaker":"Macy Stonner","startTime":528.23,"endTime":532.19,"body":"a little bit on the later end,"},{"speaker":"Macy Stonner","startTime":528.23,"endTime":532.19,"body":"two days is definitely early. I"},{"speaker":"Macy Stonner","startTime":532.19,"endTime":535.7,"body":"think pain might get in the way."},{"speaker":"Macy Stonner","startTime":532.19,"endTime":535.7,"body":"Five to seven days is pretty"},{"speaker":"Macy Stonner","startTime":535.7,"endTime":536.18,"body":"standard."},{"speaker":"Charles Goldfarb","startTime":536.48,"endTime":538.79,"body":"So you're"},{"speaker":"Charles Goldfarb","startTime":536.48,"endTime":538.79,"body":"looking for a time where you"},{"speaker":"Charles Goldfarb","startTime":538.79,"endTime":541.22,"body":"know I'm gonna put the patient"},{"speaker":"Charles Goldfarb","startTime":538.79,"endTime":541.22,"body":"in this example it says a little"},{"speaker":"Charles Goldfarb","startTime":541.22,"endTime":544.28,"body":"finger and an ulnar gutter"},{"speaker":"Charles Goldfarb","startTime":541.22,"endTime":544.28,"body":"splint. Hopefully, any"},{"speaker":"Charles Goldfarb","startTime":544.28,"endTime":548.3,"body":"discomfort calms down, any"},{"speaker":"Charles Goldfarb","startTime":544.28,"endTime":548.3,"body":"swelling might calm down. So"},{"speaker":"Charles Goldfarb","startTime":548.3,"endTime":552.71,"body":"you're looking for a time when"},{"speaker":"Charles Goldfarb","startTime":548.3,"endTime":552.71,"body":"the situation is good to start"},{"speaker":"Charles Goldfarb","startTime":552.71,"endTime":560.54,"body":"motion. Okay, and then"},{"speaker":"Charles Goldfarb","startTime":552.71,"endTime":560.54,"body":"reasonable patient, you believe"},{"speaker":"Charles Goldfarb","startTime":560.54,"endTime":564.26,"body":"this patient will be compliant."},{"speaker":"Charles Goldfarb","startTime":560.54,"endTime":564.26,"body":"talk through kind of what type"},{"speaker":"Charles Goldfarb","startTime":564.26,"endTime":567.68,"body":"of resting splint you consider"},{"speaker":"Charles Goldfarb","startTime":564.26,"endTime":567.68,"body":"and how you start the patient"},{"speaker":"Charles Goldfarb","startTime":567.71,"endTime":568.16,"body":"moving."},{"speaker":"Macy Stonner","startTime":569.83,"endTime":572.44,"body":"Sure, so day one,"},{"speaker":"Macy Stonner","startTime":569.83,"endTime":572.44,"body":"I would do a lot of education,"},{"speaker":"Macy Stonner","startTime":572.47,"endTime":577.15,"body":"edema management, wound care"},{"speaker":"Macy Stonner","startTime":572.47,"endTime":577.15,"body":"type stuff, make them a custom"},{"speaker":"Macy Stonner","startTime":577.15,"endTime":581.26,"body":"orthosis ensuring that their PIP"},{"speaker":"Macy Stonner","startTime":577.15,"endTime":581.26,"body":"joint is in perfect extension."},{"speaker":"Macy Stonner","startTime":581.98,"endTime":585.79,"body":"those nasty keloid fractures get"},{"speaker":"Macy Stonner","startTime":581.98,"endTime":585.79,"body":"an extensor lag or PIP flesh and"},{"speaker":"Macy Stonner","startTime":585.79,"endTime":589.96,"body":"traction are pretty easily so"},{"speaker":"Macy Stonner","startTime":585.79,"endTime":589.96,"body":"adequate splinting is key for"},{"speaker":"Macy Stonner","startTime":589.96,"endTime":594.34,"body":"that. And then in terms of"},{"speaker":"Macy Stonner","startTime":589.96,"endTime":594.34,"body":"flexion teaching them active"},{"speaker":"Macy Stonner","startTime":594.34,"endTime":597.25,"body":"tendon glides to start just"},{"speaker":"Macy Stonner","startTime":594.34,"endTime":597.25,"body":"something very standard very"},{"speaker":"Macy Stonner","startTime":597.25,"endTime":600.01,"body":"simple. And then I would see"},{"speaker":"Macy Stonner","startTime":597.25,"endTime":600.01,"body":"them back weekly, twice."},{"speaker":"Macy Stonner","startTime":600.19,"endTime":602.44,"body":"Depending on the patient's"},{"speaker":"Macy Stonner","startTime":600.19,"endTime":602.44,"body":"personality, depending on how"},{"speaker":"Macy Stonner","startTime":602.44,"endTime":604.57,"body":"stiff they are, depending on"},{"speaker":"Macy Stonner","startTime":602.44,"endTime":604.57,"body":"their insurance, depending on"},{"speaker":"Macy Stonner","startTime":604.57,"endTime":607.78,"body":"how close they are to therapy,"},{"speaker":"Macy Stonner","startTime":604.57,"endTime":607.78,"body":"all these different factors, and"},{"speaker":"Macy Stonner","startTime":607.78,"endTime":610.39,"body":"I would reevaluate them, if"},{"speaker":"Macy Stonner","startTime":607.78,"endTime":610.39,"body":"they're still really stiff, I"},{"speaker":"Macy Stonner","startTime":610.39,"endTime":614.32,"body":"would start them on, oh gosh,"},{"speaker":"Macy Stonner","startTime":610.39,"endTime":614.32,"body":"isolated joint blocking,"},{"speaker":"Macy Stonner","startTime":614.32,"endTime":618.19,"body":"potentially passive flexion. If"},{"speaker":"Macy Stonner","startTime":614.32,"endTime":618.19,"body":"the surgeon allows it, and if"},{"speaker":"Macy Stonner","startTime":618.19,"endTime":622.93,"body":"they tell me that the fixation"},{"speaker":"Macy Stonner","startTime":618.19,"endTime":622.93,"body":"is solid, and depending on pain,"},{"speaker":"Macy Stonner","startTime":622.99,"endTime":625.21,"body":"you know, if their pain level is"},{"speaker":"Macy Stonner","startTime":622.99,"endTime":625.21,"body":"above five, I'm not gonna do"},{"speaker":"Macy Stonner","startTime":625.21,"endTime":630.37,"body":"passive motion. So there's no"},{"speaker":"Macy Stonner","startTime":625.21,"endTime":630.37,"body":"protocol, that word is very, I"},{"speaker":"Macy Stonner","startTime":630.37,"endTime":633.4,"body":"don't know, I don't follow a"},{"speaker":"Macy Stonner","startTime":630.37,"endTime":633.4,"body":"protocol just kind of depends on"},{"speaker":"Macy Stonner","startTime":633.4,"endTime":636.94,"body":"the surgeon, the patient"},{"speaker":"Macy Stonner","startTime":633.4,"endTime":636.94,"body":"surgery, the therapist, it's"},{"speaker":"Macy Stonner","startTime":636.94,"endTime":638.59,"body":"kind of all altogether."},{"speaker":"Chris Dy","startTime":639.46,"endTime":642.22,"body":"So you mentioned all"},{"speaker":"Chris Dy","startTime":639.46,"endTime":642.22,"body":"the various things that help you"},{"speaker":"Chris Dy","startTime":642.22,"endTime":646.09,"body":"decide how frequently you see"},{"speaker":"Chris Dy","startTime":642.22,"endTime":646.09,"body":"patients. What are the red"},{"speaker":"Chris Dy","startTime":646.09,"endTime":648.94,"body":"flags? Like? What are the things"},{"speaker":"Chris Dy","startTime":646.09,"endTime":648.94,"body":"that when a patient comes in,"},{"speaker":"Chris Dy","startTime":648.97,"endTime":651.61,"body":"that you assess, they're like,"},{"speaker":"Chris Dy","startTime":648.97,"endTime":651.61,"body":"Ooh, this patient either needs"},{"speaker":"Chris Dy","startTime":651.61,"endTime":653.92,"body":"to come in more frequently, or I"},{"speaker":"Chris Dy","startTime":651.61,"endTime":653.92,"body":"know that this patient is going"},{"speaker":"Chris Dy","startTime":653.92,"endTime":655.09,"body":"to have a really hard time."},{"speaker":"Macy Stonner","startTime":656.71,"endTime":659.5,"body":"Let's see. So the"},{"speaker":"Macy Stonner","startTime":656.71,"endTime":659.5,"body":"way that I decided I need to"},{"speaker":"Macy Stonner","startTime":659.5,"endTime":661.87,"body":"come in more frequently is if"},{"speaker":"Macy Stonner","startTime":659.5,"endTime":661.87,"body":"they seem as though they're"},{"speaker":"Macy Stonner","startTime":661.87,"endTime":664.93,"body":"going to be non compliant, or"},{"speaker":"Macy Stonner","startTime":661.87,"endTime":664.93,"body":"they might not have understood"},{"speaker":"Macy Stonner","startTime":664.93,"endTime":668.56,"body":"my instructions. So they require"},{"speaker":"Macy Stonner","startTime":664.93,"endTime":668.56,"body":"repeated instructions, just to"},{"speaker":"Macy Stonner","startTime":668.56,"endTime":673.75,"body":"understand simple active range"},{"speaker":"Macy Stonner","startTime":668.56,"endTime":673.75,"body":"of motion. If they seem like the"},{"speaker":"Macy Stonner","startTime":673.81,"endTime":677.23,"body":"type that's going to be non"},{"speaker":"Macy Stonner","startTime":673.81,"endTime":677.23,"body":"compliant with their splint, or"},{"speaker":"Macy Stonner","startTime":677.26,"endTime":680.23,"body":"the activities that they choose"},{"speaker":"Macy Stonner","startTime":677.26,"endTime":680.23,"body":"to do, I might have them come a"},{"speaker":"Macy Stonner","startTime":680.23,"endTime":682.93,"body":"little bit more frequently. And"},{"speaker":"Macy Stonner","startTime":680.23,"endTime":682.93,"body":"if they come in with total"},{"speaker":"Macy Stonner","startTime":682.93,"endTime":686.8,"body":"active motion of 10 degrees, 20"},{"speaker":"Macy Stonner","startTime":682.93,"endTime":686.8,"body":"degrees, and it's just very,"},{"speaker":"Macy Stonner","startTime":686.8,"endTime":688.99,"body":"very stiff. I'm going to say,"},{"speaker":"Macy Stonner","startTime":686.8,"endTime":688.99,"body":"Oh, you need to send me again"},{"speaker":"Macy Stonner","startTime":688.99,"endTime":692.35,"body":"next week early. So there's just"},{"speaker":"Macy Stonner","startTime":688.99,"endTime":692.35,"body":"a lot of different factors at"},{"speaker":"Macy Stonner","startTime":692.35,"endTime":692.86,"body":"play. And"},{"speaker":"Charles Goldfarb","startTime":693.67,"endTime":696.64,"body":"So a comment"},{"speaker":"Charles Goldfarb","startTime":693.67,"endTime":696.64,"body":"and kind of follow up. So first"},{"speaker":"Charles Goldfarb","startTime":696.64,"endTime":700.54,"body":"of all, I assume, would more"},{"speaker":"Charles Goldfarb","startTime":696.64,"endTime":700.54,"body":"than typical swelling, be"},{"speaker":"Charles Goldfarb","startTime":700.54,"endTime":703.15,"body":"another reason that you would be"},{"speaker":"Charles Goldfarb","startTime":700.54,"endTime":703.15,"body":"concerned and maybe bring them"},{"speaker":"Charles Goldfarb","startTime":703.15,"endTime":705.82,"body":"back or take extra care with"},{"speaker":"Charles Goldfarb","startTime":703.15,"endTime":705.82,"body":"them?"},{"speaker":"Macy Stonner","startTime":706.42,"endTime":709.66,"body":"Yes, for sure."},{"speaker":"Macy Stonner","startTime":706.42,"endTime":709.66,"body":"Particularly because as their"},{"speaker":"Macy Stonner","startTime":709.66,"endTime":712.0,"body":"swelling goes down, their splint"},{"speaker":"Macy Stonner","startTime":709.66,"endTime":712.0,"body":"is not going to be comfortable."},{"speaker":"Macy Stonner","startTime":712.0,"endTime":713.95,"body":"And they're going to slide"},{"speaker":"Macy Stonner","startTime":712.0,"endTime":713.95,"body":"around in that splint, maybe"},{"speaker":"Macy Stonner","startTime":713.95,"endTime":717.43,"body":"their PIP joint might flex a bit"},{"speaker":"Macy Stonner","startTime":713.95,"endTime":717.43,"body":"in that ulnar gutter until they"},{"speaker":"Macy Stonner","startTime":717.43,"endTime":721.0,"body":"might get a lag. So definitely"},{"speaker":"Macy Stonner","startTime":717.43,"endTime":721.0,"body":"edema plays a factor there. And"},{"speaker":"Macy Stonner","startTime":721.0,"endTime":722.23,"body":"I would have to come back"},{"speaker":"Macy Stonner","startTime":721.0,"endTime":722.23,"body":"earlier."},{"speaker":"Charles Goldfarb","startTime":722.83,"endTime":725.92,"body":"Perfect. So"},{"speaker":"Charles Goldfarb","startTime":722.83,"endTime":725.92,"body":"let's let's get a little more"},{"speaker":"Charles Goldfarb","startTime":725.92,"endTime":729.13,"body":"detailed. You threw out some"},{"speaker":"Charles Goldfarb","startTime":725.92,"endTime":729.13,"body":"terms, which are great, which I"},{"speaker":"Charles Goldfarb","startTime":729.37,"endTime":733.24,"body":"you know, I assume I understand."},{"speaker":"Charles Goldfarb","startTime":729.37,"endTime":733.24,"body":"But let's be real, I may not."},{"speaker":"Macy Stonner","startTime":733.24,"endTime":734.68,"body":"Oh my gosh, what"},{"speaker":"Macy Stonner","startTime":733.24,"endTime":734.68,"body":"did I say?"},{"speaker":"Charles Goldfarb","startTime":735.19,"endTime":737.44,"body":"Well, no, you"},{"speaker":"Charles Goldfarb","startTime":735.19,"endTime":737.44,"body":"just I think some people will"},{"speaker":"Charles Goldfarb","startTime":737.44,"endTime":740.41,"body":"not be familiar with the term."},{"speaker":"Charles Goldfarb","startTime":737.44,"endTime":740.41,"body":"So tendon glides, you start them"},{"speaker":"Charles Goldfarb","startTime":740.41,"endTime":743.26,"body":"on some tendon glides. And you"},{"speaker":"Charles Goldfarb","startTime":740.41,"endTime":743.26,"body":"said that kind of at the clinic"},{"speaker":"Charles Goldfarb","startTime":743.26,"endTime":746.8,"body":"of visit number one, be very"},{"speaker":"Charles Goldfarb","startTime":743.26,"endTime":746.8,"body":"specific. What do you mean by"},{"speaker":"Charles Goldfarb","startTime":746.8,"endTime":747.61,"body":"tendon glides?"},{"speaker":"Macy Stonner","startTime":747.96,"endTime":750.45,"body":"Sure so a tendon"},{"speaker":"Macy Stonner","startTime":747.96,"endTime":750.45,"body":"glide is something that enables"},{"speaker":"Macy Stonner","startTime":750.45,"endTime":754.89,"body":"the FDS and the FDP tendons to"},{"speaker":"Macy Stonner","startTime":750.45,"endTime":754.89,"body":"glide freely. So I might have"},{"speaker":"Macy Stonner","startTime":755.04,"endTime":758.16,"body":"give them a very simple handout"},{"speaker":"Macy Stonner","startTime":755.04,"endTime":758.16,"body":"that has a picture of somebody"},{"speaker":"Macy Stonner","startTime":758.16,"endTime":762.33,"body":"making a fist, somebody making"},{"speaker":"Macy Stonner","startTime":758.16,"endTime":762.33,"body":"what's called a hook fist, where"},{"speaker":"Macy Stonner","startTime":762.33,"endTime":765.69,"body":"their MP joints are an"},{"speaker":"Macy Stonner","startTime":762.33,"endTime":765.69,"body":"extension, their PIP and DIP"},{"speaker":"Macy Stonner","startTime":765.87,"endTime":771.09,"body":"joints are in flexion. And then"},{"speaker":"Macy Stonner","startTime":765.87,"endTime":771.09,"body":"a photo of what's called a flat"},{"speaker":"Macy Stonner","startTime":771.09,"endTime":774.96,"body":"fist or a straight fist with our"},{"speaker":"Macy Stonner","startTime":771.09,"endTime":774.96,"body":"MP joints or flex their PIP"},{"speaker":"Macy Stonner","startTime":775.14,"endTime":778.71,"body":"joints are flexed but their DIP"},{"speaker":"Macy Stonner","startTime":775.14,"endTime":778.71,"body":"joints are straight, and that"},{"speaker":"Macy Stonner","startTime":778.71,"endTime":785.04,"body":"enables FDS excursion or PIP"},{"speaker":"Macy Stonner","startTime":778.71,"endTime":785.04,"body":"joint flexion. So it's a lot of"},{"speaker":"Macy Stonner","startTime":785.07,"endTime":790.26,"body":"hand therapy buzz lingo. But"},{"speaker":"Macy Stonner","startTime":785.07,"endTime":790.26,"body":"it's something that is somewhat"},{"speaker":"Macy Stonner","startTime":790.26,"endTime":793.41,"body":"simple for somebody to"},{"speaker":"Macy Stonner","startTime":790.26,"endTime":793.41,"body":"understand just to get active"},{"speaker":"Macy Stonner","startTime":793.41,"endTime":797.49,"body":"movement trying to facilitate a"},{"speaker":"Macy Stonner","startTime":793.41,"endTime":797.49,"body":"functional fist before we get"},{"speaker":"Macy Stonner","startTime":797.49,"endTime":800.07,"body":"fancy into any other thing. So"},{"speaker":"Macy Stonner","startTime":797.49,"endTime":800.07,"body":"that's kind of where we started"},{"speaker":"Macy Stonner","startTime":800.07,"endTime":800.58,"body":"initially."},{"speaker":"Chris Dy","startTime":801.6,"endTime":804.75,"body":"Let's talk about"},{"speaker":"Chris Dy","startTime":801.6,"endTime":804.75,"body":"blocking exercises. What does"},{"speaker":"Chris Dy","startTime":804.75,"endTime":805.14,"body":"that mean?"},{"speaker":"Macy Stonner","startTime":805.86,"endTime":808.74,"body":"So blocking"},{"speaker":"Macy Stonner","startTime":805.86,"endTime":808.74,"body":"blocking is where well, let me"},{"speaker":"Macy Stonner","startTime":808.92,"endTime":811.83,"body":"backtrack a second, tendon"},{"speaker":"Macy Stonner","startTime":808.92,"endTime":811.83,"body":"glides is when all four fingers"},{"speaker":"Macy Stonner","startTime":811.83,"endTime":815.52,"body":"are moving in unison. If you do"},{"speaker":"Macy Stonner","startTime":811.83,"endTime":815.52,"body":"blocking, that's where you do"},{"speaker":"Macy Stonner","startTime":815.55,"endTime":819.03,"body":"each finger moves in isolation."},{"speaker":"Macy Stonner","startTime":815.55,"endTime":819.03,"body":"So if you're really stuck in the"},{"speaker":"Macy Stonner","startTime":819.03,"endTime":821.31,"body":"scar, or you need a little bit"},{"speaker":"Macy Stonner","startTime":819.03,"endTime":821.31,"body":"more advanced movement, you"},{"speaker":"Macy Stonner","startTime":821.31,"endTime":825.57,"body":"might have them do isolated PIP"},{"speaker":"Macy Stonner","startTime":821.31,"endTime":825.57,"body":"joint blocking when you have the"},{"speaker":"Macy Stonner","startTime":825.57,"endTime":829.2,"body":"opposite hand support the"},{"speaker":"Macy Stonner","startTime":825.57,"endTime":829.2,"body":"proximal phalanx to encourage"},{"speaker":"Macy Stonner","startTime":829.44,"endTime":833.28,"body":"FDS glide, and then you move"},{"speaker":"Macy Stonner","startTime":829.44,"endTime":833.28,"body":"distally you block the middle"},{"speaker":"Macy Stonner","startTime":833.28,"endTime":837.54,"body":"phalanx when you have them do"},{"speaker":"Macy Stonner","startTime":833.28,"endTime":837.54,"body":"isolated DIP flexion. And so it"},{"speaker":"Macy Stonner","startTime":837.54,"endTime":842.31,"body":"just enables more advanced"},{"speaker":"Macy Stonner","startTime":837.54,"endTime":842.31,"body":"movement of the joint if they're"},{"speaker":"Macy Stonner","startTime":842.31,"endTime":845.94,"body":"not getting enough excursion of"},{"speaker":"Macy Stonner","startTime":842.31,"endTime":845.94,"body":"their tendons."},{"speaker":"Charles Goldfarb","startTime":846.33,"endTime":849.06,"body":"Do you have"},{"speaker":"Charles Goldfarb","startTime":846.33,"endTime":849.06,"body":"you know, you are very careful"},{"speaker":"Charles Goldfarb","startTime":849.06,"endTime":854.13,"body":"about stating you splint with"},{"speaker":"Charles Goldfarb","startTime":849.06,"endTime":854.13,"body":"the PIP joint and extension. If"},{"speaker":"Charles Goldfarb","startTime":854.37,"endTime":859.02,"body":"you and therefore the patient is"},{"speaker":"Charles Goldfarb","startTime":854.37,"endTime":859.02,"body":"good about wearing the splint, I"},{"speaker":"Charles Goldfarb","startTime":859.02,"endTime":862.68,"body":"assume therefore, your primary"},{"speaker":"Charles Goldfarb","startTime":859.02,"endTime":862.68,"body":"concern then is working on"},{"speaker":"Charles Goldfarb","startTime":862.68,"endTime":866.85,"body":"flexion. Is that is that"},{"speaker":"Charles Goldfarb","startTime":862.68,"endTime":866.85,"body":"generally the issue, flexion?"},{"speaker":"Macy Stonner","startTime":868.41,"endTime":871.32,"body":"Yes, if you catch"},{"speaker":"Macy Stonner","startTime":868.41,"endTime":871.32,"body":"them early, if you catch them"},{"speaker":"Macy Stonner","startTime":871.35,"endTime":874.92,"body":"early, and you ensure good"},{"speaker":"Macy Stonner","startTime":871.35,"endTime":874.92,"body":"splinting early and they do not"},{"speaker":"Macy Stonner","startTime":874.92,"endTime":879.84,"body":"have a flexion contracture."},{"speaker":"Macy Stonner","startTime":874.92,"endTime":879.84,"body":"Sure, flexion is the thing that"},{"speaker":"Macy Stonner","startTime":879.84,"endTime":883.38,"body":"we're working towards, you know,"},{"speaker":"Macy Stonner","startTime":879.84,"endTime":883.38,"body":"we realistically we don't always"},{"speaker":"Macy Stonner","startTime":883.38,"endTime":885.84,"body":"catch them five to seven days"},{"speaker":"Macy Stonner","startTime":883.38,"endTime":885.84,"body":"after surgery, and they might"},{"speaker":"Macy Stonner","startTime":885.84,"endTime":889.5,"body":"have already developed this"},{"speaker":"Macy Stonner","startTime":885.84,"endTime":889.5,"body":"gnarly, 40 degree, either"},{"speaker":"Macy Stonner","startTime":889.5,"endTime":894.3,"body":"flexion contracture or lag and"},{"speaker":"Macy Stonner","startTime":889.5,"endTime":894.3,"body":"so you're working on exercises"},{"speaker":"Macy Stonner","startTime":894.3,"endTime":898.74,"body":"to regain extension through"},{"speaker":"Macy Stonner","startTime":894.3,"endTime":898.74,"body":"active range through night"},{"speaker":"Macy Stonner","startTime":898.74,"endTime":903.36,"body":"splinting, along with Working on"},{"speaker":"Macy Stonner","startTime":898.74,"endTime":903.36,"body":"their flexion. So kind of just"},{"speaker":"Macy Stonner","startTime":903.36,"endTime":904.08,"body":"depends."},{"speaker":"Chris Dy","startTime":904.41,"endTime":906.9,"body":"Are there ever any"},{"speaker":"Chris Dy","startTime":904.41,"endTime":906.9,"body":"situations in which it's"},{"speaker":"Chris Dy","startTime":906.96,"endTime":910.68,"body":"advantageous to leave the PIP"},{"speaker":"Chris Dy","startTime":906.96,"endTime":910.68,"body":"joint free in terms of"},{"speaker":"Chris Dy","startTime":910.68,"endTime":914.43,"body":"splinting, if we've got secure"},{"speaker":"Chris Dy","startTime":910.68,"endTime":914.43,"body":"stable fixation with the goal of"},{"speaker":"Chris Dy","startTime":914.43,"endTime":917.19,"body":"trying to maximize the amount of"},{"speaker":"Chris Dy","startTime":914.43,"endTime":917.19,"body":"flexion, that you could obtain?"},{"speaker":"Macy Stonner","startTime":917.96,"endTime":922.52,"body":"Absolutely. Only"},{"speaker":"Macy Stonner","startTime":917.96,"endTime":922.52,"body":"if they don't have a PIP"},{"speaker":"Macy Stonner","startTime":923.39,"endTime":925.85,"body":"function interaction or lag,"},{"speaker":"Macy Stonner","startTime":923.39,"endTime":925.85,"body":"because if they have their PIP"},{"speaker":"Macy Stonner","startTime":926.03,"endTime":930.71,"body":"joints free, they're going to be"},{"speaker":"Macy Stonner","startTime":926.03,"endTime":930.71,"body":"sitting in this PIP flexed state"},{"speaker":"Macy Stonner","startTime":930.74,"endTime":934.91,"body":"all day. So unless they have"},{"speaker":"Macy Stonner","startTime":930.74,"endTime":934.91,"body":"good extension, it's not"},{"speaker":"Macy Stonner","startTime":934.91,"endTime":937.67,"body":"something that I would"},{"speaker":"Macy Stonner","startTime":934.91,"endTime":937.67,"body":"necessarily encourage. And also"},{"speaker":"Macy Stonner","startTime":937.67,"endTime":941.0,"body":"if their fracture is relatively"},{"speaker":"Macy Stonner","startTime":937.67,"endTime":941.0,"body":"proximal, I think it's okay."},{"speaker":"Charles Goldfarb","startTime":941.43,"endTime":944.88,"body":"When I don't"},{"speaker":"Charles Goldfarb","startTime":941.43,"endTime":944.88,"body":"have maybe, maybe if you're not"},{"speaker":"Charles Goldfarb","startTime":944.88,"endTime":946.86,"body":"around or say something around,"},{"speaker":"Charles Goldfarb","startTime":944.88,"endTime":946.86,"body":"and I'm in clinic, and I'm"},{"speaker":"Charles Goldfarb","startTime":946.86,"endTime":952.62,"body":"talking to a patient about edema"},{"speaker":"Charles Goldfarb","startTime":946.86,"endTime":952.62,"body":"control. You know, I guess I'd"},{"speaker":"Charles Goldfarb","startTime":952.62,"endTime":956.28,"body":"love for your thoughts on how"},{"speaker":"Charles Goldfarb","startTime":952.62,"endTime":956.28,"body":"you instruct the patient on need"},{"speaker":"Charles Goldfarb","startTime":956.28,"endTime":960.54,"body":"to control the very specific"},{"speaker":"Charles Goldfarb","startTime":956.28,"endTime":960.54,"body":"instruction you give them to"},{"speaker":"Charles Goldfarb","startTime":960.57,"endTime":963.75,"body":"minimize swelling or to address"},{"speaker":"Charles Goldfarb","startTime":960.57,"endTime":963.75,"body":"a patient who already has a"},{"speaker":"Charles Goldfarb","startTime":963.75,"endTime":965.46,"body":"swollen finger. What do you tell"},{"speaker":"Charles Goldfarb","startTime":963.75,"endTime":965.46,"body":"him?"},{"speaker":"Macy Stonner","startTime":967.31,"endTime":968.63,"body":"It's a great"},{"speaker":"Macy Stonner","startTime":967.31,"endTime":968.63,"body":"question, because people are"},{"speaker":"Macy Stonner","startTime":968.63,"endTime":972.38,"body":"very concerned about swelling I"},{"speaker":"Macy Stonner","startTime":968.63,"endTime":972.38,"body":"hear often, I can't move my"},{"speaker":"Macy Stonner","startTime":972.38,"endTime":975.26,"body":"finger right now I'm still"},{"speaker":"Macy Stonner","startTime":972.38,"endTime":975.26,"body":"swollen. In fact, Dr. Goldfarb"},{"speaker":"Macy Stonner","startTime":975.26,"endTime":977.93,"body":"the other day in your clinic,"},{"speaker":"Macy Stonner","startTime":975.26,"endTime":977.93,"body":"somebody told me that. And so"},{"speaker":"Macy Stonner","startTime":978.53,"endTime":982.55,"body":"it's just a myth. And so I like"},{"speaker":"Macy Stonner","startTime":978.53,"endTime":982.55,"body":"to say, you know, if you wait"},{"speaker":"Macy Stonner","startTime":982.97,"endTime":986.12,"body":"until your team is down to start"},{"speaker":"Macy Stonner","startTime":982.97,"endTime":986.12,"body":"moving, your finger is going to"},{"speaker":"Macy Stonner","startTime":986.12,"endTime":989.87,"body":"be so stiff already. So in fact,"},{"speaker":"Macy Stonner","startTime":986.12,"endTime":989.87,"body":"the best way to get rid of edema"},{"speaker":"Macy Stonner","startTime":989.93,"endTime":992.78,"body":"is by movement. So keeping those"},{"speaker":"Macy Stonner","startTime":989.93,"endTime":992.78,"body":"fingers moving, you've been"},{"speaker":"Macy Stonner","startTime":992.78,"endTime":996.32,"body":"elevated and keeping it"},{"speaker":"Macy Stonner","startTime":992.78,"endTime":996.32,"body":"compressed. So just simple coban"},{"speaker":"Macy Stonner","startTime":996.32,"endTime":1000.4,"body":"wrapping distally to proximally"},{"speaker":"Macy Stonner","startTime":996.32,"endTime":1000.4,"body":"can really help control digital"},{"speaker":"Macy Stonner","startTime":1000.4,"endTime":1004.36,"body":"edema. And that's a very simple"},{"speaker":"Macy Stonner","startTime":1000.4,"endTime":1004.36,"body":"way for people to understand the"},{"speaker":"Macy Stonner","startTime":1004.36,"endTime":1007.24,"body":"edema control. So I often teach"},{"speaker":"Macy Stonner","startTime":1004.36,"endTime":1007.24,"body":"that pretty early on."},{"speaker":"Chris Dy","startTime":1007.79,"endTime":1013.22,"body":"So I have a question"},{"speaker":"Chris Dy","startTime":1007.79,"endTime":1013.22,"body":"when when we put in pins, we"},{"speaker":"Chris Dy","startTime":1013.22,"endTime":1015.74,"body":"think we put them in the best"},{"speaker":"Chris Dy","startTime":1013.22,"endTime":1015.74,"body":"position and bend them in a"},{"speaker":"Chris Dy","startTime":1015.74,"endTime":1018.77,"body":"certain way to keep them out of"},{"speaker":"Chris Dy","startTime":1015.74,"endTime":1018.77,"body":"the way. What are some of the"},{"speaker":"Chris Dy","startTime":1018.77,"endTime":1022.82,"body":"more boneheaded things that"},{"speaker":"Chris Dy","startTime":1018.77,"endTime":1022.82,"body":"surgeons have done to make it"},{"speaker":"Chris Dy","startTime":1022.82,"endTime":1025.49,"body":"harder on you in terms of the"},{"speaker":"Chris Dy","startTime":1022.82,"endTime":1025.49,"body":"way that the pins are bent? Are"},{"speaker":"Chris Dy","startTime":1025.49,"endTime":1028.73,"body":"there any pearls for that you"},{"speaker":"Chris Dy","startTime":1025.49,"endTime":1028.73,"body":"can teach us about where to"},{"speaker":"Chris Dy","startTime":1028.73,"endTime":1031.34,"body":"place the pins and how to keep"},{"speaker":"Chris Dy","startTime":1028.73,"endTime":1031.34,"body":"them out of web spaces, all that"},{"speaker":"Chris Dy","startTime":1031.34,"endTime":1031.91,"body":"kind of stuff?"},{"speaker":"Charles Goldfarb","startTime":1032.18,"endTime":1034.7,"body":"Or, or what"},{"speaker":"Charles Goldfarb","startTime":1032.18,"endTime":1034.7,"body":"frustrates you, when you see"},{"speaker":"Charles Goldfarb","startTime":1034.7,"endTime":1037.34,"body":"pins whether maybe every time we"},{"speaker":"Charles Goldfarb","startTime":1034.7,"endTime":1037.34,"body":"put it in a pin, you get"},{"speaker":"Charles Goldfarb","startTime":1037.34,"endTime":1040.55,"body":"frustrated, but any thoughts and"},{"speaker":"Charles Goldfarb","startTime":1037.34,"endTime":1040.55,"body":"maybe a random question about"},{"speaker":"Charles Goldfarb","startTime":1040.55,"endTime":1041.81,"body":"it. I like I liked the question."},{"speaker":"Macy Stonner","startTime":1042.62,"endTime":1046.97,"body":"I guess what you"},{"speaker":"Macy Stonner","startTime":1042.62,"endTime":1046.97,"body":"mentioned about the web space,"},{"speaker":"Macy Stonner","startTime":1046.97,"endTime":1051.29,"body":"so ensuring that it's not no"},{"speaker":"Macy Stonner","startTime":1046.97,"endTime":1051.29,"body":"right in the web space to where"},{"speaker":"Macy Stonner","startTime":1051.32,"endTime":1055.34,"body":"they get masturbation in their"},{"speaker":"Macy Stonner","startTime":1051.32,"endTime":1055.34,"body":"fingers or where they have a lot"},{"speaker":"Macy Stonner","startTime":1055.34,"endTime":1060.56,"body":"of pain with their splint. If"},{"speaker":"Macy Stonner","startTime":1055.34,"endTime":1060.56,"body":"it's obviously pinned through"},{"speaker":"Macy Stonner","startTime":1060.56,"endTime":1065.03,"body":"the joint, then that provides a"},{"speaker":"Macy Stonner","startTime":1060.56,"endTime":1065.03,"body":"lot more difficulties long term."},{"speaker":"Charles Goldfarb","startTime":1065.51,"endTime":1068.21,"body":"What What if"},{"speaker":"Charles Goldfarb","startTime":1065.51,"endTime":1068.21,"body":"you know sometimes when I pin"},{"speaker":"Charles Goldfarb","startTime":1068.21,"endTime":1073.91,"body":"say, if I retrograde pin a"},{"speaker":"Charles Goldfarb","startTime":1068.21,"endTime":1073.91,"body":"metacarpal there are times when"},{"speaker":"Charles Goldfarb","startTime":1074.36,"endTime":1076.82,"body":"I feel like the extensor"},{"speaker":"Charles Goldfarb","startTime":1074.36,"endTime":1076.82,"body":"mechanism is caught up in the"},{"speaker":"Charles Goldfarb","startTime":1076.82,"endTime":1081.89,"body":"pin. And that may be okay"},{"speaker":"Charles Goldfarb","startTime":1076.82,"endTime":1081.89,"body":"because the fracture looks"},{"speaker":"Charles Goldfarb","startTime":1081.89,"endTime":1084.86,"body":"great, does that end up"},{"speaker":"Charles Goldfarb","startTime":1081.89,"endTime":1084.86,"body":"frustrating you or you're not"},{"speaker":"Charles Goldfarb","startTime":1084.86,"endTime":1087.2,"body":"too worried about it because"},{"speaker":"Charles Goldfarb","startTime":1084.86,"endTime":1087.2,"body":"when the pin comes out, you're"},{"speaker":"Charles Goldfarb","startTime":1087.2,"endTime":1088.64,"body":"confident you can regain motion."},{"speaker":"Macy Stonner","startTime":1089.33,"endTime":1091.4,"body":"They're not gonna"},{"speaker":"Macy Stonner","startTime":1089.33,"endTime":1091.4,"body":"worry about it because I I work"},{"speaker":"Macy Stonner","startTime":1091.4,"endTime":1093.86,"body":"with great surgeons and so I"},{"speaker":"Macy Stonner","startTime":1091.4,"endTime":1093.86,"body":"trust that they are going to"},{"speaker":"Macy Stonner","startTime":1093.86,"endTime":1097.58,"body":"make the right clinical call in"},{"speaker":"Macy Stonner","startTime":1093.86,"endTime":1097.58,"body":"the OR that is going to maximize"},{"speaker":"Macy Stonner","startTime":1097.58,"endTime":1100.52,"body":"fracture fixation stability long"},{"speaker":"Macy Stonner","startTime":1097.58,"endTime":1100.52,"body":"term and I'm just going to work"},{"speaker":"Macy Stonner","startTime":1100.52,"endTime":1104.48,"body":"with what I can. But I just"},{"speaker":"Macy Stonner","startTime":1100.52,"endTime":1104.48,"body":"educate them a lot on scarring"},{"speaker":"Macy Stonner","startTime":1104.48,"endTime":1107.54,"body":"and the anatomy involved in"},{"speaker":"Macy Stonner","startTime":1104.48,"endTime":1107.54,"body":"fractures and tendon adhesions."},{"speaker":"Macy Stonner","startTime":1107.93,"endTime":1111.8,"body":"And I educate them on the"},{"speaker":"Macy Stonner","startTime":1107.93,"endTime":1111.8,"body":"exercises to do so a metacarpal."},{"speaker":"Macy Stonner","startTime":1111.8,"endTime":1116.15,"body":"That's been pinned, I talked"},{"speaker":"Macy Stonner","startTime":1111.8,"endTime":1116.15,"body":"about the EDC and I talked about"},{"speaker":"Macy Stonner","startTime":1116.36,"endTime":1120.38,"body":"an exercise called and EDC"},{"speaker":"Macy Stonner","startTime":1116.36,"endTime":1120.38,"body":"glide, which is again is a hand"},{"speaker":"Macy Stonner","startTime":1120.38,"endTime":1124.34,"body":"therapy term. But it really"},{"speaker":"Macy Stonner","startTime":1120.38,"endTime":1124.34,"body":"encourages extensor tendon"},{"speaker":"Macy Stonner","startTime":1124.34,"endTime":1129.05,"body":"excursion through the pin. And"},{"speaker":"Macy Stonner","startTime":1124.34,"endTime":1129.05,"body":"yeah, I trust that the surgeons"},{"speaker":"Macy Stonner","startTime":1129.05,"endTime":1131.39,"body":"are making the right call and I"},{"speaker":"Macy Stonner","startTime":1129.05,"endTime":1131.39,"body":"don't think that frustrates me."},{"speaker":"Macy Stonner","startTime":1131.72,"endTime":1134.33,"body":"But I know that what has to be"},{"speaker":"Macy Stonner","startTime":1131.72,"endTime":1134.33,"body":"has to be done."},{"speaker":"Chris Dy","startTime":1135.98,"endTime":1138.95,"body":"A question Chuck for"},{"speaker":"Chris Dy","startTime":1135.98,"endTime":1138.95,"body":"you. When you cut your pins"},{"speaker":"Chris Dy","startTime":1138.95,"endTime":1141.68,"body":"exterior to the skin, say for"},{"speaker":"Chris Dy","startTime":1138.95,"endTime":1141.68,"body":"example, this one where I'm"},{"speaker":"Chris Dy","startTime":1141.68,"endTime":1145.73,"body":"assuming we have a couple of"},{"speaker":"Chris Dy","startTime":1141.68,"endTime":1145.73,"body":"crossed antegrade wires into the"},{"speaker":"Chris Dy","startTime":1145.73,"endTime":1150.14,"body":"proximal phalanx? Do you bend"},{"speaker":"Chris Dy","startTime":1145.73,"endTime":1150.14,"body":"them before you cut them? Or do"},{"speaker":"Chris Dy","startTime":1150.14,"endTime":1151.91,"body":"you just leave them straight?"},{"speaker":"Charles Goldfarb","startTime":1153.14,"endTime":1155.18,"body":"I tend to"},{"speaker":"Charles Goldfarb","startTime":1153.14,"endTime":1155.18,"body":"leave my pin straight. Well, let"},{"speaker":"Charles Goldfarb","startTime":1155.18,"endTime":1157.67,"body":"me back up a step. So the first"},{"speaker":"Charles Goldfarb","startTime":1155.18,"endTime":1157.67,"body":"thing is when I'm having a"},{"speaker":"Charles Goldfarb","startTime":1157.67,"endTime":1161.15,"body":"trainee with me, when I placed"},{"speaker":"Charles Goldfarb","startTime":1157.67,"endTime":1161.15,"body":"the pins obviously want the pin"},{"speaker":"Charles Goldfarb","startTime":1161.15,"endTime":1165.02,"body":"place to appropriately address"},{"speaker":"Charles Goldfarb","startTime":1161.15,"endTime":1165.02,"body":"the fracture. To me one of the"},{"speaker":"Charles Goldfarb","startTime":1165.02,"endTime":1169.4,"body":"keys is not plunging through"},{"speaker":"Charles Goldfarb","startTime":1165.02,"endTime":1169.4,"body":"that second cortex and having to"},{"speaker":"Charles Goldfarb","startTime":1169.4,"endTime":1172.91,"body":"pull the pin back then I worried"},{"speaker":"Charles Goldfarb","startTime":1169.4,"endTime":1172.91,"body":"about pins, then I worry about"},{"speaker":"Charles Goldfarb","startTime":1172.91,"endTime":1179.21,"body":"pin stability. As long as that's"},{"speaker":"Charles Goldfarb","startTime":1172.91,"endTime":1179.21,"body":"not a worry. I cut the pins cap"},{"speaker":"Charles Goldfarb","startTime":1179.21,"endTime":1181.67,"body":"them, don't bend them. Do you?"},{"speaker":"Charles Goldfarb","startTime":1179.21,"endTime":1181.67,"body":"Do you bend them?"},{"speaker":"Chris Dy","startTime":1182.36,"endTime":1184.88,"body":"I bend them but I've"},{"speaker":"Chris Dy","startTime":1182.36,"endTime":1184.88,"body":"started to become I've started"},{"speaker":"Chris Dy","startTime":1184.88,"endTime":1187.46,"body":"to question whether I should be"},{"speaker":"Chris Dy","startTime":1184.88,"endTime":1187.46,"body":"bending them. There are some"},{"speaker":"Chris Dy","startTime":1187.46,"endTime":1190.4,"body":"situations in which, you know, I"},{"speaker":"Chris Dy","startTime":1187.46,"endTime":1190.4,"body":"think the bend can create more"},{"speaker":"Chris Dy","startTime":1190.4,"endTime":1194.06,"body":"of a hassle than it's worth. And"},{"speaker":"Chris Dy","startTime":1190.4,"endTime":1194.06,"body":"I don't know Macy do you think"},{"speaker":"Chris Dy","startTime":1194.06,"endTime":1197.93,"body":"that bending the pins is bad or"},{"speaker":"Chris Dy","startTime":1194.06,"endTime":1197.93,"body":"good or helpful? I mean, you"},{"speaker":"Chris Dy","startTime":1197.93,"endTime":1200.87,"body":"know, ideally it doesn't affect"},{"speaker":"Chris Dy","startTime":1197.93,"endTime":1200.87,"body":"us to do it so would you rather"},{"speaker":"Chris Dy","startTime":1200.87,"endTime":1203.9,"body":"have just Is it easier to advise"},{"speaker":"Chris Dy","startTime":1200.87,"endTime":1203.9,"body":"patients to take care of pins"},{"speaker":"Chris Dy","startTime":1203.9,"endTime":1204.5,"body":"that aren't bent?"},{"speaker":"Macy Stonner","startTime":1205.58,"endTime":1207.62,"body":"No, it's never"},{"speaker":"Macy Stonner","startTime":1205.58,"endTime":1207.62,"body":"crossed her mind ever until you"},{"speaker":"Macy Stonner","startTime":1207.62,"endTime":1211.34,"body":"just mentioned it, I don't think"},{"speaker":"Macy Stonner","startTime":1207.62,"endTime":1211.34,"body":"that it affects my job or their"},{"speaker":"Macy Stonner","startTime":1211.34,"endTime":1214.52,"body":"job in terms of pin care or"},{"speaker":"Macy Stonner","startTime":1211.34,"endTime":1214.52,"body":"range of motion. I don't think"},{"speaker":"Macy Stonner","startTime":1214.52,"endTime":1217.04,"body":"that's and people might disagree"},{"speaker":"Macy Stonner","startTime":1214.52,"endTime":1217.04,"body":"with me. But I don't think"},{"speaker":"Macy Stonner","startTime":1217.04,"endTime":1220.82,"body":"that's something that really is"},{"speaker":"Macy Stonner","startTime":1217.04,"endTime":1220.82,"body":"a big determinant of outcome"},{"speaker":"Macy Stonner","startTime":1220.82,"endTime":1221.96,"body":"from a therapy perspective."},{"speaker":"Chris Dy","startTime":1222.77,"endTime":1225.23,"body":"Do patients actually"},{"speaker":"Chris Dy","startTime":1222.77,"endTime":1225.23,"body":"move their finger their joint"},{"speaker":"Chris Dy","startTime":1225.23,"endTime":1228.17,"body":"when it's been like I we have"},{"speaker":"Chris Dy","startTime":1225.23,"endTime":1228.17,"body":"some partners to say nobody"},{"speaker":"Chris Dy","startTime":1228.17,"endTime":1229.46,"body":"really moves when they're"},{"speaker":"Chris Dy","startTime":1228.17,"endTime":1229.46,"body":"pinned?"},{"speaker":"Macy Stonner","startTime":1230.54,"endTime":1233.69,"body":"Sure. I think so."},{"speaker":"Macy Stonner","startTime":1230.54,"endTime":1233.69,"body":"I think that it depends on the"},{"speaker":"Macy Stonner","startTime":1233.69,"endTime":1237.17,"body":"patient's personality. People"},{"speaker":"Macy Stonner","startTime":1233.69,"endTime":1237.17,"body":"have some people have more fear"},{"speaker":"Macy Stonner","startTime":1237.17,"endTime":1243.17,"body":"than others, and people are just"},{"speaker":"Macy Stonner","startTime":1237.17,"endTime":1243.17,"body":"more careful. But I think that"},{"speaker":"Macy Stonner","startTime":1243.17,"endTime":1245.39,"body":"they do just fine. If you tell"},{"speaker":"Macy Stonner","startTime":1243.17,"endTime":1245.39,"body":"them it's okay. If you look them"},{"speaker":"Macy Stonner","startTime":1245.39,"endTime":1247.82,"body":"in the eyes and say, it's okay"},{"speaker":"Macy Stonner","startTime":1245.39,"endTime":1247.82,"body":"to move this, your doctor said"},{"speaker":"Macy Stonner","startTime":1247.82,"endTime":1250.46,"body":"it was fine. Nothing that I'm"},{"speaker":"Macy Stonner","startTime":1247.82,"endTime":1250.46,"body":"going to teach you right now is"},{"speaker":"Macy Stonner","startTime":1250.46,"endTime":1253.79,"body":"going to harm you. It might hurt"},{"speaker":"Macy Stonner","startTime":1250.46,"endTime":1253.79,"body":"a little bit, but it will not"},{"speaker":"Macy Stonner","startTime":1253.85,"endTime":1257.18,"body":"harm you. And that always gives"},{"speaker":"Macy Stonner","startTime":1253.85,"endTime":1257.18,"body":"a lot of confidence to the"},{"speaker":"Macy Stonner","startTime":1257.18,"endTime":1258.08,"body":"patient if you say that."},{"speaker":"Charles Goldfarb","startTime":1259.13,"endTime":1260.48,"body":"I like that."},{"speaker":"Charles Goldfarb","startTime":1259.13,"endTime":1260.48,"body":"And I think that's a good"},{"speaker":"Charles Goldfarb","startTime":1260.48,"endTime":1264.86,"body":"question, Chris, because I have"},{"speaker":"Charles Goldfarb","startTime":1260.48,"endTime":1264.86,"body":"heard that before. So before we"},{"speaker":"Charles Goldfarb","startTime":1264.86,"endTime":1268.25,"body":"jump to discussion of an open"},{"speaker":"Charles Goldfarb","startTime":1264.86,"endTime":1268.25,"body":"reduction, internal fixation of"},{"speaker":"Charles Goldfarb","startTime":1268.25,"endTime":1271.25,"body":"a similar fracture, perhaps with"},{"speaker":"Charles Goldfarb","startTime":1268.25,"endTime":1271.25,"body":"the playing screw before we jump"},{"speaker":"Charles Goldfarb","startTime":1271.25,"endTime":1277.64,"body":"to that similar case, I am lazy."},{"speaker":"Charles Goldfarb","startTime":1271.25,"endTime":1277.64,"body":"And so I often say to the"},{"speaker":"Charles Goldfarb","startTime":1277.64,"endTime":1281.84,"body":"patient, go to therapy, they'll"},{"speaker":"Charles Goldfarb","startTime":1277.64,"endTime":1281.84,"body":"take your surgical dressing off,"},{"speaker":"Charles Goldfarb","startTime":1281.87,"endTime":1284.87,"body":"they'll make you a beautiful"},{"speaker":"Charles Goldfarb","startTime":1281.87,"endTime":1284.87,"body":"custom fabricated splint, and"},{"speaker":"Charles Goldfarb","startTime":1284.87,"endTime":1288.17,"body":"they will teach you how to care"},{"speaker":"Charles Goldfarb","startTime":1284.87,"endTime":1288.17,"body":"for those pins. What do you tell"},{"speaker":"Charles Goldfarb","startTime":1288.2,"endTime":1290.96,"body":"my patients when you teach them"},{"speaker":"Charles Goldfarb","startTime":1288.2,"endTime":1290.96,"body":"how to care for those pins?"},{"speaker":"Macy Stonner","startTime":1291.08,"endTime":1295.61,"body":"We get little"},{"speaker":"Macy Stonner","startTime":1291.08,"endTime":1295.61,"body":"Dixie cups of 50% hydrogen"},{"speaker":"Macy Stonner","startTime":1295.61,"endTime":1301.1,"body":"peroxide 50% water, instruct"},{"speaker":"Macy Stonner","startTime":1295.61,"endTime":1301.1,"body":"them and pin care with a Q tip"},{"speaker":"Macy Stonner","startTime":1301.49,"endTime":1305.15,"body":"is they do this once a day if"},{"speaker":"Macy Stonner","startTime":1301.49,"endTime":1305.15,"body":"you have little crusties at the"},{"speaker":"Macy Stonner","startTime":1305.15,"endTime":1308.09,"body":"base of your pin, sometimes they"},{"speaker":"Macy Stonner","startTime":1305.15,"endTime":1308.09,"body":"don't even need to do anything."},{"speaker":"Macy Stonner","startTime":1308.09,"endTime":1310.79,"body":"If they're clean and dry. No"},{"speaker":"Macy Stonner","startTime":1308.09,"endTime":1310.79,"body":"signs of infection, no pain, no"},{"speaker":"Macy Stonner","startTime":1310.79,"endTime":1314.33,"body":"tenderness, no redness, you're"},{"speaker":"Macy Stonner","startTime":1310.79,"endTime":1314.33,"body":"fine. So it kind of depends on"},{"speaker":"Macy Stonner","startTime":1314.33,"endTime":1315.11,"body":"what they look like."},{"speaker":"Charles Goldfarb","startTime":1315.41,"endTime":1317.69,"body":"I agree and,"},{"speaker":"Charles Goldfarb","startTime":1315.41,"endTime":1317.69,"body":"and I am fine with my patients"},{"speaker":"Charles Goldfarb","startTime":1317.69,"endTime":1322.43,"body":"showering and I you know, I like"},{"speaker":"Charles Goldfarb","startTime":1317.69,"endTime":1322.43,"body":"them to share actually getting"},{"speaker":"Charles Goldfarb","startTime":1322.43,"endTime":1327.14,"body":"their pins wet. And just using"},{"speaker":"Charles Goldfarb","startTime":1322.43,"endTime":1327.14,"body":"soap and water around the pins"},{"speaker":"Charles Goldfarb","startTime":1327.14,"endTime":1330.23,"body":"in the shower. And then I love"},{"speaker":"Charles Goldfarb","startTime":1327.14,"endTime":1330.23,"body":"what you said, I don't think you"},{"speaker":"Charles Goldfarb","startTime":1330.23,"endTime":1333.11,"body":"and I've ever had a discussion."},{"speaker":"Charles Goldfarb","startTime":1330.23,"endTime":1333.11,"body":"But I appreciate what you said."},{"speaker":"Chris Dy","startTime":1333.8,"endTime":1335.81,"body":"I guarantee I"},{"speaker":"Chris Dy","startTime":1333.8,"endTime":1335.81,"body":"guarantee you there's a little"},{"speaker":"Chris Dy","startTime":1336.23,"endTime":1338.84,"body":"index card floating around the"},{"speaker":"Chris Dy","startTime":1336.23,"endTime":1338.84,"body":"Milliken hand Therapy Center"},{"speaker":"Chris Dy","startTime":1338.84,"endTime":1341.96,"body":"with all the Goldfarb pin"},{"speaker":"Chris Dy","startTime":1338.84,"endTime":1341.96,"body":"preferences from when you first"},{"speaker":"Chris Dy","startTime":1341.96,"endTime":1343.67,"body":"started and you probable didn't"},{"speaker":"Chris Dy","startTime":1341.96,"endTime":1343.67,"body":"even know it's out there."},{"speaker":"Macy Stonner","startTime":1344.45,"endTime":1347.36,"body":"We have a file"},{"speaker":"Macy Stonner","startTime":1344.45,"endTime":1347.36,"body":"folder of every surgeon we work"},{"speaker":"Macy Stonner","startTime":1347.36,"endTime":1350.81,"body":"with. And it says wound care"},{"speaker":"Macy Stonner","startTime":1347.36,"endTime":1350.81,"body":"preferences for each doctor. And"},{"speaker":"Macy Stonner","startTime":1350.81,"endTime":1353.18,"body":"we just go through however now"},{"speaker":"Macy Stonner","startTime":1350.81,"endTime":1353.18,"body":"we kind of have everybody"},{"speaker":"Macy Stonner","startTime":1353.18,"endTime":1353.99,"body":"memorized. So."},{"speaker":"Chris Dy","startTime":1354.02,"endTime":1356.0,"body":"The reason I know that"},{"speaker":"Chris Dy","startTime":1354.02,"endTime":1356.0,"body":"is because I remember having to"},{"speaker":"Chris Dy","startTime":1356.0,"endTime":1358.43,"body":"answer these questions when I"},{"speaker":"Chris Dy","startTime":1356.0,"endTime":1358.43,"body":"was about to start and be like,"},{"speaker":"Chris Dy","startTime":1358.46,"endTime":1359.93,"body":"Oh shit, just do what Goldfarb"},{"speaker":"Chris Dy","startTime":1358.46,"endTime":1359.93,"body":"does."},{"speaker":"Charles Goldfarb","startTime":1362.03,"endTime":1364.13,"body":"Well, is"},{"speaker":"Charles Goldfarb","startTime":1362.03,"endTime":1364.13,"body":"totally fair. And we have a"},{"speaker":"Charles Goldfarb","startTime":1364.13,"endTime":1366.98,"body":"group of six surgeons and four"},{"speaker":"Charles Goldfarb","startTime":1364.13,"endTime":1366.98,"body":"of us regularly performed wrist"},{"speaker":"Charles Goldfarb","startTime":1366.98,"endTime":1370.43,"body":"arthroscopy as an example. And"},{"speaker":"Charles Goldfarb","startTime":1366.98,"endTime":1370.43,"body":"so Lindley Wall was trying to"},{"speaker":"Charles Goldfarb","startTime":1370.67,"endTime":1374.0,"body":"help our therapy partners by"},{"speaker":"Charles Goldfarb","startTime":1370.67,"endTime":1374.0,"body":"trying to consolidate a couple"},{"speaker":"Charles Goldfarb","startTime":1374.0,"endTime":1378.56,"body":"of protocols. And it was really"},{"speaker":"Charles Goldfarb","startTime":1374.0,"endTime":1378.56,"body":"tough. I mean, we just, you"},{"speaker":"Charles Goldfarb","startTime":1378.56,"endTime":1382.22,"body":"know, if we've done it this way,"},{"speaker":"Charles Goldfarb","startTime":1378.56,"endTime":1382.22,"body":"for three years, why would I"},{"speaker":"Charles Goldfarb","startTime":1382.22,"endTime":1385.19,"body":"change and so those"},{"speaker":"Charles Goldfarb","startTime":1382.22,"endTime":1385.19,"body":"conversations are tough, but it"},{"speaker":"Charles Goldfarb","startTime":1385.19,"endTime":1388.64,"body":"is not particularly fair that"},{"speaker":"Charles Goldfarb","startTime":1385.19,"endTime":1388.64,"body":"six surgeons have six different"},{"speaker":"Charles Goldfarb","startTime":1388.64,"endTime":1391.85,"body":"pin site, you know, care"},{"speaker":"Charles Goldfarb","startTime":1388.64,"endTime":1391.85,"body":"preferences, it's crazy. It's"},{"speaker":"Charles Goldfarb","startTime":1391.85,"endTime":1392.24,"body":"crazy."},{"speaker":"Chris Dy","startTime":1392.66,"endTime":1396.05,"body":"So I will say this"},{"speaker":"Chris Dy","startTime":1392.66,"endTime":1396.05,"body":"episode's gonna drop in July."},{"speaker":"Chris Dy","startTime":1396.8,"endTime":1399.83,"body":"And that means that there are a"},{"speaker":"Chris Dy","startTime":1396.8,"endTime":1399.83,"body":"lot of fellows that are about to"},{"speaker":"Chris Dy","startTime":1399.86,"endTime":1402.86,"body":"move institutions and graduate,"},{"speaker":"Chris Dy","startTime":1399.86,"endTime":1402.86,"body":"you probably already know this,"},{"speaker":"Chris Dy","startTime":1402.86,"endTime":1406.34,"body":"but you should be scrambling to"},{"speaker":"Chris Dy","startTime":1402.86,"endTime":1406.34,"body":"get every protocol you can, from"},{"speaker":"Chris Dy","startTime":1406.34,"endTime":1410.48,"body":"something as simple as how does"},{"speaker":"Chris Dy","startTime":1406.34,"endTime":1410.48,"body":"the type of needles you need to"},{"speaker":"Chris Dy","startTime":1410.48,"endTime":1414.77,"body":"set up an injection in the"},{"speaker":"Chris Dy","startTime":1410.48,"endTime":1414.77,"body":"clinic to as complex as somebody"},{"speaker":"Chris Dy","startTime":1414.8,"endTime":1418.88,"body":"wound care protocols, their"},{"speaker":"Chris Dy","startTime":1414.8,"endTime":1418.88,"body":"their clinic templates, as well"},{"speaker":"Chris Dy","startTime":1418.88,"endTime":1421.73,"body":"as all their therapy protocols."},{"speaker":"Chris Dy","startTime":1418.88,"endTime":1421.73,"body":"And a lot of that's available in"},{"speaker":"Chris Dy","startTime":1421.73,"endTime":1424.73,"body":"epic now through dot phrases and"},{"speaker":"Chris Dy","startTime":1421.73,"endTime":1424.73,"body":"whatnot. But make sure you're"},{"speaker":"Chris Dy","startTime":1424.73,"endTime":1426.59,"body":"grabbing all that stuff now"},{"speaker":"Chris Dy","startTime":1424.73,"endTime":1426.59,"body":"before you leave."},{"speaker":"Charles Goldfarb","startTime":1427.58,"endTime":1429.77,"body":"That is That"},{"speaker":"Charles Goldfarb","startTime":1427.58,"endTime":1429.77,"body":"is very true. And we know what's"},{"speaker":"Charles Goldfarb","startTime":1429.77,"endTime":1432.38,"body":"happening. It's already started"},{"speaker":"Charles Goldfarb","startTime":1429.77,"endTime":1432.38,"body":"happening here, as you certainly"},{"speaker":"Charles Goldfarb","startTime":1432.38,"endTime":1435.8,"body":"know, Chris. Alright, may see"},{"speaker":"Charles Goldfarb","startTime":1432.38,"endTime":1435.8,"body":"let's go back to that 25 year"},{"speaker":"Charles Goldfarb","startTime":1435.8,"endTime":1441.08,"body":"old. And let's pretend that I"},{"speaker":"Charles Goldfarb","startTime":1435.8,"endTime":1441.08,"body":"was unable to obtain a"},{"speaker":"Charles Goldfarb","startTime":1441.08,"endTime":1445.55,"body":"satisfactory closed reduction. I"},{"speaker":"Charles Goldfarb","startTime":1441.08,"endTime":1445.55,"body":"made an incision dorsally over"},{"speaker":"Charles Goldfarb","startTime":1445.55,"endTime":1450.59,"body":"the proximal phalanx, I split"},{"speaker":"Charles Goldfarb","startTime":1445.55,"endTime":1450.59,"body":"the extensor mechanism. And"},{"speaker":"Charles Goldfarb","startTime":1450.62,"endTime":1453.98,"body":"let's say I needed to put a"},{"speaker":"Charles Goldfarb","startTime":1450.62,"endTime":1453.98,"body":"small plate and screws in so I"},{"speaker":"Charles Goldfarb","startTime":1453.98,"endTime":1459.5,"body":"put a 1.5 millimeter plate in"},{"speaker":"Charles Goldfarb","startTime":1453.98,"endTime":1459.5,"body":"with five screws was really"},{"speaker":"Charles Goldfarb","startTime":1459.5,"endTime":1462.71,"body":"happy when I left the or I re"},{"speaker":"Charles Goldfarb","startTime":1459.5,"endTime":1462.71,"body":"approximate the extensor"},{"speaker":"Charles Goldfarb","startTime":1462.71,"endTime":1467.15,"body":"mechanism, close the skin."},{"speaker":"Charles Goldfarb","startTime":1462.71,"endTime":1467.15,"body":"Splint it for four days and sent"},{"speaker":"Charles Goldfarb","startTime":1467.15,"endTime":1471.23,"body":"them to you number one, are you"},{"speaker":"Charles Goldfarb","startTime":1467.15,"endTime":1471.23,"body":"happier that I did an ORIF"},{"speaker":"Charles Goldfarb","startTime":1471.26,"endTime":1475.04,"body":"versus a pinning? Does it make"},{"speaker":"Charles Goldfarb","startTime":1471.26,"endTime":1475.04,"body":"your life easier or harder? And"},{"speaker":"Charles Goldfarb","startTime":1475.04,"endTime":1478.46,"body":"how would you address this"},{"speaker":"Charles Goldfarb","startTime":1475.04,"endTime":1478.46,"body":"patient differently if at all."},{"speaker":"Macy Stonner","startTime":1479.03,"endTime":1481.94,"body":"I have had great"},{"speaker":"Macy Stonner","startTime":1479.03,"endTime":1481.94,"body":"outcomes with both it's kind of"},{"speaker":"Macy Stonner","startTime":1481.94,"endTime":1486.23,"body":"hard to say I think on my for"},{"speaker":"Macy Stonner","startTime":1481.94,"endTime":1486.23,"body":"her pinning because of that"},{"speaker":"Macy Stonner","startTime":1486.23,"endTime":1492.35,"body":"gnarly PIP extensor lag."},{"speaker":"Macy Stonner","startTime":1486.23,"endTime":1492.35,"body":"Whenever I have a plate fixation"},{"speaker":"Macy Stonner","startTime":1492.35,"endTime":1496.46,"body":"of a p one fracture I get"},{"speaker":"Macy Stonner","startTime":1492.35,"endTime":1496.46,"body":"immediately concerned about PIP"},{"speaker":"Macy Stonner","startTime":1496.46,"endTime":1499.46,"body":"extension just because you have"},{"speaker":"Macy Stonner","startTime":1496.46,"endTime":1499.46,"body":"more swelling and more scarring"},{"speaker":"Macy Stonner","startTime":1499.46,"endTime":1504.29,"body":"along that zone three extension"},{"speaker":"Macy Stonner","startTime":1499.46,"endTime":1504.29,"body":"mechanism. And so reverse"},{"speaker":"Macy Stonner","startTime":1504.29,"endTime":1508.88,"body":"blocking again therapy term to"},{"speaker":"Macy Stonner","startTime":1504.29,"endTime":1508.88,"body":"get active tip extension is an"},{"speaker":"Macy Stonner","startTime":1508.88,"endTime":1513.08,"body":"exercise that I would implement"},{"speaker":"Macy Stonner","startTime":1508.88,"endTime":1513.08,"body":"earlier. So like I said, it kind"},{"speaker":"Macy Stonner","startTime":1513.08,"endTime":1515.42,"body":"of dodged your question, but I"},{"speaker":"Macy Stonner","startTime":1513.08,"endTime":1515.42,"body":"guess I'll prefer pinning."},{"speaker":"Chris Dy","startTime":1515.81,"endTime":1517.94,"body":"So wait, hold on a"},{"speaker":"Chris Dy","startTime":1515.81,"endTime":1517.94,"body":"question for both of you then."},{"speaker":"Chris Dy","startTime":1517.94,"endTime":1520.94,"body":"So if, if this is truly a"},{"speaker":"Chris Dy","startTime":1517.94,"endTime":1520.94,"body":"shorter oblique fracture, maybe"},{"speaker":"Chris Dy","startTime":1520.94,"endTime":1524.15,"body":"if it was a longer oblique"},{"speaker":"Chris Dy","startTime":1520.94,"endTime":1524.15,"body":"fracture, what if we had fixed"},{"speaker":"Chris Dy","startTime":1524.15,"endTime":1527.63,"body":"it with three or four screws"},{"speaker":"Chris Dy","startTime":1524.15,"endTime":1527.63,"body":"still done the same approach"},{"speaker":"Chris Dy","startTime":1527.66,"endTime":1531.59,"body":"maybe or kind of danced around"},{"speaker":"Chris Dy","startTime":1527.66,"endTime":1531.59,"body":"the extensor mechanism? So"},{"speaker":"Chris Dy","startTime":1531.59,"endTime":1534.89,"body":"there's still some concern for"},{"speaker":"Chris Dy","startTime":1531.59,"endTime":1534.89,"body":"scarring around the extensor"},{"speaker":"Chris Dy","startTime":1534.89,"endTime":1537.92,"body":"mechanism, but there's no plate"},{"speaker":"Chris Dy","startTime":1534.89,"endTime":1537.92,"body":"physically sitting dorsally."},{"speaker":"Chris Dy","startTime":1538.31,"endTime":1541.61,"body":"There are inner fragmentary"},{"speaker":"Chris Dy","startTime":1538.31,"endTime":1541.61,"body":"screws or perhaps lag screws"},{"speaker":"Chris Dy","startTime":1542.24,"endTime":1545.18,"body":"that are holding that fracture"},{"speaker":"Chris Dy","startTime":1542.24,"endTime":1545.18,"body":"together really solid. Chuck,"},{"speaker":"Chris Dy","startTime":1545.18,"endTime":1548.9,"body":"would you send that prescription"},{"speaker":"Chris Dy","startTime":1545.18,"endTime":1548.9,"body":"over any differently than Macy?"},{"speaker":"Chris Dy","startTime":1548.9,"endTime":1551.27,"body":"Would you? I don't know if you"},{"speaker":"Chris Dy","startTime":1548.9,"endTime":1551.27,"body":"would actually end up knowing"},{"speaker":"Chris Dy","startTime":1551.27,"endTime":1553.76,"body":"what type of construct was in"},{"speaker":"Chris Dy","startTime":1551.27,"endTime":1553.76,"body":"there. But would that change"},{"speaker":"Chris Dy","startTime":1553.76,"endTime":1558.08,"body":"your your optimism or pessimism"},{"speaker":"Chris Dy","startTime":1553.76,"endTime":1558.08,"body":"about the extensor? mechanism?"},{"speaker":"Charles Goldfarb","startTime":1560.09,"endTime":1564.8,"body":"Again, great"},{"speaker":"Charles Goldfarb","startTime":1560.09,"endTime":1564.8,"body":"question. I think when I do an"},{"speaker":"Charles Goldfarb","startTime":1564.8,"endTime":1568.94,"body":"ORIF and I have solid fixation"},{"speaker":"Charles Goldfarb","startTime":1564.8,"endTime":1568.94,"body":"and feels feel really good about"},{"speaker":"Charles Goldfarb","startTime":1568.94,"endTime":1571.49,"body":"what I have, I guess I always"},{"speaker":"Charles Goldfarb","startTime":1568.94,"endTime":1571.49,"body":"thought that Macy would have"},{"speaker":"Charles Goldfarb","startTime":1571.49,"endTime":1574.58,"body":"been happier with me then then"},{"speaker":"Charles Goldfarb","startTime":1571.49,"endTime":1574.58,"body":"if I can, just because you're"},{"speaker":"Charles Goldfarb","startTime":1574.58,"endTime":1578.21,"body":"not fighting the pins per se,"},{"speaker":"Charles Goldfarb","startTime":1574.58,"endTime":1578.21,"body":"but but I hear her loud and"},{"speaker":"Charles Goldfarb","startTime":1578.21,"endTime":1583.49,"body":"clear about the concerns about"},{"speaker":"Charles Goldfarb","startTime":1578.21,"endTime":1583.49,"body":"an extensor lag. If I have"},{"speaker":"Charles Goldfarb","startTime":1583.49,"endTime":1588.26,"body":"really good fixation, operate on"},{"speaker":"Charles Goldfarb","startTime":1583.49,"endTime":1588.26,"body":"Wednesdays primarily, I would"},{"speaker":"Charles Goldfarb","startTime":1588.26,"endTime":1592.34,"body":"say that I would send them over"},{"speaker":"Charles Goldfarb","startTime":1588.26,"endTime":1592.34,"body":"for Monday. Really not"},{"speaker":"Charles Goldfarb","startTime":1592.34,"endTime":1595.49,"body":"considering pins played or"},{"speaker":"Charles Goldfarb","startTime":1592.34,"endTime":1595.49,"body":"screws, but I don't think it"},{"speaker":"Charles Goldfarb","startTime":1595.49,"endTime":1599.09,"body":"changes my referral. I guess it"},{"speaker":"Charles Goldfarb","startTime":1595.49,"endTime":1599.09,"body":"changes my optimism on how"},{"speaker":"Charles Goldfarb","startTime":1599.09,"endTime":1603.38,"body":"aggressive Macy can comfortably"},{"speaker":"Charles Goldfarb","startTime":1599.09,"endTime":1603.38,"body":"be. But but maybe not."},{"speaker":"Chris Dy","startTime":1603.77,"endTime":1606.05,"body":"Do you write in your"},{"speaker":"Chris Dy","startTime":1603.77,"endTime":1606.05,"body":"prescription to be different in"},{"speaker":"Chris Dy","startTime":1606.05,"endTime":1610.7,"body":"terms of how aggressively Macy"},{"speaker":"Chris Dy","startTime":1606.05,"endTime":1610.7,"body":"or any of our therapy colleagues"},{"speaker":"Chris Dy","startTime":1610.7,"endTime":1616.76,"body":"can be if it's pins, plate and"},{"speaker":"Chris Dy","startTime":1610.7,"endTime":1616.76,"body":"screws or independent screws?"},{"speaker":"Charles Goldfarb","startTime":1617.6,"endTime":1620.45,"body":"If I'm"},{"speaker":"Charles Goldfarb","startTime":1617.6,"endTime":1620.45,"body":"interacting with an external"},{"speaker":"Charles Goldfarb","startTime":1620.45,"endTime":1623.6,"body":"therapist, and there we look,"},{"speaker":"Charles Goldfarb","startTime":1620.45,"endTime":1623.6,"body":"let's be clear, St. Louis is"},{"speaker":"Charles Goldfarb","startTime":1623.6,"endTime":1627.14,"body":"blessed with a number of really"},{"speaker":"Charles Goldfarb","startTime":1623.6,"endTime":1627.14,"body":"good therapists, you know, that"},{"speaker":"Charles Goldfarb","startTime":1627.14,"endTime":1631.04,"body":"I know of and I'm sure there's"},{"speaker":"Charles Goldfarb","startTime":1627.14,"endTime":1631.04,"body":"others, but I am much more clear"},{"speaker":"Charles Goldfarb","startTime":1631.43,"endTime":1637.31,"body":"about what I would like when I"},{"speaker":"Charles Goldfarb","startTime":1631.43,"endTime":1637.31,"body":"send them to Oh, gosh, maybe"},{"speaker":"Charles Goldfarb","startTime":1637.31,"endTime":1641.84,"body":"this is not okay. But when I"},{"speaker":"Charles Goldfarb","startTime":1637.31,"endTime":1641.84,"body":"send to Macy, or to Stacey, I am"},{"speaker":"Charles Goldfarb","startTime":1641.87,"endTime":1645.08,"body":"I guess less clear, I will state"},{"speaker":"Charles Goldfarb","startTime":1641.87,"endTime":1645.08,"body":"you know, early active motion,"},{"speaker":"Charles Goldfarb","startTime":1645.08,"endTime":1648.62,"body":"gentle passive motion, but I"},{"speaker":"Charles Goldfarb","startTime":1645.08,"endTime":1648.62,"body":"trust that they will progress"},{"speaker":"Charles Goldfarb","startTime":1648.62,"endTime":1652.01,"body":"along. But I'm perhaps not as"},{"speaker":"Charles Goldfarb","startTime":1648.62,"endTime":1652.01,"body":"clear as that could be."},{"speaker":"Macy Stonner","startTime":1654.05,"endTime":1656.09,"body":"We just are"},{"speaker":"Macy Stonner","startTime":1654.05,"endTime":1656.09,"body":"spoiled and we know your"},{"speaker":"Macy Stonner","startTime":1656.09,"endTime":1659.27,"body":"preferences. And so we don't"},{"speaker":"Macy Stonner","startTime":1656.09,"endTime":1659.27,"body":"really need you to be clear. And"},{"speaker":"Macy Stonner","startTime":1659.27,"endTime":1662.6,"body":"so we appreciate that, that you"},{"speaker":"Macy Stonner","startTime":1659.27,"endTime":1662.6,"body":"trust us enough to guide the"},{"speaker":"Macy Stonner","startTime":1662.6,"endTime":1666.98,"body":"patient a lot. And so you're"},{"speaker":"Macy Stonner","startTime":1662.6,"endTime":1666.98,"body":"right, if it was plated, I do"},{"speaker":"Macy Stonner","startTime":1666.98,"endTime":1669.38,"body":"feel like I can progress to"},{"speaker":"Macy Stonner","startTime":1666.98,"endTime":1669.38,"body":"passive earlier because let's be"},{"speaker":"Macy Stonner","startTime":1669.38,"endTime":1671.6,"body":"honest, a few one fracture that"},{"speaker":"Macy Stonner","startTime":1669.38,"endTime":1671.6,"body":"was fixed is going to need"},{"speaker":"Macy Stonner","startTime":1671.6,"endTime":1675.59,"body":"passive motion at some point, if"},{"speaker":"Macy Stonner","startTime":1671.6,"endTime":1675.59,"body":"they were pinned, and I'm not as"},{"speaker":"Macy Stonner","startTime":1675.59,"endTime":1680.03,"body":"convinced of the fixation as a"},{"speaker":"Macy Stonner","startTime":1675.59,"endTime":1680.03,"body":"different approach, I might wait"},{"speaker":"Macy Stonner","startTime":1680.03,"endTime":1684.26,"body":"on passive and because I'd be"},{"speaker":"Macy Stonner","startTime":1680.03,"endTime":1684.26,"body":"fearful of instability, I guess."},{"speaker":"Macy Stonner","startTime":1684.77,"endTime":1689.09,"body":"But yes, a plate I feel like I"},{"speaker":"Macy Stonner","startTime":1684.77,"endTime":1689.09,"body":"can be much more quick with"},{"speaker":"Macy Stonner","startTime":1689.09,"endTime":1692.57,"body":"passive motion but you know ask"},{"speaker":"Macy Stonner","startTime":1689.09,"endTime":1692.57,"body":"other people my colleague Emily"},{"speaker":"Macy Stonner","startTime":1692.57,"endTime":1696.86,"body":"potassium hope she's listening"},{"speaker":"Macy Stonner","startTime":1692.57,"endTime":1696.86,"body":"will always prefer an ORIF of a"},{"speaker":"Macy Stonner","startTime":1697.07,"endTime":1700.88,"body":"P one fracture versus a pin"},{"speaker":"Macy Stonner","startTime":1697.07,"endTime":1700.88,"body":"because she's convinced that if"},{"speaker":"Macy Stonner","startTime":1700.88,"endTime":1703.19,"body":"you're pinned you're not going"},{"speaker":"Macy Stonner","startTime":1700.88,"endTime":1703.19,"body":"to move like we had talked"},{"speaker":"Macy Stonner","startTime":1703.19,"endTime":1706.88,"body":"earlier. And so if you don't"},{"speaker":"Macy Stonner","startTime":1703.19,"endTime":1706.88,"body":"have visually a pins coming at"},{"speaker":"Macy Stonner","startTime":1706.88,"endTime":1709.43,"body":"your finger, you're gonna move a"},{"speaker":"Macy Stonner","startTime":1706.88,"endTime":1709.43,"body":"lot better. So I think it"},{"speaker":"Macy Stonner","startTime":1709.43,"endTime":1713.33,"body":"depends on the patient depends"},{"speaker":"Macy Stonner","startTime":1709.43,"endTime":1713.33,"body":"on the therapist. Can't go wrong"},{"speaker":"Macy Stonner","startTime":1713.33,"endTime":1713.72,"body":"either way."},{"speaker":"Charles Goldfarb","startTime":1713.99,"endTime":1718.16,"body":"Did did Emily"},{"speaker":"Charles Goldfarb","startTime":1713.99,"endTime":1718.16,"body":"brainwash her collaborative"},{"speaker":"Charles Goldfarb","startTime":1718.16,"endTime":1721.94,"body":"surgeon or did her collaborative"},{"speaker":"Charles Goldfarb","startTime":1718.16,"endTime":1721.94,"body":"surgeon brainwash Emily?"},{"speaker":"Macy Stonner","startTime":1722.42,"endTime":1723.92,"body":"That's a great"},{"speaker":"Macy Stonner","startTime":1722.42,"endTime":1723.92,"body":"question. It's probably the"},{"speaker":"Macy Stonner","startTime":1723.92,"endTime":1724.46,"body":"latter."},{"speaker":"Chris Dy","startTime":1728.03,"endTime":1732.08,"body":"No, no comment. I"},{"speaker":"Chris Dy","startTime":1728.03,"endTime":1732.08,"body":"really don't know. I've seen"},{"speaker":"Chris Dy","startTime":1732.08,"endTime":1734.63,"body":"Emily with her collaborative"},{"speaker":"Chris Dy","startTime":1732.08,"endTime":1734.63,"body":"surgeon in clinic and Emily is"},{"speaker":"Chris Dy","startTime":1735.11,"endTime":1739.76,"body":"Emily's smart as a whip and very"},{"speaker":"Chris Dy","startTime":1735.11,"endTime":1739.76,"body":"open to expressing opinion. So I"},{"speaker":"Chris Dy","startTime":1739.76,"endTime":1740.87,"body":"think that's, that's great."},{"speaker":"Macy Stonner","startTime":1741.17,"endTime":1742.94,"body":"Yeah she'll always"},{"speaker":"Macy Stonner","startTime":1741.17,"endTime":1742.94,"body":"prefer an ORIF."},{"speaker":"Chris Dy","startTime":1743.99,"endTime":1746.66,"body":"So, I had a question"},{"speaker":"Chris Dy","startTime":1743.99,"endTime":1746.66,"body":"before we switch to say a case"},{"speaker":"Chris Dy","startTime":1746.66,"endTime":1750.35,"body":"where we have some stiffness in"},{"speaker":"Chris Dy","startTime":1746.66,"endTime":1750.35,"body":"any way that the fracture is"},{"speaker":"Chris Dy","startTime":1750.35,"endTime":1754.28,"body":"fixed. When do you start to add"},{"speaker":"Chris Dy","startTime":1750.35,"endTime":1754.28,"body":"some resistant work in terms of"},{"speaker":"Chris Dy","startTime":1754.28,"endTime":1758.06,"body":"putty and eventually"},{"speaker":"Chris Dy","startTime":1754.28,"endTime":1758.06,"body":"strengthening? Is it when we"},{"speaker":"Chris Dy","startTime":1758.06,"endTime":1761.18,"body":"asked you to or are there points"},{"speaker":"Chris Dy","startTime":1758.06,"endTime":1761.18,"body":"in the therapy course of"},{"speaker":"Chris Dy","startTime":1761.18,"endTime":1763.46,"body":"therapy? were like, Oh, this"},{"speaker":"Chris Dy","startTime":1761.18,"endTime":1763.46,"body":"patient's like, ready for the"},{"speaker":"Chris Dy","startTime":1763.46,"endTime":1764.03,"body":"next step?"},{"speaker":"Macy Stonner","startTime":1765.65,"endTime":1767.42,"body":"Oh, great"},{"speaker":"Macy Stonner","startTime":1765.65,"endTime":1767.42,"body":"question. Definitely after"},{"speaker":"Macy Stonner","startTime":1767.42,"endTime":1771.14,"body":"they're healed, and that can be"},{"speaker":"Macy Stonner","startTime":1767.42,"endTime":1771.14,"body":"very different for every"},{"speaker":"Macy Stonner","startTime":1771.14,"endTime":1775.13,"body":"patient. But I would say once"},{"speaker":"Macy Stonner","startTime":1771.14,"endTime":1775.13,"body":"they're healed, I'm pretty free"},{"speaker":"Macy Stonner","startTime":1775.13,"endTime":1779.06,"body":"game with any passive motion"},{"speaker":"Macy Stonner","startTime":1775.13,"endTime":1779.06,"body":"that I want. And then once they"},{"speaker":"Macy Stonner","startTime":1779.06,"endTime":1782.36,"body":"start passive, wherever that"},{"speaker":"Macy Stonner","startTime":1779.06,"endTime":1782.36,"body":"point may be, whether that's two"},{"speaker":"Macy Stonner","startTime":1782.36,"endTime":1785.75,"body":"weeks, whether that's eight"},{"speaker":"Macy Stonner","startTime":1782.36,"endTime":1785.75,"body":"weeks, and they're relatively"},{"speaker":"Macy Stonner","startTime":1785.75,"endTime":1789.5,"body":"pain free at rest, I can start"},{"speaker":"Macy Stonner","startTime":1785.75,"endTime":1789.5,"body":"some strengthening shortly"},{"speaker":"Macy Stonner","startTime":1789.5,"endTime":1792.44,"body":"after. So that's a bad answer,"},{"speaker":"Macy Stonner","startTime":1789.5,"endTime":1792.44,"body":"because I'm not giving you a"},{"speaker":"Macy Stonner","startTime":1792.44,"endTime":1798.68,"body":"specific week. It totally case"},{"speaker":"Macy Stonner","startTime":1792.44,"endTime":1798.68,"body":"dependent, but I go off pain. I"},{"speaker":"Macy Stonner","startTime":1798.68,"endTime":1803.87,"body":"go up when they started Passive"},{"speaker":"Macy Stonner","startTime":1798.68,"endTime":1803.87,"body":"and when they're healed,"},{"speaker":"Chris Dy","startTime":1804.5,"endTime":1807.38,"body":"But is there like a"},{"speaker":"Chris Dy","startTime":1804.5,"endTime":1807.38,"body":"specific value for total active"},{"speaker":"Chris Dy","startTime":1807.38,"endTime":1811.43,"body":"motion or DPC where you say"},{"speaker":"Chris Dy","startTime":1807.38,"endTime":1811.43,"body":"okay, now we can start to do"},{"speaker":"Chris Dy","startTime":1811.43,"endTime":1812.24,"body":"some strengthening."},{"speaker":"Macy Stonner","startTime":1813.83,"endTime":1817.16,"body":"I think that if"},{"speaker":"Macy Stonner","startTime":1813.83,"endTime":1817.16,"body":"joint stiffness is the concern,"},{"speaker":"Macy Stonner","startTime":1818.66,"endTime":1824.06,"body":"strengthening is definitely not"},{"speaker":"Macy Stonner","startTime":1818.66,"endTime":1824.06,"body":"my prioritizing treatment plan."},{"speaker":"Macy Stonner","startTime":1824.96,"endTime":1828.41,"body":"Because I say, Hey, I get this"},{"speaker":"Macy Stonner","startTime":1824.96,"endTime":1828.41,"body":"soapbox every time like, Hey,"},{"speaker":"Macy Stonner","startTime":1828.62,"endTime":1832.13,"body":"you have your whole life to"},{"speaker":"Macy Stonner","startTime":1828.62,"endTime":1832.13,"body":"regain strength, you can always"},{"speaker":"Macy Stonner","startTime":1832.25,"endTime":1836.21,"body":"gain muscle mass, you have more"},{"speaker":"Macy Stonner","startTime":1832.25,"endTime":1836.21,"body":"of a limited opportunity or"},{"speaker":"Macy Stonner","startTime":1836.21,"endTime":1841.46,"body":"limited time to regain motion,"},{"speaker":"Macy Stonner","startTime":1836.21,"endTime":1841.46,"body":"you have this nice window, and"},{"speaker":"Macy Stonner","startTime":1841.46,"endTime":1845.45,"body":"fingers do not tolerate trauma"},{"speaker":"Macy Stonner","startTime":1841.46,"endTime":1845.45,"body":"well, so let's really work on"},{"speaker":"Macy Stonner","startTime":1845.45,"endTime":1849.32,"body":"stretching. Because if you have"},{"speaker":"Macy Stonner","startTime":1845.45,"endTime":1849.32,"body":"sickness in the finger, it"},{"speaker":"Macy Stonner","startTime":1849.32,"endTime":1852.53,"body":"doesn't just naturally get"},{"speaker":"Macy Stonner","startTime":1849.32,"endTime":1852.53,"body":"better with time. It gets"},{"speaker":"Macy Stonner","startTime":1852.53,"endTime":1856.43,"body":"naturally better with stretch."},{"speaker":"Macy Stonner","startTime":1852.53,"endTime":1856.43,"body":"So let's really stretch."},{"speaker":"Charles Goldfarb","startTime":1857.51,"endTime":1860.51,"body":"I was I was"},{"speaker":"Charles Goldfarb","startTime":1857.51,"endTime":1860.51,"body":"recently at a an informal"},{"speaker":"Charles Goldfarb","startTime":1860.51,"endTime":1864.29,"body":"meeting. And I guess I'll leave"},{"speaker":"Charles Goldfarb","startTime":1860.51,"endTime":1864.29,"body":"the names out of it. Hopefully,"},{"speaker":"Charles Goldfarb","startTime":1864.29,"endTime":1869.12,"body":"that's okay. Were they the"},{"speaker":"Charles Goldfarb","startTime":1864.29,"endTime":1869.12,"body":"presenter stated, gave really a"},{"speaker":"Charles Goldfarb","startTime":1869.12,"endTime":1874.76,"body":"presentation about why I hate"},{"speaker":"Charles Goldfarb","startTime":1869.12,"endTime":1874.76,"body":"the squeezy ball. He basically"},{"speaker":"Charles Goldfarb","startTime":1874.76,"endTime":1878.12,"body":"showed the example of if you"},{"speaker":"Charles Goldfarb","startTime":1874.76,"endTime":1878.12,"body":"have a squeezy ball and you're"},{"speaker":"Charles Goldfarb","startTime":1878.12,"endTime":1881.9,"body":"squeezing, and you're going from"},{"speaker":"Charles Goldfarb","startTime":1878.12,"endTime":1881.9,"body":"the DPC the distal palmar crease"},{"speaker":"Charles Goldfarb","startTime":1881.9,"endTime":1885.38,"body":"measurement. For those who don't"},{"speaker":"Charles Goldfarb","startTime":1881.9,"endTime":1885.38,"body":"use that term of say, six"},{"speaker":"Charles Goldfarb","startTime":1885.38,"endTime":1888.56,"body":"centimeters to three"},{"speaker":"Charles Goldfarb","startTime":1885.38,"endTime":1888.56,"body":"centimeters, you're actually not"},{"speaker":"Charles Goldfarb","startTime":1888.56,"endTime":1891.92,"body":"fully arranging the fingers. And"},{"speaker":"Charles Goldfarb","startTime":1888.56,"endTime":1891.92,"body":"it may be counterproductive for"},{"speaker":"Charles Goldfarb","startTime":1891.92,"endTime":1895.37,"body":"regaining motion at a time when"},{"speaker":"Charles Goldfarb","startTime":1891.92,"endTime":1895.37,"body":"you need to focus on motion, not"},{"speaker":"Charles Goldfarb","startTime":1895.37,"endTime":1897.86,"body":"strength. But it was pretty"},{"speaker":"Charles Goldfarb","startTime":1895.37,"endTime":1897.86,"body":"insightful."},{"speaker":"Macy Stonner","startTime":1897.86,"endTime":1899.75,"body":"Completely agree"},{"speaker":"Macy Stonner","startTime":1897.86,"endTime":1899.75,"body":"with that. I love whoever said"},{"speaker":"Macy Stonner","startTime":1899.75,"endTime":1900.65,"body":"that. Was that Dr. Boyer?"},{"speaker":"Charles Goldfarb","startTime":1901.13,"endTime":1904.55,"body":"It was not. No"},{"speaker":"Charles Goldfarb","startTime":1901.13,"endTime":1904.55,"body":"reason to love Dr. Boyer."},{"speaker":"Macy Stonner","startTime":1905.75,"endTime":1908.06,"body":"I agree with that"},{"speaker":"Macy Stonner","startTime":1905.75,"endTime":1908.06,"body":"completely. People have this"},{"speaker":"Macy Stonner","startTime":1908.09,"endTime":1913.61,"body":"incomplete flexion arc when they"},{"speaker":"Macy Stonner","startTime":1908.09,"endTime":1913.61,"body":"do it stressful. So we do a lot"},{"speaker":"Macy Stonner","startTime":1913.61,"endTime":1917.51,"body":"of therapy putty, which has"},{"speaker":"Macy Stonner","startTime":1913.61,"endTime":1917.51,"body":"different resistances. And that"},{"speaker":"Macy Stonner","startTime":1917.57,"endTime":1921.29,"body":"we encourage people to do it's a"},{"speaker":"Macy Stonner","startTime":1917.57,"endTime":1921.29,"body":"full arc of flexion to get all"},{"speaker":"Macy Stonner","startTime":1921.29,"endTime":1925.94,"body":"the way to a DPC of zero. So I"},{"speaker":"Macy Stonner","startTime":1921.29,"endTime":1925.94,"body":"agree with whoever made that"},{"speaker":"Macy Stonner","startTime":1925.94,"endTime":1926.39,"body":"comment."},{"speaker":"Chris Dy","startTime":1926.72,"endTime":1929.24,"body":"Well, that's the"},{"speaker":"Chris Dy","startTime":1926.72,"endTime":1929.24,"body":"reason why every time we open"},{"speaker":"Chris Dy","startTime":1929.24,"endTime":1932.63,"body":"one of those slings that has the"},{"speaker":"Chris Dy","startTime":1929.24,"endTime":1932.63,"body":"stress ball included, I toss the"},{"speaker":"Chris Dy","startTime":1932.63,"endTime":1935.99,"body":"stress ball out. Patients see"},{"speaker":"Chris Dy","startTime":1932.63,"endTime":1935.99,"body":"that they're going like, Oh, I'm"},{"speaker":"Chris Dy","startTime":1935.99,"endTime":1938.48,"body":"supposed to be using this like,"},{"speaker":"Chris Dy","startTime":1935.99,"endTime":1938.48,"body":"nope, no way."},{"speaker":"Charles Goldfarb","startTime":1939.23,"endTime":1939.95,"body":"Yeah, that's"},{"speaker":"Charles Goldfarb","startTime":1939.23,"endTime":1939.95,"body":"great."},{"speaker":"Macy Stonner","startTime":1939.93,"endTime":1942.21,"body":"I see that all the"},{"speaker":"Macy Stonner","startTime":1939.93,"endTime":1942.21,"body":"time with somebody who's two"},{"speaker":"Macy Stonner","startTime":1942.21,"endTime":1945.18,"body":"weeks out from a central slip"},{"speaker":"Macy Stonner","startTime":1942.21,"endTime":1945.18,"body":"repair and they're like"},{"speaker":"Macy Stonner","startTime":1945.18,"endTime":1946.92,"body":"squeezing a stress ball because"},{"speaker":"Macy Stonner","startTime":1945.18,"endTime":1946.92,"body":"they think that that's what's"},{"speaker":"Macy Stonner","startTime":1946.92,"endTime":1949.02,"body":"going to make them better. And"},{"speaker":"Macy Stonner","startTime":1946.92,"endTime":1949.02,"body":"I'm like, Oh gosh, please don't."},{"speaker":"Chris Dy","startTime":1949.02,"endTime":1952.74,"body":"So don- so donjoy USA,"},{"speaker":"Chris Dy","startTime":1949.02,"endTime":1952.74,"body":"if you're listening, make those"},{"speaker":"Chris Dy","startTime":1952.74,"endTime":1955.98,"body":"splints, or the slings and you"},{"speaker":"Chris Dy","startTime":1952.74,"endTime":1955.98,"body":"include the stress ball save"},{"speaker":"Chris Dy","startTime":1955.98,"endTime":1958.35,"body":"yourself some money man, don't"},{"speaker":"Chris Dy","startTime":1955.98,"endTime":1958.35,"body":"even put them in."},{"speaker":"Charles Goldfarb","startTime":1958.92,"endTime":1961.86,"body":"They're cute"},{"speaker":"Charles Goldfarb","startTime":1958.92,"endTime":1961.86,"body":"and all but alright, let's"},{"speaker":"Charles Goldfarb","startTime":1961.92,"endTime":1965.73,"body":"finish up the show and talk"},{"speaker":"Charles Goldfarb","startTime":1961.92,"endTime":1965.73,"body":"briefly about the patient will"},{"speaker":"Charles Goldfarb","startTime":1965.73,"endTime":1970.89,"body":"give you the scenario. patient"},{"speaker":"Charles Goldfarb","startTime":1965.73,"endTime":1970.89,"body":"is now eight weeks out of that"},{"speaker":"Charles Goldfarb","startTime":1970.89,"endTime":1975.39,"body":"initial oblique p one fracture"},{"speaker":"Charles Goldfarb","startTime":1970.89,"endTime":1975.39,"body":"that we pinned. We pulled the"},{"speaker":"Charles Goldfarb","startTime":1975.39,"endTime":1980.19,"body":"pins at about five weeks and"},{"speaker":"Charles Goldfarb","startTime":1975.39,"endTime":1980.19,"body":"radiographs, you know look fine."},{"speaker":"Charles Goldfarb","startTime":1980.34,"endTime":1982.89,"body":"And they're back today is now"},{"speaker":"Charles Goldfarb","startTime":1980.34,"endTime":1982.89,"body":"eight weeks out they've been"},{"speaker":"Charles Goldfarb","startTime":1982.89,"endTime":1986.1,"body":"seeing you may see and making"},{"speaker":"Charles Goldfarb","startTime":1982.89,"endTime":1986.1,"body":"some progress, but not as much"},{"speaker":"Charles Goldfarb","startTime":1986.1,"endTime":1990.57,"body":"as we would like another eight"},{"speaker":"Charles Goldfarb","startTime":1986.1,"endTime":1990.57,"body":"weeks out. And let's say their"},{"speaker":"Charles Goldfarb","startTime":1990.57,"endTime":1992.97,"body":"Extension has been good. They've"},{"speaker":"Charles Goldfarb","startTime":1990.57,"endTime":1992.97,"body":"been good about wearing the"},{"speaker":"Charles Goldfarb","startTime":1992.97,"endTime":2000.32,"body":"splint, but they just don't have"},{"speaker":"Charles Goldfarb","startTime":1992.97,"endTime":2000.32,"body":"active motion or sufficient"},{"speaker":"Charles Goldfarb","startTime":2000.32,"endTime":2004.76,"body":"active motion. So as they"},{"speaker":"Charles Goldfarb","startTime":2000.32,"endTime":2004.76,"body":"attempt to flex, they are"},{"speaker":"Charles Goldfarb","startTime":2004.76,"endTime":2007.85,"body":"limited to a DPC of you know"},{"speaker":"Charles Goldfarb","startTime":2004.76,"endTime":2007.85,"body":"four centimeters and we can talk"},{"speaker":"Charles Goldfarb","startTime":2007.85,"endTime":2010.91,"body":"more specifics. But how do you"},{"speaker":"Charles Goldfarb","startTime":2007.85,"endTime":2010.91,"body":"think about that patient? And"},{"speaker":"Charles Goldfarb","startTime":2010.91,"endTime":2011.84,"body":"what do you do with them?"},{"speaker":"Chris Dy","startTime":2012.17,"endTime":2014.48,"body":"Oh, wait, wait, wait,"},{"speaker":"Chris Dy","startTime":2012.17,"endTime":2014.48,"body":"hold on, Chuck. Just so follow"},{"speaker":"Chris Dy","startTime":2014.48,"endTime":2018.05,"body":"up on our prior episode, we we"},{"speaker":"Chris Dy","startTime":2014.48,"endTime":2018.05,"body":"should know what's the passive"},{"speaker":"Chris Dy","startTime":2018.05,"endTime":2020.75,"body":"motion before we can talk about"},{"speaker":"Chris Dy","startTime":2018.05,"endTime":2020.75,"body":"the active. So give us that"},{"speaker":"Chris Dy","startTime":2020.75,"endTime":2021.14,"body":"info."},{"speaker":"Charles Goldfarb","startTime":2021.29,"endTime":2025.4,"body":"Thank you. So"},{"speaker":"Charles Goldfarb","startTime":2021.29,"endTime":2025.4,"body":"in this patient, they have good"},{"speaker":"Charles Goldfarb","startTime":2025.43,"endTime":2030.53,"body":"active and passive extension."},{"speaker":"Charles Goldfarb","startTime":2025.43,"endTime":2030.53,"body":"And they have good passive"},{"speaker":"Charles Goldfarb","startTime":2030.53,"endTime":2036.05,"body":"flexion. To a DPC of zero but"},{"speaker":"Charles Goldfarb","startTime":2030.53,"endTime":2036.05,"body":"when I asked him to actively"},{"speaker":"Charles Goldfarb","startTime":2036.05,"endTime":2038.51,"body":"make a fist, they are limited."},{"speaker":"Macy Stonner","startTime":2038.87,"endTime":2041.81,"body":"Okay, so this"},{"speaker":"Macy Stonner","startTime":2038.87,"endTime":2041.81,"body":"patient, if they have a passive"},{"speaker":"Macy Stonner","startTime":2041.84,"endTime":2045.62,"body":"DPC of zero, I wouldn't consider"},{"speaker":"Macy Stonner","startTime":2041.84,"endTime":2045.62,"body":"that a stiff finger. I would"},{"speaker":"Macy Stonner","startTime":2045.62,"endTime":2048.86,"body":"consider that as tendon"},{"speaker":"Macy Stonner","startTime":2045.62,"endTime":2048.86,"body":"excursion problem. So active"},{"speaker":"Macy Stonner","startTime":2048.86,"endTime":2052.19,"body":"active active motion, a little"},{"speaker":"Macy Stonner","startTime":2048.86,"endTime":2052.19,"body":"bit of resistance to encourage"},{"speaker":"Macy Stonner","startTime":2052.19,"endTime":2056.51,"body":"your tendons to glide through"},{"speaker":"Macy Stonner","startTime":2052.19,"endTime":2056.51,"body":"some stress, encouraging full"},{"speaker":"Macy Stonner","startTime":2056.51,"endTime":2060.2,"body":"functional use of the hand using"},{"speaker":"Macy Stonner","startTime":2056.51,"endTime":2060.2,"body":"it for every daily activity. But"},{"speaker":"Macy Stonner","startTime":2060.2,"endTime":2066.71,"body":"does that person need a static"},{"speaker":"Macy Stonner","startTime":2060.2,"endTime":2066.71,"body":"progressive splint? No, because"},{"speaker":"Macy Stonner","startTime":2066.86,"endTime":2070.67,"body":"they're not passively limited."},{"speaker":"Macy Stonner","startTime":2066.86,"endTime":2070.67,"body":"They're actively limited. So"},{"speaker":"Macy Stonner","startTime":2070.79,"endTime":2072.05,"body":"active motion all the way."},{"speaker":"Chris Dy","startTime":2072.68,"endTime":2076.07,"body":"So then just to keep"},{"speaker":"Chris Dy","startTime":2072.68,"endTime":2076.07,"body":"breaking down terms, what is a"},{"speaker":"Chris Dy","startTime":2076.07,"endTime":2077.42,"body":"static progressive split."},{"speaker":"Macy Stonner","startTime":2078.02,"endTime":2081.14,"body":"So a static"},{"speaker":"Macy Stonner","startTime":2078.02,"endTime":2081.14,"body":"progressive splint is a type of"},{"speaker":"Macy Stonner","startTime":2082.01,"endTime":2086.39,"body":"orthosis or splint that has a"},{"speaker":"Macy Stonner","startTime":2082.01,"endTime":2086.39,"body":"component on the finger like a"},{"speaker":"Macy Stonner","startTime":2086.39,"endTime":2091.1,"body":"tab where you pull on it with"},{"speaker":"Macy Stonner","startTime":2086.39,"endTime":2091.1,"body":"your opposite hand to provide"},{"speaker":"Macy Stonner","startTime":2091.13,"endTime":2095.12,"body":"external or passive motion. So"},{"speaker":"Macy Stonner","startTime":2091.13,"endTime":2095.12,"body":"it's something that you don't"},{"speaker":"Macy Stonner","startTime":2095.12,"endTime":2099.77,"body":"have to think about the"},{"speaker":"Macy Stonner","startTime":2095.12,"endTime":2099.77,"body":"technique involved in a manual"},{"speaker":"Macy Stonner","startTime":2100.34,"endTime":2105.05,"body":"She just kind of passively place"},{"speaker":"Macy Stonner","startTime":2100.34,"endTime":2105.05,"body":"your finger in a device, a"},{"speaker":"Macy Stonner","startTime":2105.08,"endTime":2108.41,"body":"torture device that a lot of"},{"speaker":"Macy Stonner","startTime":2105.08,"endTime":2108.41,"body":"patients describe. And it just"},{"speaker":"Macy Stonner","startTime":2108.44,"endTime":2112.49,"body":"kind of takes you into the"},{"speaker":"Macy Stonner","startTime":2108.44,"endTime":2112.49,"body":"motion you need to have. And you"},{"speaker":"Macy Stonner","startTime":2112.49,"endTime":2115.43,"body":"can think about other things,"},{"speaker":"Macy Stonner","startTime":2112.49,"endTime":2115.43,"body":"watch a show or whatever in"},{"speaker":"Macy Stonner","startTime":2115.43,"endTime":2119.69,"body":"order to really maximize motion."},{"speaker":"Macy Stonner","startTime":2115.43,"endTime":2119.69,"body":"And so if it's a truly stiff"},{"speaker":"Macy Stonner","startTime":2119.69,"endTime":2123.29,"body":"finger stiffness, meaning"},{"speaker":"Macy Stonner","startTime":2119.69,"endTime":2123.29,"body":"passively limited, that's where"},{"speaker":"Macy Stonner","startTime":2123.29,"endTime":2127.49,"body":"we typically go. But in the case"},{"speaker":"Macy Stonner","startTime":2123.29,"endTime":2127.49,"body":"that you described, I wouldn't"},{"speaker":"Macy Stonner","startTime":2127.49,"endTime":2129.68,"body":"think that that would be"},{"speaker":"Macy Stonner","startTime":2127.49,"endTime":2129.68,"body":"necessary."},{"speaker":"Charles Goldfarb","startTime":2130.58,"endTime":2134.03,"body":"So what you're"},{"speaker":"Charles Goldfarb","startTime":2130.58,"endTime":2134.03,"body":"hoping for, in the case that I"},{"speaker":"Charles Goldfarb","startTime":2134.03,"endTime":2138.29,"body":"described where we have a flexor"},{"speaker":"Charles Goldfarb","startTime":2134.03,"endTime":2138.29,"body":"tendon adhesion? Is that that"},{"speaker":"Charles Goldfarb","startTime":2138.29,"endTime":2142.73,"body":"adhesion will break up with"},{"speaker":"Charles Goldfarb","startTime":2138.29,"endTime":2142.73,"body":"daily activities or just the"},{"speaker":"Charles Goldfarb","startTime":2142.73,"endTime":2144.65,"body":"active motion or even"},{"speaker":"Charles Goldfarb","startTime":2142.73,"endTime":2144.65,"body":"strengthening?"},{"speaker":"Macy Stonner","startTime":2145.07,"endTime":2145.49,"body":"Sure."},{"speaker":"Charles Goldfarb","startTime":2145.79,"endTime":2148.88,"body":"When do you"},{"speaker":"Charles Goldfarb","startTime":2145.79,"endTime":2148.88,"body":"apply e-stim it because that"},{"speaker":"Charles Goldfarb","startTime":2148.88,"endTime":2152.24,"body":"would be the next step I assume"},{"speaker":"Charles Goldfarb","startTime":2148.88,"endTime":2152.24,"body":"for you? Or when does e-stim"},{"speaker":"Charles Goldfarb","startTime":2152.24,"endTime":2152.66,"body":"come in?"},{"speaker":"Macy Stonner","startTime":2153.29,"endTime":2156.86,"body":"So I ever you"},{"speaker":"Macy Stonner","startTime":2153.29,"endTime":2156.86,"body":"asked me this question in our"},{"speaker":"Macy Stonner","startTime":2157.1,"endTime":2162.29,"body":"flexor tendon podcast in the"},{"speaker":"Macy Stonner","startTime":2157.1,"endTime":2162.29,"body":"fall. And it kind of depends on"},{"speaker":"Macy Stonner","startTime":2162.29,"endTime":2165.71,"body":"the therapist, some therapists"},{"speaker":"Macy Stonner","startTime":2162.29,"endTime":2165.71,"body":"really value that and others"},{"speaker":"Macy Stonner","startTime":2165.77,"endTime":2169.28,"body":"might not. I am, I have a lot of"},{"speaker":"Macy Stonner","startTime":2165.77,"endTime":2169.28,"body":"colleagues that use it. And I"},{"speaker":"Macy Stonner","startTime":2169.28,"endTime":2173.51,"body":"think there's definitely a role."},{"speaker":"Macy Stonner","startTime":2169.28,"endTime":2173.51,"body":"I don't use it a ton. Because I"},{"speaker":"Macy Stonner","startTime":2173.51,"endTime":2176.63,"body":"think that that's an external"},{"speaker":"Macy Stonner","startTime":2173.51,"endTime":2176.63,"body":"force that's doing the movement."},{"speaker":"Macy Stonner","startTime":2176.66,"endTime":2179.75,"body":"And that's not sustainable,"},{"speaker":"Macy Stonner","startTime":2176.66,"endTime":2179.75,"body":"necessarily, if they let's say"},{"speaker":"Macy Stonner","startTime":2179.75,"endTime":2182.87,"body":"that they're PIP flexion is, 40,"},{"speaker":"Macy Stonner","startTime":2179.75,"endTime":2182.87,"body":"actively, and then you put some"},{"speaker":"Macy Stonner","startTime":2182.9,"endTime":2187.01,"body":"e-stim on there, and they can"},{"speaker":"Macy Stonner","startTime":2182.9,"endTime":2187.01,"body":"get 70. That's great. But if"},{"speaker":"Macy Stonner","startTime":2187.01,"endTime":2190.07,"body":"they can't maintain that, every"},{"speaker":"Macy Stonner","startTime":2187.01,"endTime":2190.07,"body":"day, as they're using their"},{"speaker":"Macy Stonner","startTime":2190.07,"endTime":2194.78,"body":"hand, I'm not so sure that it's"},{"speaker":"Macy Stonner","startTime":2190.07,"endTime":2194.78,"body":"totally doing what it needs to"},{"speaker":"Macy Stonner","startTime":2194.78,"endTime":2197.9,"body":"do. I'm not against it, but it's"},{"speaker":"Macy Stonner","startTime":2194.78,"endTime":2197.9,"body":"just not my first treatment"},{"speaker":"Macy Stonner","startTime":2198.2,"endTime":2198.89,"body":"strategy."},{"speaker":"Chris Dy","startTime":2199.82,"endTime":2205.22,"body":"So the case that Chuck"},{"speaker":"Chris Dy","startTime":2199.82,"endTime":2205.22,"body":"gave you is one that I don't"},{"speaker":"Chris Dy","startTime":2205.22,"endTime":2208.67,"body":"often see, what I typically"},{"speaker":"Chris Dy","startTime":2205.22,"endTime":2208.67,"body":"would see is active DPC of four"},{"speaker":"Chris Dy","startTime":2208.67,"endTime":2212.03,"body":"and passive DPC of two. Right,"},{"speaker":"Chris Dy","startTime":2208.67,"endTime":2212.03,"body":"let's work through that"},{"speaker":"Chris Dy","startTime":2212.03,"endTime":2212.6,"body":"scenario."},{"speaker":"Macy Stonner","startTime":2213.71,"endTime":2216.68,"body":"So I think in that"},{"speaker":"Macy Stonner","startTime":2213.71,"endTime":2216.68,"body":"scenario, you still continue the"},{"speaker":"Macy Stonner","startTime":2216.68,"endTime":2219.44,"body":"treatment strategies, as"},{"speaker":"Macy Stonner","startTime":2216.68,"endTime":2219.44,"body":"mentioned. So active tendon"},{"speaker":"Macy Stonner","startTime":2219.44,"endTime":2223.31,"body":"glides, joint blocking, using"},{"speaker":"Macy Stonner","startTime":2219.44,"endTime":2223.31,"body":"the hand as much as possible,"},{"speaker":"Macy Stonner","startTime":2223.61,"endTime":2227.36,"body":"light strengthening with the"},{"speaker":"Macy Stonner","startTime":2223.61,"endTime":2227.36,"body":"addition of some potential"},{"speaker":"Macy Stonner","startTime":2227.36,"endTime":2232.07,"body":"dynamic or static progressive"},{"speaker":"Macy Stonner","startTime":2227.36,"endTime":2232.07,"body":"splint use, which I mentioned"},{"speaker":"Macy Stonner","startTime":2232.07,"endTime":2234.95,"body":"earlier, is just an external"},{"speaker":"Macy Stonner","startTime":2232.07,"endTime":2234.95,"body":"type of orthotic which can"},{"speaker":"Macy Stonner","startTime":2235.4,"endTime":2239.0,"body":"stretch your finger passively,"},{"speaker":"Macy Stonner","startTime":2235.4,"endTime":2239.0,"body":"as you go about doing other"},{"speaker":"Macy Stonner","startTime":2239.0,"endTime":2239.6,"body":"things."},{"speaker":"Chris Dy","startTime":2240.14,"endTime":2242.63,"body":"Now that dynamic"},{"speaker":"Chris Dy","startTime":2240.14,"endTime":2242.63,"body":"splint, very different from a"},{"speaker":"Chris Dy","startTime":2242.63,"endTime":2243.74,"body":"static progressive splint,"},{"speaker":"Macy Stonner","startTime":2245.21,"endTime":2247.73,"body":"Kind of so static"},{"speaker":"Macy Stonner","startTime":2245.21,"endTime":2247.73,"body":"progressive splint is one where"},{"speaker":"Macy Stonner","startTime":2247.73,"endTime":2251.72,"body":"you would strap this device on"},{"speaker":"Macy Stonner","startTime":2247.73,"endTime":2251.72,"body":"your finger, pull a tab on your"},{"speaker":"Macy Stonner","startTime":2251.72,"endTime":2256.19,"body":"PIP joint, and it's kind of"},{"speaker":"Macy Stonner","startTime":2251.72,"endTime":2256.19,"body":"anchor the mechanism to your"},{"speaker":"Macy Stonner","startTime":2256.49,"endTime":2260.36,"body":"forearm. And you just kind of"},{"speaker":"Macy Stonner","startTime":2256.49,"endTime":2260.36,"body":"let it sit there. You reassess"},{"speaker":"Macy Stonner","startTime":2260.36,"endTime":2263.54,"body":"your pain after three to five"},{"speaker":"Macy Stonner","startTime":2260.36,"endTime":2263.54,"body":"minutes, let's say your pain"},{"speaker":"Macy Stonner","startTime":2263.54,"endTime":2268.07,"body":"initially is a three. After a"},{"speaker":"Macy Stonner","startTime":2263.54,"endTime":2268.07,"body":"few minutes, if your pain goes"},{"speaker":"Macy Stonner","startTime":2268.07,"endTime":2271.64,"body":"down to a one or a zero, that's"},{"speaker":"Macy Stonner","startTime":2268.07,"endTime":2271.64,"body":"great. That means that your"},{"speaker":"Macy Stonner","startTime":2272.03,"endTime":2276.02,"body":"joint is kind of accommodating"},{"speaker":"Macy Stonner","startTime":2272.03,"endTime":2276.02,"body":"well to the stretch. So static,"},{"speaker":"Macy Stonner","startTime":2276.02,"endTime":2278.93,"body":"progressive, meaning you can"},{"speaker":"Macy Stonner","startTime":2276.02,"endTime":2278.93,"body":"progress this motion even"},{"speaker":"Macy Stonner","startTime":2278.93,"endTime":2283.4,"body":"further. But it's a static"},{"speaker":"Macy Stonner","startTime":2278.93,"endTime":2283.4,"body":"stretch. Again, a lot of"},{"speaker":"Macy Stonner","startTime":2283.4,"endTime":2285.17,"body":"therapists will be listening to"},{"speaker":"Macy Stonner","startTime":2283.4,"endTime":2285.17,"body":"this thinking, Oh, yeah, this is"},{"speaker":"Macy Stonner","startTime":2285.17,"endTime":2290.06,"body":"all therapy lingo that they"},{"speaker":"Macy Stonner","startTime":2285.17,"endTime":2290.06,"body":"know. And then a dynamic brace"},{"speaker":"Macy Stonner","startTime":2290.09,"endTime":2294.02,"body":"would be one that is kind of"},{"speaker":"Macy Stonner","startTime":2290.09,"endTime":2294.02,"body":"like you're familiar with an LNB"},{"speaker":"Macy Stonner","startTime":2294.56,"endTime":2297.68,"body":"or something like that, that's"},{"speaker":"Macy Stonner","startTime":2294.56,"endTime":2297.68,"body":"just like a constant stretch, no"},{"speaker":"Macy Stonner","startTime":2297.68,"endTime":2300.89,"body":"matter what you can't adjust the"},{"speaker":"Macy Stonner","startTime":2297.68,"endTime":2300.89,"body":"tension per se. It's just like a"},{"speaker":"Macy Stonner","startTime":2300.89,"endTime":2303.95,"body":"constant level of stretch. I"},{"speaker":"Macy Stonner","startTime":2300.89,"endTime":2303.95,"body":"think they both have a role, you"},{"speaker":"Macy Stonner","startTime":2303.95,"endTime":2305.36,"body":"just kind of have to take a case"},{"speaker":"Macy Stonner","startTime":2303.95,"endTime":2305.36,"body":"by case."},{"speaker":"Charles Goldfarb","startTime":2306.44,"endTime":2308.03,"body":"Yeah, and"},{"speaker":"Charles Goldfarb","startTime":2306.44,"endTime":2308.03,"body":"that's certainly one where I"},{"speaker":"Charles Goldfarb","startTime":2308.06,"endTime":2312.74,"body":"differ 100% to the experience of"},{"speaker":"Charles Goldfarb","startTime":2308.06,"endTime":2312.74,"body":"the therapist that I'm working"},{"speaker":"Charles Goldfarb","startTime":2312.74,"endTime":2315.68,"body":"with. And let's be clear, what"},{"speaker":"Charles Goldfarb","startTime":2312.74,"endTime":2315.68,"body":"we're talking about here is"},{"speaker":"Charles Goldfarb","startTime":2315.71,"endTime":2320.06,"body":"potentially adhesion adhesions"},{"speaker":"Charles Goldfarb","startTime":2315.71,"endTime":2320.06,"body":"on the flexor side, but more"},{"speaker":"Charles Goldfarb","startTime":2320.06,"endTime":2323.48,"body":"importantly, that lack of"},{"speaker":"Charles Goldfarb","startTime":2320.06,"endTime":2323.48,"body":"passive full motion, we're"},{"speaker":"Charles Goldfarb","startTime":2323.48,"endTime":2326.81,"body":"talking about either extensor"},{"speaker":"Charles Goldfarb","startTime":2323.48,"endTime":2326.81,"body":"tendon adhesions, which are"},{"speaker":"Charles Goldfarb","startTime":2326.81,"endTime":2330.74,"body":"preventing that finger from"},{"speaker":"Charles Goldfarb","startTime":2326.81,"endTime":2330.74,"body":"flexing, or a DI I'm sorry, or a"},{"speaker":"Charles Goldfarb","startTime":2330.74,"endTime":2335.24,"body":"PIP, joint contracture which is"},{"speaker":"Charles Goldfarb","startTime":2330.74,"endTime":2335.24,"body":"preventing that passive flexion."},{"speaker":"Charles Goldfarb","startTime":2335.24,"endTime":2336.5,"body":"Do we all agree on that?"},{"speaker":"Chris Dy","startTime":2338.15,"endTime":2341.06,"body":"Yeah, that's what I"},{"speaker":"Chris Dy","startTime":2338.15,"endTime":2341.06,"body":"had one question for you. I"},{"speaker":"Chris Dy","startTime":2341.06,"endTime":2344.99,"body":"mean, I remember Dr. Boyer"},{"speaker":"Chris Dy","startTime":2341.06,"endTime":2344.99,"body":"talking about when he was a"},{"speaker":"Chris Dy","startTime":2344.99,"endTime":2348.44,"body":"fellow in Indiana having to go"},{"speaker":"Chris Dy","startTime":2344.99,"endTime":2348.44,"body":"up and you know, as a fellow,"},{"speaker":"Chris Dy","startTime":2349.19,"endTime":2352.31,"body":"put some local anesthetic"},{"speaker":"Chris Dy","startTime":2349.19,"endTime":2352.31,"body":"injections in people's PIJ. so"},{"speaker":"Chris Dy","startTime":2352.31,"endTime":2355.46,"body":"that they could keep working"},{"speaker":"Chris Dy","startTime":2352.31,"endTime":2355.46,"body":"with therapy. Now we know of the"},{"speaker":"Chris Dy","startTime":2355.49,"endTime":2358.61,"body":"our graduation sphere taught us"},{"speaker":"Chris Dy","startTime":2355.49,"endTime":2358.61,"body":"about the effects of those local"},{"speaker":"Chris Dy","startTime":2358.61,"endTime":2362.18,"body":"anesthetics, at least the longer"},{"speaker":"Chris Dy","startTime":2358.61,"endTime":2362.18,"body":"acting ones on cartilage. Do you"},{"speaker":"Chris Dy","startTime":2362.18,"endTime":2365.78,"body":"still see a role of using, you"},{"speaker":"Chris Dy","startTime":2362.18,"endTime":2365.78,"body":"know, an adjunct to like a local"},{"speaker":"Chris Dy","startTime":2365.78,"endTime":2369.23,"body":"anesthetic if it's short acting"},{"speaker":"Chris Dy","startTime":2365.78,"endTime":2369.23,"body":"to help get patients through the"},{"speaker":"Chris Dy","startTime":2369.23,"endTime":2371.15,"body":"pain part of their therapy?"},{"speaker":"Charles Goldfarb","startTime":2372.02,"endTime":2373.52,"body":"Yeah, and"},{"speaker":"Charles Goldfarb","startTime":2372.02,"endTime":2373.52,"body":"let's just be very clear, our"},{"speaker":"Charles Goldfarb","startTime":2373.52,"endTime":2377.81,"body":"graduation speaker Constance Chu"},{"speaker":"Charles Goldfarb","startTime":2373.52,"endTime":2377.81,"body":"was suggesting that any intra"},{"speaker":"Charles Goldfarb","startTime":2377.81,"endTime":2382.97,"body":"articular injection is damaging"},{"speaker":"Charles Goldfarb","startTime":2377.81,"endTime":2382.97,"body":"to cartilage. And not I wish I"},{"speaker":"Charles Goldfarb","startTime":2382.97,"endTime":2386.06,"body":"could say I was smart enough to"},{"speaker":"Charles Goldfarb","startTime":2382.97,"endTime":2386.06,"body":"not inject for that reason, but"},{"speaker":"Charles Goldfarb","startTime":2386.06,"endTime":2389.39,"body":"I don't inject in these cases. I"},{"speaker":"Charles Goldfarb","startTime":2386.06,"endTime":2389.39,"body":"do not use any local anesthetic"},{"speaker":"Charles Goldfarb","startTime":2389.57,"endTime":2394.22,"body":"to facilitate therapy. I guess I"},{"speaker":"Charles Goldfarb","startTime":2389.57,"endTime":2394.22,"body":"don't think it's crazy, but I"},{"speaker":"Charles Goldfarb","startTime":2394.22,"endTime":2399.17,"body":"haven't done it. I haven't done"},{"speaker":"Charles Goldfarb","startTime":2394.22,"endTime":2399.17,"body":"it. may see. When do you say"},{"speaker":"Charles Goldfarb","startTime":2399.2,"endTime":2402.77,"body":"uncle and I have no idea why"},{"speaker":"Charles Goldfarb","startTime":2399.2,"endTime":2402.77,"body":"that expression exists? When do"},{"speaker":"Charles Goldfarb","startTime":2402.77,"endTime":2407.63,"body":"you say therapy has not"},{"speaker":"Charles Goldfarb","startTime":2402.77,"endTime":2407.63,"body":"succeeded? And regaining motion"},{"speaker":"Charles Goldfarb","startTime":2407.63,"endTime":2413.45,"body":"is time for a surgical tenolysis"},{"speaker":"Charles Goldfarb","startTime":2407.63,"endTime":2413.45,"body":"joint release whatever is is"},{"speaker":"Charles Goldfarb","startTime":2413.45,"endTime":2416.99,"body":"there a magic number? Or is it"},{"speaker":"Charles Goldfarb","startTime":2413.45,"endTime":2416.99,"body":"simply, the patient has"},{"speaker":"Charles Goldfarb","startTime":2416.99,"endTime":2418.73,"body":"plateaued and I can't get them"},{"speaker":"Charles Goldfarb","startTime":2416.99,"endTime":2418.73,"body":"over now."},{"speaker":"Macy Stonner","startTime":2420.83,"endTime":2423.38,"body":"The second thing"},{"speaker":"Macy Stonner","startTime":2420.83,"endTime":2423.38,"body":"you said it depends on the"},{"speaker":"Macy Stonner","startTime":2423.38,"endTime":2428.81,"body":"patient. But if I'm seeing them"},{"speaker":"Macy Stonner","startTime":2423.38,"endTime":2428.81,"body":"consistently, twice a week, and"},{"speaker":"Macy Stonner","startTime":2428.84,"endTime":2432.2,"body":"I look at my range of motion"},{"speaker":"Macy Stonner","startTime":2428.84,"endTime":2432.2,"body":"measurements every week, and in"},{"speaker":"Macy Stonner","startTime":2432.2,"endTime":2436.28,"body":"my assessment, I continued to"},{"speaker":"Macy Stonner","startTime":2432.2,"endTime":2436.28,"body":"write no changes this week, he"},{"speaker":"Macy Stonner","startTime":2436.28,"endTime":2439.97,"body":"continues to demonstrate"},{"speaker":"Macy Stonner","startTime":2436.28,"endTime":2439.97,"body":"significant joint stiffness. And"},{"speaker":"Macy Stonner","startTime":2439.97,"endTime":2442.73,"body":"I haven't been able to type"},{"speaker":"Macy Stonner","startTime":2439.97,"endTime":2442.73,"body":"anything different, I get"},{"speaker":"Macy Stonner","startTime":2442.73,"endTime":2445.91,"body":"concerned that each session,"},{"speaker":"Macy Stonner","startTime":2442.73,"endTime":2445.91,"body":"there's no change. So I'm going"},{"speaker":"Macy Stonner","startTime":2445.91,"endTime":2448.46,"body":"to send an email or an in basket"},{"speaker":"Macy Stonner","startTime":2445.91,"endTime":2448.46,"body":"through epic to the surgeon to"},{"speaker":"Macy Stonner","startTime":2448.46,"endTime":2450.92,"body":"let them know. And I kind of"},{"speaker":"Macy Stonner","startTime":2448.46,"endTime":2450.92,"body":"look in the system to see where"},{"speaker":"Macy Stonner","startTime":2450.92,"endTime":2453.74,"body":"they're seeing the doctor,"},{"speaker":"Macy Stonner","startTime":2450.92,"endTime":2453.74,"body":"again, to let the patient and"},{"speaker":"Macy Stonner","startTime":2453.74,"endTime":2456.71,"body":"the physician have that"},{"speaker":"Macy Stonner","startTime":2453.74,"endTime":2456.71,"body":"conversation about surgery. But"},{"speaker":"Macy Stonner","startTime":2456.77,"endTime":2459.05,"body":"to dance around your question,"},{"speaker":"Macy Stonner","startTime":2456.77,"endTime":2459.05,"body":"there's no magic date, and kind"},{"speaker":"Macy Stonner","startTime":2459.05,"endTime":2461.09,"body":"of just depends on how they're"},{"speaker":"Macy Stonner","startTime":2459.05,"endTime":2461.09,"body":"progressing therapy."},{"speaker":"Chris Dy","startTime":2462.88,"endTime":2465.7,"body":"So to bring us to a"},{"speaker":"Chris Dy","startTime":2462.88,"endTime":2465.7,"body":"close, Macy, can you give us"},{"speaker":"Chris Dy","startTime":2465.73,"endTime":2471.22,"body":"either one Pearl, you know, that"},{"speaker":"Chris Dy","startTime":2465.73,"endTime":2471.22,"body":"would make us better at"},{"speaker":"Chris Dy","startTime":2471.22,"endTime":2475.03,"body":"communicating with our"},{"speaker":"Chris Dy","startTime":2471.22,"endTime":2475.03,"body":"therapists about this, you know,"},{"speaker":"Chris Dy","startTime":2475.03,"endTime":2479.56,"body":"these kinds of patients are one,"},{"speaker":"Chris Dy","startTime":2475.03,"endTime":2479.56,"body":"you know, constantly frustrating"},{"speaker":"Chris Dy","startTime":2479.56,"endTime":2483.67,"body":"thing that you noticed that"},{"speaker":"Chris Dy","startTime":2479.56,"endTime":2483.67,"body":"surgeons do that. That makes"},{"speaker":"Chris Dy","startTime":2483.67,"endTime":2484.69,"body":"your life a little harder."},{"speaker":"Macy Stonner","startTime":2486.01,"endTime":2488.5,"body":"No, I don't think"},{"speaker":"Macy Stonner","startTime":2486.01,"endTime":2488.5,"body":"there's anything that your"},{"speaker":"Macy Stonner","startTime":2488.68,"endTime":2491.2,"body":"surgeons are doing that makes"},{"speaker":"Macy Stonner","startTime":2488.68,"endTime":2491.2,"body":"our life harder. I think that"},{"speaker":"Macy Stonner","startTime":2491.2,"endTime":2495.19,"body":"it's really important when you"},{"speaker":"Macy Stonner","startTime":2491.2,"endTime":2495.19,"body":"go to therapy to have a one on"},{"speaker":"Macy Stonner","startTime":2495.19,"endTime":2499.93,"body":"one session, I'm really spoiled."},{"speaker":"Macy Stonner","startTime":2495.19,"endTime":2499.93,"body":"And at Milliken, we always have"},{"speaker":"Macy Stonner","startTime":2500.68,"endTime":2505.0,"body":"one therapist, one patient per"},{"speaker":"Macy Stonner","startTime":2500.68,"endTime":2505.0,"body":"session. And particularly with"},{"speaker":"Macy Stonner","startTime":2505.0,"endTime":2508.15,"body":"digital stiffness, that's"},{"speaker":"Macy Stonner","startTime":2505.0,"endTime":2508.15,"body":"important to address one on one,"},{"speaker":"Macy Stonner","startTime":2508.6,"endTime":2512.92,"body":"if you have multiple patients at"},{"speaker":"Macy Stonner","startTime":2508.6,"endTime":2512.92,"body":"once. And I know that different"},{"speaker":"Macy Stonner","startTime":2512.92,"endTime":2516.61,"body":"employers are, are different and"},{"speaker":"Macy Stonner","startTime":2512.92,"endTime":2516.61,"body":"require that it's just it's just"},{"speaker":"Macy Stonner","startTime":2516.61,"endTime":2521.44,"body":"challenging to really address"},{"speaker":"Macy Stonner","startTime":2516.61,"endTime":2521.44,"body":"stiffness. It's a very manual"},{"speaker":"Macy Stonner","startTime":2521.47,"endTime":2524.56,"body":"type of session. And so I think"},{"speaker":"Macy Stonner","startTime":2521.47,"endTime":2524.56,"body":"that having that one on one is"},{"speaker":"Macy Stonner","startTime":2524.56,"endTime":2528.22,"body":"important, and really educating"},{"speaker":"Macy Stonner","startTime":2524.56,"endTime":2528.22,"body":"them that this does not just get"},{"speaker":"Macy Stonner","startTime":2528.22,"endTime":2530.38,"body":"better naturally with time it"},{"speaker":"Macy Stonner","startTime":2528.22,"endTime":2530.38,"body":"gets better naturally with"},{"speaker":"Macy Stonner","startTime":2530.38,"endTime":2530.95,"body":"stretch."},{"speaker":"Charles Goldfarb","startTime":2531.07,"endTime":2534.91,"body":"Basie, thank"},{"speaker":"Charles Goldfarb","startTime":2531.07,"endTime":2534.91,"body":"you. Your insights are gold to"},{"speaker":"Charles Goldfarb","startTime":2534.91,"endTime":2539.23,"body":"surgeons who don't understand"},{"speaker":"Charles Goldfarb","startTime":2534.91,"endTime":2539.23,"body":"therapy as well as we would"},{"speaker":"Charles Goldfarb","startTime":2539.23,"endTime":2542.56,"body":"like. And I know it's not even a"},{"speaker":"Charles Goldfarb","startTime":2539.23,"endTime":2542.56,"body":"question. I know that our"},{"speaker":"Charles Goldfarb","startTime":2542.56,"endTime":2545.77,"body":"listeners are going to love"},{"speaker":"Charles Goldfarb","startTime":2542.56,"endTime":2545.77,"body":"this. And thank you."},{"speaker":"Macy Stonner","startTime":2546.85,"endTime":2547.75,"body":"Thank you for"},{"speaker":"Macy Stonner","startTime":2546.85,"endTime":2547.75,"body":"having me."},{"speaker":"Chris Dy","startTime":2548.29,"endTime":2549.97,"body":"Thanks for joining us,"},{"speaker":"Chris Dy","startTime":2548.29,"endTime":2549.97,"body":"basically, we look forward to"},{"speaker":"Chris Dy","startTime":2549.97,"endTime":2552.19,"body":"having you on for another"},{"speaker":"Chris Dy","startTime":2549.97,"endTime":2552.19,"body":"session soon."},{"speaker":"Charles Goldfarb","startTime":2553.15,"endTime":2555.13,"body":"Hey, Chris,"},{"speaker":"Charles Goldfarb","startTime":2553.15,"endTime":2555.13,"body":"that was fun. Let's do it again"},{"speaker":"Charles Goldfarb","startTime":2555.13,"endTime":2555.64,"body":"real soon."},{"speaker":"Chris Dy","startTime":2555.91,"endTime":2558.43,"body":"Sounds good. Well, be"},{"speaker":"Chris Dy","startTime":2555.91,"endTime":2558.43,"body":"sure to check us out on Twitter"},{"speaker":"Chris Dy","startTime":2558.67,"endTime":2560.86,"body":"@hand podcast. Hey, Chuck,"},{"speaker":"Chris Dy","startTime":2558.67,"endTime":2560.86,"body":"what's your Twitter handle?"},{"speaker":"Charles Goldfarb","startTime":2561.19,"endTime":2563.8,"body":"Mine is"},{"speaker":"Charles Goldfarb","startTime":2561.19,"endTime":2563.8,"body":"@congenital hand. What about"},{"speaker":"Charles Goldfarb","startTime":2563.8,"endTime":2564.04,"body":"you?"},{"speaker":"Chris Dy","startTime":2564.19,"endTime":2567.58,"body":"Mine is @ChrisDyMD"},{"speaker":"Chris Dy","startTime":2564.19,"endTime":2567.58,"body":"spelled d y. And if you'd like"},{"speaker":"Chris Dy","startTime":2567.58,"endTime":2570.85,"body":"to email us, you can reach us at"},{"speaker":"Chris Dy","startTime":2567.58,"endTime":2570.85,"body":"hand podcast@gmail.com."},{"speaker":"Charles Goldfarb","startTime":2571.99,"endTime":2574.15,"body":"And remember,"},{"speaker":"Charles Goldfarb","startTime":2571.99,"endTime":2574.15,"body":"please subscribe wherever you"},{"speaker":"Charles Goldfarb","startTime":2574.15,"endTime":2575.23,"body":"get your podcasts"},{"speaker":"Chris Dy","startTime":2575.26,"endTime":2577.48,"body":"and be sure to leave a"},{"speaker":"Chris Dy","startTime":2575.26,"endTime":2577.48,"body":"review that helps us get the"},{"speaker":"Chris Dy","startTime":2577.48,"endTime":2577.9,"body":"word out."},{"speaker":"Charles Goldfarb","startTime":2578.29,"endTime":2580.57,"body":"Special thanks"},{"speaker":"Charles Goldfarb","startTime":2578.29,"endTime":2580.57,"body":"to Peter Martin for the amazing"},{"speaker":"Charles Goldfarb","startTime":2580.57,"endTime":2584.53,"body":"music. And remember, keep the"},{"speaker":"Charles Goldfarb","startTime":2580.57,"endTime":2584.53,"body":"upper hand. Come back next time."}]}