{"version":"1.0.0","segments":[{"speaker":"Charles Goldfarb","startTime":10.8,"endTime":13.35,"body":"Welcome to the"},{"speaker":"Charles Goldfarb","startTime":10.8,"endTime":13.35,"body":"upper hand, where Chuck and"},{"speaker":"Charles Goldfarb","startTime":13.35,"endTime":14.49,"body":"Chris talk hand surgery."},{"speaker":"Chris Dy","startTime":14.72,"endTime":16.58,"body":"We are two hand"},{"speaker":"Chris Dy","startTime":14.72,"endTime":16.58,"body":"surgeons at Washington"},{"speaker":"Chris Dy","startTime":16.58,"endTime":19.67,"body":"University in St. Louis here to"},{"speaker":"Chris Dy","startTime":16.58,"endTime":19.67,"body":"talk about all aspects of hand"},{"speaker":"Chris Dy","startTime":19.67,"endTime":21.5,"body":"surgery from technical to"},{"speaker":"Chris Dy","startTime":19.67,"endTime":21.5,"body":"personal."},{"speaker":"Charles Goldfarb","startTime":22.07,"endTime":24.35,"body":"Thank you for"},{"speaker":"Charles Goldfarb","startTime":22.07,"endTime":24.35,"body":"subscribing, wherever you get"},{"speaker":"Charles Goldfarb","startTime":24.35,"endTime":25.25,"body":"your podcasts."},{"speaker":"Chris Dy","startTime":25.46,"endTime":27.68,"body":"And be sure to leave a"},{"speaker":"Chris Dy","startTime":25.46,"endTime":27.68,"body":"review that helps us get the"},{"speaker":"Chris Dy","startTime":27.68,"endTime":28.25,"body":"word out."},{"speaker":"Charles Goldfarb","startTime":28.91,"endTime":29.93,"body":"Oh hey, Chris."},{"speaker":"Chris Dy","startTime":30.71,"endTime":32.12,"body":"Hey, Chuck, how are"},{"speaker":"Chris Dy","startTime":30.71,"endTime":32.12,"body":"ya?"},{"speaker":"Charles Goldfarb","startTime":32.54,"endTime":34.46,"body":"I'm doing"},{"speaker":"Charles Goldfarb","startTime":32.54,"endTime":34.46,"body":"pretty well. It's a It's a"},{"speaker":"Charles Goldfarb","startTime":34.46,"endTime":38.33,"body":"Thursday night. We both had busy"},{"speaker":"Charles Goldfarb","startTime":34.46,"endTime":38.33,"body":"days. But what better way to cap"},{"speaker":"Charles Goldfarb","startTime":38.33,"endTime":39.17,"body":"off the day?"},{"speaker":"Chris Dy","startTime":39.5,"endTime":42.02,"body":"Yeah, you know, it's"},{"speaker":"Chris Dy","startTime":39.5,"endTime":42.02,"body":"been it's been a fun one. I just"},{"speaker":"Chris Dy","startTime":42.02,"endTime":46.55,"body":"spent a little bit of time on"},{"speaker":"Chris Dy","startTime":42.02,"endTime":46.55,"body":"Firsthand, my side gig Other"},{"speaker":"Chris Dy","startTime":46.55,"endTime":51.14,"body":"than this, and you know, the day"},{"speaker":"Chris Dy","startTime":46.55,"endTime":51.14,"body":"job, but I'm excited to spend"},{"speaker":"Chris Dy","startTime":51.14,"endTime":53.27,"body":"some time chatting with you. I"},{"speaker":"Chris Dy","startTime":51.14,"endTime":53.27,"body":"think we're going to get it into"},{"speaker":"Chris Dy","startTime":53.27,"endTime":56.21,"body":"one of these technically heavy"},{"speaker":"Chris Dy","startTime":53.27,"endTime":56.21,"body":"detail episodes that everybody"},{"speaker":"Chris Dy","startTime":56.21,"endTime":57.47,"body":"seems to dig so much."},{"speaker":"Charles Goldfarb","startTime":57.89,"endTime":59.87,"body":"Oh, I am"},{"speaker":"Charles Goldfarb","startTime":57.89,"endTime":59.87,"body":"looking forward to it. And that"},{"speaker":"Charles Goldfarb","startTime":59.87,"endTime":64.43,"body":"is that's a lot to have to host"},{"speaker":"Charles Goldfarb","startTime":59.87,"endTime":64.43,"body":"two podcasts on the same night."},{"speaker":"Charles Goldfarb","startTime":65.6,"endTime":67.28,"body":"Can you share who your guest"},{"speaker":"Charles Goldfarb","startTime":65.6,"endTime":67.28,"body":"was?"},{"speaker":"Chris Dy","startTime":68.15,"endTime":70.46,"body":"Yes, we had a great"},{"speaker":"Chris Dy","startTime":68.15,"endTime":70.46,"body":"conversation with David Ring. I"},{"speaker":"Chris Dy","startTime":70.46,"endTime":74.15,"body":"will say that having co hosts"},{"speaker":"Chris Dy","startTime":70.46,"endTime":74.15,"body":"for each of these things makes"},{"speaker":"Chris Dy","startTime":74.15,"endTime":77.78,"body":"it incredibly much more"},{"speaker":"Chris Dy","startTime":74.15,"endTime":77.78,"body":"enjoyable. So Megan Conte Mika"},{"speaker":"Chris Dy","startTime":77.78,"endTime":80.9,"body":"and Peter Stern, obviously for"},{"speaker":"Chris Dy","startTime":77.78,"endTime":80.9,"body":"Firsthand and some guy named"},{"speaker":"Chris Dy","startTime":80.93,"endTime":83.33,"body":"Chuck for the for the old"},{"speaker":"Chris Dy","startTime":80.93,"endTime":83.33,"body":"podcast."},{"speaker":"Charles Goldfarb","startTime":84.05,"endTime":86.39,"body":"That is"},{"speaker":"Charles Goldfarb","startTime":84.05,"endTime":86.39,"body":"awesome. I have to say I had a"},{"speaker":"Charles Goldfarb","startTime":86.39,"endTime":91.37,"body":"side gig podcast last night,"},{"speaker":"Charles Goldfarb","startTime":86.39,"endTime":91.37,"body":"which is pretty interesting."},{"speaker":"Charles Goldfarb","startTime":91.37,"endTime":97.34,"body":"Honestly. I have I have a co"},{"speaker":"Charles Goldfarb","startTime":91.37,"endTime":97.34,"body":"host, Alexander Aleem. And this"},{"speaker":"Charles Goldfarb","startTime":97.34,"endTime":101.21,"body":"is for the AOA as you I think,"},{"speaker":"Charles Goldfarb","startTime":97.34,"endTime":101.21,"body":"you know, and we interviewed Jim"},{"speaker":"Charles Goldfarb","startTime":101.21,"endTime":106.19,"body":"Herndon, who is a giant in hand"},{"speaker":"Charles Goldfarb","startTime":101.21,"endTime":106.19,"body":"surgery, and I'm sorry, a giant"},{"speaker":"Charles Goldfarb","startTime":106.19,"endTime":111.41,"body":"an orthopedic surgery. He has a"},{"speaker":"Charles Goldfarb","startTime":106.19,"endTime":111.41,"body":"ginormous five volume book"},{"speaker":"Charles Goldfarb","startTime":111.44,"endTime":115.34,"body":"coming out called a birth of a"},{"speaker":"Charles Goldfarb","startTime":111.44,"endTime":115.34,"body":"specialty I think that's what's"},{"speaker":"Charles Goldfarb","startTime":115.34,"endTime":120.98,"body":"called about orthopedics in"},{"speaker":"Charles Goldfarb","startTime":115.34,"endTime":120.98,"body":"Boston, at Harvard Medical"},{"speaker":"Charles Goldfarb","startTime":120.98,"endTime":124.1,"body":"School and the various hospital."},{"speaker":"Charles Goldfarb","startTime":120.98,"endTime":124.1,"body":"It sounds fascinating. It sounds"},{"speaker":"Charles Goldfarb","startTime":124.1,"endTime":128.03,"body":"dense. But he was just sharing"},{"speaker":"Charles Goldfarb","startTime":124.1,"endTime":128.03,"body":"some stories and anecdotes is"},{"speaker":"Charles Goldfarb","startTime":128.03,"endTime":129.11,"body":"pretty cool. Pretty fun."},{"speaker":"Chris Dy","startTime":129.51,"endTime":132.87,"body":"Talk about a labor of"},{"speaker":"Chris Dy","startTime":129.51,"endTime":132.87,"body":"love both your other podcasts as"},{"speaker":"Chris Dy","startTime":132.87,"endTime":136.2,"body":"well as Jim Herndon's book."},{"speaker":"Chris Dy","startTime":132.87,"endTime":136.2,"body":"Interesting. We were just"},{"speaker":"Chris Dy","startTime":136.2,"endTime":140.07,"body":"reading a David Ring's New"},{"speaker":"Chris Dy","startTime":136.2,"endTime":140.07,"body":"England journal article about a"},{"speaker":"Chris Dy","startTime":140.07,"endTime":143.79,"body":"wrong site surgery and it was in"},{"speaker":"Chris Dy","startTime":140.07,"endTime":143.79,"body":"the format of the m\u0026m from the"},{"speaker":"Chris Dy","startTime":143.82,"endTime":146.43,"body":"the Massachusetts General"},{"speaker":"Chris Dy","startTime":143.82,"endTime":146.43,"body":"Hospital in which Jim Herndon"},{"speaker":"Chris Dy","startTime":146.67,"endTime":150.48,"body":"contributed his thoughts. So you"},{"speaker":"Chris Dy","startTime":146.67,"endTime":150.48,"body":"know, perfect timing on that."},{"speaker":"Charles Goldfarb","startTime":151.11,"endTime":153.75,"body":"Yeah, really"},{"speaker":"Charles Goldfarb","startTime":151.11,"endTime":153.75,"body":"interesting. It was a 14 year"},{"speaker":"Charles Goldfarb","startTime":153.75,"endTime":155.49,"body":"project for Dr. Herndon."},{"speaker":"Chris Dy","startTime":157.05,"endTime":157.71,"body":"Wow, wow."},{"speaker":"Charles Goldfarb","startTime":157.8,"endTime":161.49,"body":"Yes, that is"},{"speaker":"Charles Goldfarb","startTime":157.8,"endTime":161.49,"body":"more years than your children"},{"speaker":"Charles Goldfarb","startTime":161.49,"endTime":163.02,"body":"have combined, I believe."},{"speaker":"Chris Dy","startTime":163.53,"endTime":166.68,"body":"Yeah, yeah. I mean, my"},{"speaker":"Chris Dy","startTime":163.53,"endTime":166.68,"body":"math, if I've met my arithmetic"},{"speaker":"Chris Dy","startTime":166.68,"endTime":171.57,"body":"serves me correctly. They've,"},{"speaker":"Chris Dy","startTime":166.68,"endTime":171.57,"body":"Dr. Herndon has been working on"},{"speaker":"Chris Dy","startTime":171.57,"endTime":174.06,"body":"it for five more years, and the"},{"speaker":"Chris Dy","startTime":171.57,"endTime":174.06,"body":"kids have been in existence"},{"speaker":"Chris Dy","startTime":174.06,"endTime":177.63,"body":"combined. So yeah, well, I look"},{"speaker":"Chris Dy","startTime":174.06,"endTime":177.63,"body":"forward to checking that out."},{"speaker":"Chris Dy","startTime":178.32,"endTime":181.08,"body":"You know, how often are you guys"},{"speaker":"Chris Dy","startTime":178.32,"endTime":181.08,"body":"doing the AOA podcast?"},{"speaker":"Charles Goldfarb","startTime":181.17,"endTime":184.68,"body":"It's about"},{"speaker":"Charles Goldfarb","startTime":181.17,"endTime":184.68,"body":"once a month, on average was"},{"speaker":"Charles Goldfarb","startTime":184.68,"endTime":187.23,"body":"probably not 12 months a year,"},{"speaker":"Charles Goldfarb","startTime":184.68,"endTime":187.23,"body":"maybe 10 months a year? What"},{"speaker":"Charles Goldfarb","startTime":187.23,"endTime":187.77,"body":"about you?"},{"speaker":"Chris Dy","startTime":188.52,"endTime":191.1,"body":"We do once a month for"},{"speaker":"Chris Dy","startTime":188.52,"endTime":191.1,"body":"Firsthand. We slowed down"},{"speaker":"Chris Dy","startTime":191.1,"endTime":194.58,"body":"recently, we're taking January"},{"speaker":"Chris Dy","startTime":191.1,"endTime":194.58,"body":"off. And we had a little hiatus"},{"speaker":"Chris Dy","startTime":194.61,"endTime":197.13,"body":"just to make everybody miss us a"},{"speaker":"Chris Dy","startTime":194.61,"endTime":197.13,"body":"little bit. And we'll talk about"},{"speaker":"Chris Dy","startTime":197.13,"endTime":199.05,"body":"that for our podcast in a little"},{"speaker":"Chris Dy","startTime":197.13,"endTime":199.05,"body":"bit."},{"speaker":"Charles Goldfarb","startTime":199.56,"endTime":201.21,"body":"Yeah, well,"},{"speaker":"Charles Goldfarb","startTime":199.56,"endTime":201.21,"body":"you and I have discussed we"},{"speaker":"Charles Goldfarb","startTime":201.21,"endTime":203.16,"body":"might need a little hiatus"},{"speaker":"Charles Goldfarb","startTime":201.21,"endTime":203.16,"body":"ourselves."},{"speaker":"Chris Dy","startTime":204.63,"endTime":207.66,"body":"All good. So let's"},{"speaker":"Chris Dy","startTime":204.63,"endTime":207.66,"body":"jump into this episode."},{"speaker":"Chris Dy","startTime":207.66,"endTime":210.6,"body":"Everybody loves the technical"},{"speaker":"Chris Dy","startTime":207.66,"endTime":210.6,"body":"aspects here. So I want to"},{"speaker":"Chris Dy","startTime":210.6,"endTime":213.87,"body":"present a case to you. So I've"},{"speaker":"Chris Dy","startTime":210.6,"endTime":213.87,"body":"got a 25 year old gentleman who"},{"speaker":"Chris Dy","startTime":213.87,"endTime":217.86,"body":"comes in six weeks out from an"},{"speaker":"Chris Dy","startTime":213.87,"endTime":217.86,"body":"injury in which he was using a"},{"speaker":"Chris Dy","startTime":217.92,"endTime":221.55,"body":"drill and drill bit broke, and"},{"speaker":"Chris Dy","startTime":217.92,"endTime":221.55,"body":"it kind of torqued his wrist a"},{"speaker":"Chris Dy","startTime":221.55,"endTime":226.08,"body":"little bit. And he is like I"},{"speaker":"Chris Dy","startTime":221.55,"endTime":226.08,"body":"said six weeks out, he's got"},{"speaker":"Chris Dy","startTime":226.08,"endTime":230.1,"body":"pain on the ulnar side of his"},{"speaker":"Chris Dy","startTime":226.08,"endTime":230.1,"body":"wrist. And you have evaluated"},{"speaker":"Chris Dy","startTime":230.1,"endTime":233.46,"body":"him and you've determined"},{"speaker":"Chris Dy","startTime":230.1,"endTime":233.46,"body":"they're not frank instability,"},{"speaker":"Chris Dy","startTime":233.46,"endTime":237.45,"body":"but there's enough instability"},{"speaker":"Chris Dy","startTime":233.46,"endTime":237.45,"body":"where it causes them pain. In"},{"speaker":"Chris Dy","startTime":237.45,"endTime":240.78,"body":"addition to having localized"},{"speaker":"Chris Dy","startTime":237.45,"endTime":240.78,"body":"tenderness over the owner fovea,"},{"speaker":"Chris Dy","startTime":242.1,"endTime":245.85,"body":"you have sent him for imaging"},{"speaker":"Chris Dy","startTime":242.1,"endTime":245.85,"body":"and you obtained an MRI with or"},{"speaker":"Chris Dy","startTime":245.85,"endTime":250.83,"body":"without an arthrogram that shows"},{"speaker":"Chris Dy","startTime":245.85,"endTime":250.83,"body":"a TFCC tear. And I will let you"},{"speaker":"Chris Dy","startTime":250.83,"endTime":253.38,"body":"fill me in on the details of"},{"speaker":"Chris Dy","startTime":250.83,"endTime":253.38,"body":"what you would like that MRI to"},{"speaker":"Chris Dy","startTime":253.38,"endTime":256.11,"body":"show specifically and how it"},{"speaker":"Chris Dy","startTime":253.38,"endTime":256.11,"body":"would change your management."},{"speaker":"Charles Goldfarb","startTime":256.48,"endTime":258.82,"body":"Yeah, and we"},{"speaker":"Charles Goldfarb","startTime":256.48,"endTime":258.82,"body":"could you know, we haven't done"},{"speaker":"Charles Goldfarb","startTime":258.82,"endTime":263.44,"body":"a lot of imaging discussions we"},{"speaker":"Charles Goldfarb","startTime":258.82,"endTime":263.44,"body":"can and should. The problem of"},{"speaker":"Charles Goldfarb","startTime":263.44,"endTime":266.89,"body":"course imaging is that like"},{"speaker":"Charles Goldfarb","startTime":263.44,"endTime":266.89,"body":"politics is all local and it"},{"speaker":"Charles Goldfarb","startTime":266.89,"endTime":270.4,"body":"depends on quality or magnet"},{"speaker":"Charles Goldfarb","startTime":266.89,"endTime":270.4,"body":"quality of your radiology"},{"speaker":"Charles Goldfarb","startTime":270.4,"endTime":275.11,"body":"partners etc. I will"},{"speaker":"Charles Goldfarb","startTime":270.4,"endTime":275.11,"body":"occasionally use an arthrogram I"},{"speaker":"Charles Goldfarb","startTime":275.11,"endTime":278.89,"body":"have to say many times I do not"},{"speaker":"Charles Goldfarb","startTime":275.11,"endTime":278.89,"body":"use an arthrogram It depends a"},{"speaker":"Charles Goldfarb","startTime":278.89,"endTime":281.83,"body":"little bit on where the patient"},{"speaker":"Charles Goldfarb","startTime":278.89,"endTime":281.83,"body":"may be getting the test done. I"},{"speaker":"Charles Goldfarb","startTime":281.83,"endTime":284.5,"body":"have many patients come back and"},{"speaker":"Charles Goldfarb","startTime":281.83,"endTime":284.5,"body":"say the arthrogram was one of"},{"speaker":"Charles Goldfarb","startTime":284.5,"endTime":287.56,"body":"the most uncomfortable"},{"speaker":"Charles Goldfarb","startTime":284.5,"endTime":287.56,"body":"interventions ever because of"},{"speaker":"Charles Goldfarb","startTime":287.56,"endTime":290.89,"body":"the placement of the needle in"},{"speaker":"Charles Goldfarb","startTime":287.56,"endTime":290.89,"body":"the wrist joint so I actually"},{"speaker":"Charles Goldfarb","startTime":290.89,"endTime":294.52,"body":"try to avoid it if I can but I'm"},{"speaker":"Charles Goldfarb","startTime":290.89,"endTime":294.52,"body":"really you know with with the"},{"speaker":"Charles Goldfarb","startTime":294.52,"endTime":299.11,"body":"description that you provided."},{"speaker":"Charles Goldfarb","startTime":294.52,"endTime":299.11,"body":"You know, you can get a"},{"speaker":"Charles Goldfarb","startTime":299.11,"endTime":305.02,"body":"peripheral tear and have pain"},{"speaker":"Charles Goldfarb","startTime":299.11,"endTime":305.02,"body":"only when you start to have even"},{"speaker":"Charles Goldfarb","startTime":305.02,"endTime":308.53,"body":"a suggestion of some laxity, and"},{"speaker":"Charles Goldfarb","startTime":305.02,"endTime":308.53,"body":"by laxity, we're talking piano"},{"speaker":"Charles Goldfarb","startTime":308.53,"endTime":313.66,"body":"key testing or shock of the"},{"speaker":"Charles Goldfarb","startTime":308.53,"endTime":313.66,"body":"DREJ, then I worry, there's"},{"speaker":"Charles Goldfarb","startTime":313.66,"endTime":318.88,"body":"really a bigger type tear, a"},{"speaker":"Charles Goldfarb","startTime":313.66,"endTime":318.88,"body":"structural tear that may affect"},{"speaker":"Charles Goldfarb","startTime":318.88,"endTime":322.33,"body":"the fovea. Those can be hard to"},{"speaker":"Charles Goldfarb","startTime":318.88,"endTime":322.33,"body":"pick up on MRI. So I think it's"},{"speaker":"Charles Goldfarb","startTime":322.33,"endTime":326.95,"body":"a combination of exam and"},{"speaker":"Charles Goldfarb","startTime":322.33,"endTime":326.95,"body":"discussion with the patient and"},{"speaker":"Charles Goldfarb","startTime":326.95,"endTime":328.12,"body":"the MRI contributes."},{"speaker":"Chris Dy","startTime":328.51,"endTime":331.69,"body":"So before we get into"},{"speaker":"Chris Dy","startTime":328.51,"endTime":331.69,"body":"the specifics of how you tease"},{"speaker":"Chris Dy","startTime":331.69,"endTime":334.93,"body":"out the differences in those"},{"speaker":"Chris Dy","startTime":331.69,"endTime":334.93,"body":"tears and the implications, so"},{"speaker":"Chris Dy","startTime":334.93,"endTime":337.54,"body":"if I'm starting out in practice,"},{"speaker":"Chris Dy","startTime":334.93,"endTime":337.54,"body":"and like you said, All imaging"},{"speaker":"Chris Dy","startTime":337.54,"endTime":340.69,"body":"is local, should I just call a"},{"speaker":"Chris Dy","startTime":337.54,"endTime":340.69,"body":"radiologist and ask, you know,"},{"speaker":"Chris Dy","startTime":340.69,"endTime":343.24,"body":"what's going to give me a better"},{"speaker":"Chris Dy","startTime":340.69,"endTime":343.24,"body":"picture at the place that I'm"},{"speaker":"Chris Dy","startTime":343.24,"endTime":345.85,"body":"having most of my imaging done?"},{"speaker":"Chris Dy","startTime":343.24,"endTime":345.85,"body":"I mean, because I think we"},{"speaker":"Chris Dy","startTime":345.85,"endTime":348.28,"body":"talked about this before on this"},{"speaker":"Chris Dy","startTime":345.85,"endTime":348.28,"body":"podcast, or one of our other"},{"speaker":"Chris Dy","startTime":348.28,"endTime":351.16,"body":"venues, maybe it was conference"},{"speaker":"Chris Dy","startTime":348.28,"endTime":351.16,"body":"or hand conference, but remember"},{"speaker":"Chris Dy","startTime":351.16,"endTime":353.47,"body":"starting out in practice, and"},{"speaker":"Chris Dy","startTime":351.16,"endTime":353.47,"body":"you saying, I always get an"},{"speaker":"Chris Dy","startTime":353.47,"endTime":355.75,"body":"arthrogram? Why would you do"},{"speaker":"Chris Dy","startTime":353.47,"endTime":355.75,"body":"anything else, duh?"},{"speaker":"Charles Goldfarb","startTime":357.37,"endTime":357.82,"body":"It's funny-"},{"speaker":"Chris Dy","startTime":357.82,"endTime":359.56,"body":"Maybe not with a duh"},{"speaker":"Chris Dy","startTime":357.82,"endTime":359.56,"body":"at the end, but you know."},{"speaker":"Charles Goldfarb","startTime":359.92,"endTime":363.94,"body":"Maybe with the"},{"speaker":"Charles Goldfarb","startTime":359.92,"endTime":363.94,"body":"duh. I was actually thinking, as"},{"speaker":"Charles Goldfarb","startTime":363.94,"endTime":366.25,"body":"I was talking about you and I"},{"speaker":"Charles Goldfarb","startTime":363.94,"endTime":366.25,"body":"have discussed this, but I don't"},{"speaker":"Charles Goldfarb","startTime":366.25,"endTime":367.99,"body":"remember where either."},{"speaker":"Chris Dy","startTime":368.44,"endTime":369.49,"body":"Multiple venues."},{"speaker":"Charles Goldfarb","startTime":369.55,"endTime":372.34,"body":"Yeah. So I do"},{"speaker":"Charles Goldfarb","startTime":369.55,"endTime":372.34,"body":"think that's probably good"},{"speaker":"Charles Goldfarb","startTime":372.34,"endTime":376.96,"body":"advice. Many radiologists will"},{"speaker":"Charles Goldfarb","startTime":372.34,"endTime":376.96,"body":"recommend the arthrogram. It"},{"speaker":"Charles Goldfarb","startTime":376.96,"endTime":380.26,"body":"probably does give a little"},{"speaker":"Charles Goldfarb","startTime":376.96,"endTime":380.26,"body":"additional information. It's a"},{"speaker":"Charles Goldfarb","startTime":380.26,"endTime":382.69,"body":"cost benefit analysis. And I"},{"speaker":"Charles Goldfarb","startTime":380.26,"endTime":382.69,"body":"even I'm not even talking"},{"speaker":"Charles Goldfarb","startTime":382.69,"endTime":386.47,"body":"physical cost. I'm talking kind"},{"speaker":"Charles Goldfarb","startTime":382.69,"endTime":386.47,"body":"of the implications of the"},{"speaker":"Charles Goldfarb","startTime":386.47,"endTime":390.7,"body":"needle placement of getting the"},{"speaker":"Charles Goldfarb","startTime":386.47,"endTime":390.7,"body":"arthrogram, injection, etc. I"},{"speaker":"Charles Goldfarb","startTime":390.7,"endTime":393.34,"body":"would say most of us would agree"},{"speaker":"Charles Goldfarb","startTime":390.7,"endTime":393.34,"body":"that it would increase the"},{"speaker":"Charles Goldfarb","startTime":393.34,"endTime":397.63,"body":"sensitivity, and likely the"},{"speaker":"Charles Goldfarb","startTime":393.34,"endTime":397.63,"body":"specificity for identification"},{"speaker":"Charles Goldfarb","startTime":397.63,"endTime":402.43,"body":"of a TFCC tear. How much again,"},{"speaker":"Charles Goldfarb","startTime":397.63,"endTime":402.43,"body":"very local so I would I would"},{"speaker":"Charles Goldfarb","startTime":402.43,"endTime":404.83,"body":"talk to your radiologists get a"},{"speaker":"Charles Goldfarb","startTime":402.43,"endTime":404.83,"body":"sense of what's going on. And"},{"speaker":"Charles Goldfarb","startTime":404.83,"endTime":408.85,"body":"then once you do a handful, and"},{"speaker":"Charles Goldfarb","startTime":404.83,"endTime":408.85,"body":"you'll get a sense of whether"},{"speaker":"Charles Goldfarb","startTime":408.85,"endTime":410.08,"body":"it's helpful or not."},{"speaker":"Chris Dy","startTime":410.56,"endTime":414.13,"body":"In 2021 with your"},{"speaker":"Chris Dy","startTime":410.56,"endTime":414.13,"body":"skills of being a hand surgeon"},{"speaker":"Chris Dy","startTime":414.13,"endTime":418.27,"body":"for at least 50 years. Do you"},{"speaker":"Chris Dy","startTime":414.13,"endTime":418.27,"body":"feel like the arthrogram"},{"speaker":"Chris Dy","startTime":418.27,"endTime":421.63,"body":"extravasation down the sigmoid"},{"speaker":"Chris Dy","startTime":418.27,"endTime":421.63,"body":"notch, the so called J sign,"},{"speaker":"Chris Dy","startTime":421.63,"endTime":425.62,"body":"does that help you establish any"},{"speaker":"Chris Dy","startTime":421.63,"endTime":425.62,"body":"prognosticators about tear? Are"},{"speaker":"Chris Dy","startTime":425.62,"endTime":428.17,"body":"you getting all that info on"},{"speaker":"Chris Dy","startTime":425.62,"endTime":428.17,"body":"your examination? Since you've"},{"speaker":"Chris Dy","startTime":428.17,"endTime":430.6,"body":"been examining patients for"},{"speaker":"Chris Dy","startTime":428.17,"endTime":430.6,"body":"about 60-70 years now?"},{"speaker":"Charles Goldfarb","startTime":431.2,"endTime":432.46,"body":"Yeah, 80-90"},{"speaker":"Charles Goldfarb","startTime":431.2,"endTime":432.46,"body":"years."},{"speaker":"Chris Dy","startTime":433.36,"endTime":434.29,"body":"It just keeps going"},{"speaker":"Chris Dy","startTime":433.36,"endTime":434.29,"body":"up."},{"speaker":"Charles Goldfarb","startTime":435.31,"endTime":439.15,"body":"I don't think"},{"speaker":"Charles Goldfarb","startTime":435.31,"endTime":439.15,"body":"there arthrogram really helps me"},{"speaker":"Charles Goldfarb","startTime":439.18,"endTime":443.68,"body":"I think I can get a sense of"},{"speaker":"Charles Goldfarb","startTime":439.18,"endTime":443.68,"body":"what's going on by clinical"},{"speaker":"Charles Goldfarb","startTime":443.68,"endTime":449.11,"body":"exam. MRI definitely adds"},{"speaker":"Charles Goldfarb","startTime":443.68,"endTime":449.11,"body":"information. Like I said, Let"},{"speaker":"Charles Goldfarb","startTime":449.11,"endTime":452.74,"body":"fewer and fewer reasons for me"},{"speaker":"Charles Goldfarb","startTime":449.11,"endTime":452.74,"body":"to get the arthrogram moving"},{"speaker":"Charles Goldfarb","startTime":452.74,"endTime":453.19,"body":"forward."},{"speaker":"Chris Dy","startTime":453.7,"endTime":455.26,"body":"I mean it's"},{"speaker":"Chris Dy","startTime":453.7,"endTime":455.26,"body":"interesting over here to talk"},{"speaker":"Chris Dy","startTime":455.26,"endTime":457.81,"body":"about like surgical details, but"},{"speaker":"Chris Dy","startTime":455.26,"endTime":457.81,"body":"I noticed that the stuff that"},{"speaker":"Chris Dy","startTime":457.81,"endTime":461.14,"body":"I'm super comfortable with, at"},{"speaker":"Chris Dy","startTime":457.81,"endTime":461.14,"body":"this point in my career, I guess"},{"speaker":"Chris Dy","startTime":461.14,"endTime":464.38,"body":"six year six and a half years of"},{"speaker":"Chris Dy","startTime":461.14,"endTime":464.38,"body":"practice now, I order less"},{"speaker":"Chris Dy","startTime":464.38,"endTime":467.26,"body":"studies for that stuff. But the"},{"speaker":"Chris Dy","startTime":464.38,"endTime":467.26,"body":"stuff where I'm still populating"},{"speaker":"Chris Dy","startTime":467.26,"endTime":470.53,"body":"my algorithm on clinical exam"},{"speaker":"Chris Dy","startTime":467.26,"endTime":470.53,"body":"and how patients look and how"},{"speaker":"Chris Dy","startTime":470.53,"endTime":473.11,"body":"patients are going to do, I"},{"speaker":"Chris Dy","startTime":470.53,"endTime":473.11,"body":"still get studies and I would"},{"speaker":"Chris Dy","startTime":473.11,"endTime":475.9,"body":"say probably get more studies"},{"speaker":"Chris Dy","startTime":473.11,"endTime":475.9,"body":"now. Because I'm still trying to"},{"speaker":"Chris Dy","startTime":475.9,"endTime":479.8,"body":"own what I see on my exam, what"},{"speaker":"Chris Dy","startTime":475.9,"endTime":479.8,"body":"I see in the OR versus what I"},{"speaker":"Chris Dy","startTime":479.8,"endTime":481.81,"body":"see on their imaging, because"},{"speaker":"Chris Dy","startTime":479.8,"endTime":481.81,"body":"I've become more interested to"},{"speaker":"Chris Dy","startTime":481.81,"endTime":483.49,"body":"see how good I am at predicting"},{"speaker":"Chris Dy","startTime":481.81,"endTime":483.49,"body":"that now."},{"speaker":"Charles Goldfarb","startTime":484.06,"endTime":486.07,"body":"It's such an"},{"speaker":"Charles Goldfarb","startTime":484.06,"endTime":486.07,"body":"interesting point and is so"},{"speaker":"Charles Goldfarb","startTime":486.07,"endTime":490.9,"body":"true. And certainly when you get"},{"speaker":"Charles Goldfarb","startTime":486.07,"endTime":490.9,"body":"old, like one of us, you don't"},{"speaker":"Charles Goldfarb","startTime":490.9,"endTime":494.89,"body":"want to stop being inquisitive"},{"speaker":"Charles Goldfarb","startTime":490.9,"endTime":494.89,"body":"and stop trying to improve that"},{"speaker":"Charles Goldfarb","startTime":494.89,"endTime":498.43,"body":"correlation assessment of"},{"speaker":"Charles Goldfarb","startTime":494.89,"endTime":498.43,"body":"imaging. And but I do wonder"},{"speaker":"Charles Goldfarb","startTime":498.43,"endTime":501.7,"body":"less tests than I used to. And I"},{"speaker":"Charles Goldfarb","startTime":498.43,"endTime":501.7,"body":"think I do that from a place of"},{"speaker":"Charles Goldfarb","startTime":501.7,"endTime":506.02,"body":"knowledge. I'm not critical of"},{"speaker":"Charles Goldfarb","startTime":501.7,"endTime":506.02,"body":"those who ordered tests, and"},{"speaker":"Charles Goldfarb","startTime":506.02,"endTime":509.32,"body":"sort of there's value in test."},{"speaker":"Charles Goldfarb","startTime":506.02,"endTime":509.32,"body":"But I do think my indications"},{"speaker":"Charles Goldfarb","startTime":509.32,"endTime":510.7,"body":"have narrowed for sure."},{"speaker":"Chris Dy","startTime":511.81,"endTime":515.05,"body":"So say you've got this"},{"speaker":"Chris Dy","startTime":511.81,"endTime":515.05,"body":"patient and say they've got"},{"speaker":"Chris Dy","startTime":515.08,"endTime":519.07,"body":"quote, just a peripheral tear,"},{"speaker":"Chris Dy","startTime":515.08,"endTime":519.07,"body":"but they still got that subtle"},{"speaker":"Chris Dy","startTime":519.07,"endTime":523.06,"body":"instability on your exam. How"},{"speaker":"Chris Dy","startTime":519.07,"endTime":523.06,"body":"are you getting what what are"},{"speaker":"Chris Dy","startTime":523.06,"endTime":527.68,"body":"your options here for treatment?"},{"speaker":"Chris Dy","startTime":523.06,"endTime":527.68,"body":"Are you going to, you know, try"},{"speaker":"Chris Dy","startTime":527.68,"endTime":530.8,"body":"some therapy. So maybe you're"},{"speaker":"Chris Dy","startTime":527.68,"endTime":530.8,"body":"just widget, you're going to do"},{"speaker":"Chris Dy","startTime":530.8,"endTime":532.87,"body":"an injection? Are we going to"},{"speaker":"Chris Dy","startTime":530.8,"endTime":532.87,"body":"the OR?"},{"speaker":"Charles Goldfarb","startTime":533.41,"endTime":535.51,"body":"So essentially"},{"speaker":"Charles Goldfarb","startTime":533.41,"endTime":535.51,"body":"the six week timeframe which you"},{"speaker":"Charles Goldfarb","startTime":535.51,"endTime":538.72,"body":"described, so twisting, you"},{"speaker":"Charles Goldfarb","startTime":535.51,"endTime":538.72,"body":"know, drill injuries six weeks,"},{"speaker":"Charles Goldfarb","startTime":538.72,"endTime":541.36,"body":"because that's that's quick,"},{"speaker":"Charles Goldfarb","startTime":538.72,"endTime":541.36,"body":"honestly, most people don't come"},{"speaker":"Charles Goldfarb","startTime":541.36,"endTime":545.53,"body":"in that soon. If they did, I"},{"speaker":"Charles Goldfarb","startTime":541.36,"endTime":545.53,"body":"would really strongly consider a"},{"speaker":"Charles Goldfarb","startTime":545.53,"endTime":548.59,"body":"cast. The problem, of course,"},{"speaker":"Charles Goldfarb","startTime":545.53,"endTime":548.59,"body":"with recommending a cast is a it"},{"speaker":"Charles Goldfarb","startTime":548.59,"endTime":552.64,"body":"needs to be a long arm or a"},{"speaker":"Charles Goldfarb","startTime":548.59,"endTime":552.64,"body":"monster, and b I can't give good"},{"speaker":"Charles Goldfarb","startTime":552.64,"endTime":555.43,"body":"data and I can't promise it'll"},{"speaker":"Charles Goldfarb","startTime":552.64,"endTime":555.43,"body":"work and then you put someone in"},{"speaker":"Charles Goldfarb","startTime":555.43,"endTime":557.59,"body":"a cast for six weeks, and you"},{"speaker":"Charles Goldfarb","startTime":555.43,"endTime":557.59,"body":"may not have anything to show"},{"speaker":"Charles Goldfarb","startTime":557.59,"endTime":561.16,"body":"for it. But I do think that's"},{"speaker":"Charles Goldfarb","startTime":557.59,"endTime":561.16,"body":"reasonable in the acute or"},{"speaker":"Charles Goldfarb","startTime":561.16,"endTime":566.41,"body":"subacute setting. Once this is"},{"speaker":"Charles Goldfarb","startTime":561.16,"endTime":566.41,"body":"it three months or six months, I"},{"speaker":"Charles Goldfarb","startTime":566.41,"endTime":570.82,"body":"really do like a single"},{"speaker":"Charles Goldfarb","startTime":566.41,"endTime":570.82,"body":"injection with a wrist splint,"},{"speaker":"Charles Goldfarb","startTime":571.06,"endTime":575.05,"body":"anti inflammatories, activity"},{"speaker":"Charles Goldfarb","startTime":571.06,"endTime":575.05,"body":"modifications, I do not believe"},{"speaker":"Charles Goldfarb","startTime":575.05,"endTime":578.26,"body":"in repetitive wrist injections,"},{"speaker":"Charles Goldfarb","startTime":575.05,"endTime":578.26,"body":"but a single injection gives me"},{"speaker":"Charles Goldfarb","startTime":578.26,"endTime":581.41,"body":"a lot number one, it hopefully"},{"speaker":"Charles Goldfarb","startTime":578.26,"endTime":581.41,"body":"helps the patient maybe not"},{"speaker":"Charles Goldfarb","startTime":581.41,"endTime":585.79,"body":"forever but helps the patient"},{"speaker":"Charles Goldfarb","startTime":581.41,"endTime":585.79,"body":"number two, it is a diagnostic"},{"speaker":"Charles Goldfarb","startTime":585.79,"endTime":591.19,"body":"test, let's be honest. And it"},{"speaker":"Charles Goldfarb","startTime":585.79,"endTime":591.19,"body":"also helps me and the patient."},{"speaker":"Charles Goldfarb","startTime":592.3,"endTime":595.69,"body":"Understand that if the injection"},{"speaker":"Charles Goldfarb","startTime":592.3,"endTime":595.69,"body":"works and wears off, then"},{"speaker":"Charles Goldfarb","startTime":595.72,"endTime":599.65,"body":"surgery really feels much more"},{"speaker":"Charles Goldfarb","startTime":595.72,"endTime":599.65,"body":"comfortable rather than just"},{"speaker":"Charles Goldfarb","startTime":599.65,"endTime":603.37,"body":"jumping Surgery? I don't know,"},{"speaker":"Charles Goldfarb","startTime":599.65,"endTime":603.37,"body":"do you? Does that resonate? Or"},{"speaker":"Charles Goldfarb","startTime":603.37,"endTime":604.45,"body":"do you see it differently?"},{"speaker":"Chris Dy","startTime":605.02,"endTime":607.6,"body":"Yeah, no, I have"},{"speaker":"Chris Dy","startTime":605.02,"endTime":607.6,"body":"resonates with me. I mean, I try"},{"speaker":"Chris Dy","startTime":607.6,"endTime":610.45,"body":"not to jump into surgery"},{"speaker":"Chris Dy","startTime":607.6,"endTime":610.45,"body":"quickly. And you know, I think"},{"speaker":"Chris Dy","startTime":610.45,"endTime":613.81,"body":"that, you know, the injection is"},{"speaker":"Chris Dy","startTime":610.45,"endTime":613.81,"body":"totally reasonable. I like a"},{"speaker":"Chris Dy","startTime":613.81,"endTime":616.57,"body":"wrist widget, as many of our"},{"speaker":"Chris Dy","startTime":613.81,"endTime":616.57,"body":"therapy colleagues have pointed"},{"speaker":"Chris Dy","startTime":616.57,"endTime":623.32,"body":"out in the past. I guess for me,"},{"speaker":"Chris Dy","startTime":616.57,"endTime":623.32,"body":"say we fast forward to three"},{"speaker":"Chris Dy","startTime":623.32,"endTime":627.16,"body":"months, some relief from the"},{"speaker":"Chris Dy","startTime":623.32,"endTime":627.16,"body":"injection, still has that"},{"speaker":"Chris Dy","startTime":627.16,"endTime":631.45,"body":"instability absolutely wants"},{"speaker":"Chris Dy","startTime":627.16,"endTime":631.45,"body":"something done. They come to the"},{"speaker":"Chris Dy","startTime":631.45,"endTime":635.44,"body":"master the professor, the"},{"speaker":"Chris Dy","startTime":631.45,"endTime":635.44,"body":"Executive Vice Chair, Chuck"},{"speaker":"Chris Dy","startTime":635.44,"endTime":639.25,"body":"Goldfarb, and they need to know"},{"speaker":"Chris Dy","startTime":635.44,"endTime":639.25,"body":"what are you going to do to me?"},{"speaker":"Chris Dy","startTime":639.28,"endTime":640.87,"body":"What What can you do to help me?"},{"speaker":"Charles Goldfarb","startTime":641.369,"endTime":644.879,"body":"Well, let me"},{"speaker":"Charles Goldfarb","startTime":641.369,"endTime":644.879,"body":"first say that of all the"},{"speaker":"Charles Goldfarb","startTime":644.879,"endTime":649.379,"body":"therapy tricks and tools, the"},{"speaker":"Charles Goldfarb","startTime":644.879,"endTime":649.379,"body":"risks widget is one of my"},{"speaker":"Charles Goldfarb","startTime":649.379,"endTime":655.469,"body":"favorite, it is a fantastic"},{"speaker":"Charles Goldfarb","startTime":649.379,"endTime":655.469,"body":"option for all things onerous"},{"speaker":"Charles Goldfarb","startTime":655.469,"endTime":659.939,"body":"added risk pain, it can be TFCC"},{"speaker":"Charles Goldfarb","startTime":655.469,"endTime":659.939,"body":"it can be ECU it can be vague"},{"speaker":"Charles Goldfarb","startTime":659.939,"endTime":663.989,"body":"wrist pain, there's a chance the"},{"speaker":"Charles Goldfarb","startTime":659.939,"endTime":663.989,"body":"wrist widget cures it so I love"},{"speaker":"Charles Goldfarb","startTime":663.989,"endTime":667.259,"body":"that suggestion. We you know"},{"speaker":"Charles Goldfarb","startTime":663.989,"endTime":667.259,"body":"sometimes that therapist custom"},{"speaker":"Charles Goldfarb","startTime":667.259,"endTime":670.409,"body":"Macomb you can order it on"},{"speaker":"Charles Goldfarb","startTime":667.259,"endTime":670.409,"body":"Amazon, there's there's a"},{"speaker":"Charles Goldfarb","startTime":670.409,"endTime":673.889,"body":"variety of different types. It's"},{"speaker":"Charles Goldfarb","startTime":670.409,"endTime":673.889,"body":"a great tool."},{"speaker":"Chris Dy","startTime":674.249,"endTime":677.459,"body":"I love the risk, which"},{"speaker":"Chris Dy","startTime":674.249,"endTime":677.459,"body":"it mainly because it I see a lot"},{"speaker":"Chris Dy","startTime":677.459,"endTime":680.939,"body":"of vague on their side of risk"},{"speaker":"Chris Dy","startTime":677.459,"endTime":680.939,"body":"paint my practice, and maybe"},{"speaker":"Chris Dy","startTime":680.939,"endTime":684.599,"body":"it's because I, I'm seeing"},{"speaker":"Chris Dy","startTime":680.939,"endTime":684.599,"body":"certain diagnoses and there are"},{"speaker":"Chris Dy","startTime":684.599,"endTime":688.469,"body":"they're seeing me and I'm not"},{"speaker":"Chris Dy","startTime":684.599,"endTime":688.469,"body":"seeing them, but it works. It"},{"speaker":"Chris Dy","startTime":688.469,"endTime":691.469,"body":"works. It's a great first step,"},{"speaker":"Chris Dy","startTime":688.469,"endTime":691.469,"body":"and patients seem to like it."},{"speaker":"Chris Dy","startTime":691.469,"endTime":693.599,"body":"And obviously our therapy"},{"speaker":"Chris Dy","startTime":691.469,"endTime":693.599,"body":"colleagues provide a great"},{"speaker":"Chris Dy","startTime":693.599,"endTime":694.439,"body":"resource with that."},{"speaker":"Charles Goldfarb","startTime":694.54,"endTime":697.33,"body":"So so let me"},{"speaker":"Charles Goldfarb","startTime":694.54,"endTime":697.33,"body":"let me envision the Chris Dy"},{"speaker":"Charles Goldfarb","startTime":697.36,"endTime":701.56,"body":"ulnar sided wrist pain exam."},{"speaker":"Charles Goldfarb","startTime":697.36,"endTime":701.56,"body":"Starts with cubital tunnel,"},{"speaker":"Charles Goldfarb","startTime":701.56,"endTime":705.16,"body":"careful examination, make sure"},{"speaker":"Charles Goldfarb","startTime":701.56,"endTime":705.16,"body":"that nerve is stable, and then a"},{"speaker":"Charles Goldfarb","startTime":705.16,"endTime":709.03,"body":"distal ulnar tunnel, a tinel's"},{"speaker":"Charles Goldfarb","startTime":705.16,"endTime":709.03,"body":"and a compression test. And then"},{"speaker":"Charles Goldfarb","startTime":709.15,"endTime":711.58,"body":"we don't want to forget the"},{"speaker":"Charles Goldfarb","startTime":709.15,"endTime":711.58,"body":"sensory branch of the ulnar"},{"speaker":"Charles Goldfarb","startTime":711.58,"endTime":711.67,"body":"nerve."},{"speaker":"Chris Dy","startTime":711.67,"endTime":714.4,"body":"Yeah, exactly exactly"},{"speaker":"Chris Dy","startTime":711.67,"endTime":714.4,"body":"the nerve of Calfee, as our"},{"speaker":"Chris Dy","startTime":714.4,"endTime":717.34,"body":"partner Ryan Calfee described in"},{"speaker":"Chris Dy","startTime":714.4,"endTime":717.34,"body":"his award winning article. Yeah,"},{"speaker":"Chris Dy","startTime":717.34,"endTime":719.38,"body":"so I mean, you always got to"},{"speaker":"Chris Dy","startTime":717.34,"endTime":719.38,"body":"start with the thing that's most"},{"speaker":"Chris Dy","startTime":719.38,"endTime":723.49,"body":"important. And there're"},{"speaker":"Chris Dy","startTime":719.38,"endTime":723.49,"body":"apparently bones and tendons and"},{"speaker":"Chris Dy","startTime":723.49,"endTime":724.42,"body":"stuff underneath."},{"speaker":"Charles Goldfarb","startTime":725.17,"endTime":728.35,"body":"Irrelevant."},{"speaker":"Charles Goldfarb","startTime":725.17,"endTime":728.35,"body":"Alright, so in all seriousness,"},{"speaker":"Charles Goldfarb","startTime":728.35,"endTime":731.5,"body":"if this patient comes to"},{"speaker":"Charles Goldfarb","startTime":728.35,"endTime":731.5,"body":"surgery, and for me that, you"},{"speaker":"Charles Goldfarb","startTime":731.5,"endTime":734.05,"body":"know, there are a lot of"},{"speaker":"Charles Goldfarb","startTime":731.5,"endTime":734.05,"body":"variables, but a younger patient"},{"speaker":"Charles Goldfarb","startTime":734.14,"endTime":737.86,"body":"who had a great response to an"},{"speaker":"Charles Goldfarb","startTime":734.14,"endTime":737.86,"body":"injection, that wore off,"},{"speaker":"Charles Goldfarb","startTime":737.86,"endTime":739.99,"body":"whether that'd be three months"},{"speaker":"Charles Goldfarb","startTime":737.86,"endTime":739.99,"body":"or six weeks, I really feel is a"},{"speaker":"Charles Goldfarb","startTime":739.99,"endTime":743.05,"body":"good indication for surgery. The"},{"speaker":"Charles Goldfarb","startTime":739.99,"endTime":743.05,"body":"reason I think it's a good"},{"speaker":"Charles Goldfarb","startTime":743.05,"endTime":747.01,"body":"indication is number one, an"},{"speaker":"Charles Goldfarb","startTime":743.05,"endTime":747.01,"body":"arthroscopic intervention done"},{"speaker":"Charles Goldfarb","startTime":747.01,"endTime":752.5,"body":"well is safe, minimal morbidity,"},{"speaker":"Charles Goldfarb","startTime":747.01,"endTime":752.5,"body":"can be done, you know, in a"},{"speaker":"Charles Goldfarb","startTime":752.5,"endTime":756.43,"body":"relatively short fashion, and I"},{"speaker":"Charles Goldfarb","startTime":752.5,"endTime":756.43,"body":"just have good results. So I"},{"speaker":"Charles Goldfarb","startTime":756.43,"endTime":759.16,"body":"like it. And I don't think"},{"speaker":"Charles Goldfarb","startTime":756.43,"endTime":759.16,"body":"everyone would agree with"},{"speaker":"Charles Goldfarb","startTime":759.16,"endTime":763.0,"body":"everything I just said. But I"},{"speaker":"Charles Goldfarb","startTime":759.16,"endTime":763.0,"body":"like the procedure. So for me,"},{"speaker":"Charles Goldfarb","startTime":763.0,"endTime":767.2,"body":"it's a wrist arthroscopy, as I"},{"speaker":"Charles Goldfarb","startTime":763.0,"endTime":767.2,"body":"think I've said on this show"},{"speaker":"Charles Goldfarb","startTime":767.2,"endTime":771.16,"body":"before. I don't love diagnostic"},{"speaker":"Charles Goldfarb","startTime":767.2,"endTime":771.16,"body":"wrist arthroscopy as I like to"},{"speaker":"Charles Goldfarb","startTime":771.16,"endTime":775.3,"body":"have an idea of what I'm going"},{"speaker":"Charles Goldfarb","startTime":771.16,"endTime":775.3,"body":"to do. I don't almost ever do a"},{"speaker":"Charles Goldfarb","startTime":775.3,"endTime":778.99,"body":"wrist arthroscopy to just see"},{"speaker":"Charles Goldfarb","startTime":775.3,"endTime":778.99,"body":"what's going on. That doesn't"},{"speaker":"Charles Goldfarb","startTime":778.99,"endTime":781.9,"body":"feel right to me, although"},{"speaker":"Charles Goldfarb","startTime":778.99,"endTime":781.9,"body":"again, I recognize that for some"},{"speaker":"Charles Goldfarb","startTime":781.9,"endTime":785.2,"body":"it can be a true diagnostic"},{"speaker":"Charles Goldfarb","startTime":781.9,"endTime":785.2,"body":"tool, but in the scenario we've"},{"speaker":"Charles Goldfarb","startTime":785.2,"endTime":788.68,"body":"provided, and yes, you're going"},{"speaker":"Charles Goldfarb","startTime":785.2,"endTime":788.68,"body":"to confirm what's going on with"},{"speaker":"Charles Goldfarb","startTime":788.68,"endTime":792.76,"body":"the TFCC and with the ulnar side"},{"speaker":"Charles Goldfarb","startTime":788.68,"endTime":792.76,"body":"wrist pain, but kind of have a"},{"speaker":"Charles Goldfarb","startTime":792.82,"endTime":796.15,"body":"have a sense of what might be"},{"speaker":"Charles Goldfarb","startTime":792.82,"endTime":796.15,"body":"going on before the case."},{"speaker":"Chris Dy","startTime":796.54,"endTime":798.82,"body":"It's interesting what"},{"speaker":"Chris Dy","startTime":796.54,"endTime":798.82,"body":"we did last Firsthand in"},{"speaker":"Chris Dy","startTime":798.82,"endTime":802.21,"body":"November with Jeff Greenberg"},{"speaker":"Chris Dy","startTime":798.82,"endTime":802.21,"body":"from the Indiana Hand center to"},{"speaker":"Chris Dy","startTime":802.21,"endTime":805.51,"body":"maybe feel like ordered way too"},{"speaker":"Chris Dy","startTime":802.21,"endTime":805.51,"body":"many MRIs because I like to know"},{"speaker":"Chris Dy","startTime":805.54,"endTime":808.06,"body":"really have a good sense of"},{"speaker":"Chris Dy","startTime":805.54,"endTime":808.06,"body":"what's going on before I hit the"},{"speaker":"Chris Dy","startTime":808.06,"endTime":813.22,"body":"O R. But his feeling was that I"},{"speaker":"Chris Dy","startTime":808.06,"endTime":813.22,"body":"presume he's ordering less MRIs"},{"speaker":"Chris Dy","startTime":813.22,"endTime":817.24,"body":"and he's using the the scope to"},{"speaker":"Chris Dy","startTime":813.22,"endTime":817.24,"body":"confirm his clinical diagnosis,"},{"speaker":"Chris Dy","startTime":817.24,"endTime":820.69,"body":"which again, after many years,"},{"speaker":"Chris Dy","startTime":817.24,"endTime":820.69,"body":"has been honed to the point"},{"speaker":"Chris Dy","startTime":820.69,"endTime":824.35,"body":"where maybe he doesn't need an"},{"speaker":"Chris Dy","startTime":820.69,"endTime":824.35,"body":"MRI. So I think you know, there"},{"speaker":"Chris Dy","startTime":824.35,"endTime":827.56,"body":"are a lot of ways to do it. I"},{"speaker":"Chris Dy","startTime":824.35,"endTime":827.56,"body":"fall more into your camp than"},{"speaker":"Chris Dy","startTime":827.59,"endTime":830.05,"body":"then his but maybe one day I'll"},{"speaker":"Chris Dy","startTime":827.59,"endTime":830.05,"body":"get there."},{"speaker":"Charles Goldfarb","startTime":830.53,"endTime":832.75,"body":"Yeah, I think"},{"speaker":"Charles Goldfarb","startTime":830.53,"endTime":832.75,"body":"I'm heading in that direction."},{"speaker":"Charles Goldfarb","startTime":832.75,"endTime":836.26,"body":"But but I'm not there yet. And"},{"speaker":"Charles Goldfarb","startTime":832.75,"endTime":836.26,"body":"there's so many is so many"},{"speaker":"Charles Goldfarb","startTime":836.26,"endTime":838.54,"body":"variables, whether it's work"},{"speaker":"Charles Goldfarb","startTime":836.26,"endTime":838.54,"body":"comp or not, and getting"},{"speaker":"Charles Goldfarb","startTime":838.54,"endTime":843.28,"body":"approval and, and the like so"},{"speaker":"Charles Goldfarb","startTime":838.54,"endTime":843.28,"body":"maybe I'll just talk through the"},{"speaker":"Charles Goldfarb","startTime":843.31,"endTime":845.65,"body":"the scope process, how I how I,"},{"speaker":"Charles Goldfarb","startTime":843.31,"endTime":845.65,"body":"how I do."},{"speaker":"Chris Dy","startTime":845.95,"endTime":847.69,"body":"Why don't I give you,"},{"speaker":"Chris Dy","startTime":845.95,"endTime":847.69,"body":"why don't I give you a lightning"},{"speaker":"Chris Dy","startTime":847.69,"endTime":850.33,"body":"round. And you can answer some"},{"speaker":"Chris Dy","startTime":847.69,"endTime":850.33,"body":"of these questions. How about"},{"speaker":"Chris Dy","startTime":850.33,"endTime":850.63,"body":"that?"},{"speaker":"Charles Goldfarb","startTime":850.66,"endTime":852.04,"body":"Making it easy"},{"speaker":"Charles Goldfarb","startTime":850.66,"endTime":852.04,"body":"for the old guy."},{"speaker":"Chris Dy","startTime":852.46,"endTime":855.37,"body":"Alright, perfect. So"},{"speaker":"Chris Dy","startTime":852.46,"endTime":855.37,"body":"in the OR, normal hand table?"},{"speaker":"Charles Goldfarb","startTime":855.82,"endTime":857.32,"body":"Normal hand"},{"speaker":"Charles Goldfarb","startTime":855.82,"endTime":857.32,"body":"table with a leg."},{"speaker":"Chris Dy","startTime":857.89,"endTime":859.9,"body":"Okay, hand table with"},{"speaker":"Chris Dy","startTime":857.89,"endTime":859.9,"body":"the leg, why the leg?"},{"speaker":"Charles Goldfarb","startTime":860.62,"endTime":863.41,"body":"You don't want"},{"speaker":"Charles Goldfarb","startTime":860.62,"endTime":863.41,"body":"the hand table kind of wobbling"},{"speaker":"Charles Goldfarb","startTime":863.41,"endTime":866.29,"body":"up and down without the"},{"speaker":"Charles Goldfarb","startTime":863.41,"endTime":866.29,"body":"stability. So just like you"},{"speaker":"Charles Goldfarb","startTime":866.29,"endTime":869.98,"body":"would insist on a leg to that"},{"speaker":"Charles Goldfarb","startTime":866.29,"endTime":869.98,"body":"hand table for a scope case I"},{"speaker":"Charles Goldfarb","startTime":869.98,"endTime":870.16,"body":"insist-"},{"speaker":"Chris Dy","startTime":870.16,"endTime":872.44,"body":"The right the right"},{"speaker":"Chris Dy","startTime":870.16,"endTime":872.44,"body":"kind of the cool kind of scope,"},{"speaker":"Chris Dy","startTime":872.47,"endTime":873.13,"body":"the microscope."},{"speaker":"Charles Goldfarb","startTime":873.16,"endTime":875.35,"body":"Yeah, the"},{"speaker":"Charles Goldfarb","startTime":873.16,"endTime":875.35,"body":"other kind of scope."},{"speaker":"Chris Dy","startTime":875.74,"endTime":878.08,"body":"As a as a rule for our"},{"speaker":"Chris Dy","startTime":875.74,"endTime":878.08,"body":"residents and fellows if there's"},{"speaker":"Chris Dy","startTime":878.11,"endTime":880.18,"body":"word scope involved, but a leg"},{"speaker":"Chris Dy","startTime":878.11,"endTime":880.18,"body":"on the table."},{"speaker":"Charles Goldfarb","startTime":880.24,"endTime":881.62,"body":"There we go."},{"speaker":"Charles Goldfarb","startTime":880.24,"endTime":881.62,"body":"We just simplified it."},{"speaker":"Chris Dy","startTime":881.62,"endTime":884.08,"body":"There you go. So I"},{"speaker":"Chris Dy","startTime":881.62,"endTime":884.08,"body":"feel like this is the consensus"},{"speaker":"Chris Dy","startTime":884.08,"endTime":891.19,"body":"agreement of 2021. So okay,"},{"speaker":"Chris Dy","startTime":884.08,"endTime":891.19,"body":"tourniquet, yes. Okay. And then"},{"speaker":"Chris Dy","startTime":891.25,"endTime":895.24,"body":"the we've talked about the Linde"},{"speaker":"Chris Dy","startTime":891.25,"endTime":895.24,"body":"med traction tower in the past"},{"speaker":"Chris Dy","startTime":895.24,"endTime":899.23,"body":"and shout out to the to the reps"},{"speaker":"Chris Dy","startTime":895.24,"endTime":899.23,"body":"who have contacted us to trial"},{"speaker":"Chris Dy","startTime":899.23,"endTime":901.3,"body":"their new tower I've tried it"},{"speaker":"Chris Dy","startTime":899.23,"endTime":901.3,"body":"once or twice, and it's"},{"speaker":"Chris Dy","startTime":901.3,"endTime":907.87,"body":"fantastic. But you can sponsor"},{"speaker":"Chris Dy","startTime":901.3,"endTime":907.87,"body":"the podcast, email us. And if"},{"speaker":"Chris Dy","startTime":907.87,"endTime":910.81,"body":"you're using the old tower that"},{"speaker":"Chris Dy","startTime":907.87,"endTime":910.81,"body":"everybody had from the 1990s,"},{"speaker":"Chris Dy","startTime":910.84,"endTime":914.98,"body":"that had the VHS tape on it. Do,"},{"speaker":"Chris Dy","startTime":910.84,"endTime":914.98,"body":"what do you do in terms of"},{"speaker":"Chris Dy","startTime":914.98,"endTime":918.07,"body":"setting that up, because the VHS"},{"speaker":"Chris Dy","startTime":914.98,"endTime":918.07,"body":"tape video says that you're"},{"speaker":"Chris Dy","startTime":918.07,"endTime":920.14,"body":"supposed to strap that down to"},{"speaker":"Chris Dy","startTime":918.07,"endTime":920.14,"body":"the table."},{"speaker":"Charles Goldfarb","startTime":921.1,"endTime":922.99,"body":"Yeah, so I"},{"speaker":"Charles Goldfarb","startTime":921.1,"endTime":922.99,"body":"still do use the limit tech"},{"speaker":"Charles Goldfarb","startTime":922.99,"endTime":926.17,"body":"tracking tower, I do not strap"},{"speaker":"Charles Goldfarb","startTime":922.99,"endTime":926.17,"body":"it to the table, there's two"},{"speaker":"Charles Goldfarb","startTime":926.17,"endTime":932.32,"body":"straps, I use one to hold the"},{"speaker":"Charles Goldfarb","startTime":926.17,"endTime":932.32,"body":"forearm to the vertical portion"},{"speaker":"Charles Goldfarb","startTime":932.35,"endTime":937.21,"body":"of the traction tower, the other"},{"speaker":"Charles Goldfarb","startTime":932.35,"endTime":937.21,"body":"to hold the arm to the base of"},{"speaker":"Charles Goldfarb","startTime":937.21,"endTime":939.97,"body":"the traction towers that allows"},{"speaker":"Charles Goldfarb","startTime":937.21,"endTime":939.97,"body":"you to apply traction to the"},{"speaker":"Charles Goldfarb","startTime":939.97,"endTime":943.9,"body":"fingers safely. I use towers"},{"speaker":"Charles Goldfarb","startTime":939.97,"endTime":943.9,"body":"that I'm sorry, use towels to"},{"speaker":"Charles Goldfarb","startTime":943.9,"endTime":948.52,"body":"protect the skin. And I use 10"},{"speaker":"Charles Goldfarb","startTime":943.9,"endTime":948.52,"body":"to 12 pounds of traction, almost"},{"speaker":"Charles Goldfarb","startTime":948.52,"endTime":950.29,"body":"always to the middle and ring"},{"speaker":"Charles Goldfarb","startTime":948.52,"endTime":950.29,"body":"finger alone."},{"speaker":"Chris Dy","startTime":950.95,"endTime":953.86,"body":"What is preventing the"},{"speaker":"Chris Dy","startTime":950.95,"endTime":953.86,"body":"traction that you're applying"},{"speaker":"Chris Dy","startTime":953.86,"endTime":956.29,"body":"through the finger traps from"},{"speaker":"Chris Dy","startTime":953.86,"endTime":956.29,"body":"pulling the patient off the"},{"speaker":"Chris Dy","startTime":956.29,"endTime":956.74,"body":"table?"},{"speaker":"Charles Goldfarb","startTime":958.18,"endTime":960.88,"body":"It's only 10"},{"speaker":"Charles Goldfarb","startTime":958.18,"endTime":960.88,"body":"to 12 pounds of traction. And I"},{"speaker":"Charles Goldfarb","startTime":960.88,"endTime":965.56,"body":"think as long as you hold the"},{"speaker":"Charles Goldfarb","startTime":960.88,"endTime":965.56,"body":"arm down to the tower that"},{"speaker":"Charles Goldfarb","startTime":965.56,"endTime":969.34,"body":"caught the setup is more than 10"},{"speaker":"Charles Goldfarb","startTime":965.56,"endTime":969.34,"body":"or 12 pounds. So I've never"},{"speaker":"Charles Goldfarb","startTime":969.82,"endTime":971.05,"body":"pulled the patient off the"},{"speaker":"Charles Goldfarb","startTime":969.82,"endTime":971.05,"body":"table."},{"speaker":"Chris Dy","startTime":971.77,"endTime":975.25,"body":"So as a non expert in"},{"speaker":"Chris Dy","startTime":971.77,"endTime":975.25,"body":"wrist arthroscopy, I set it up a"},{"speaker":"Chris Dy","startTime":975.25,"endTime":977.95,"body":"little differently. I follow the"},{"speaker":"Chris Dy","startTime":975.25,"endTime":977.95,"body":"old video and the old video"},{"speaker":"Chris Dy","startTime":977.95,"endTime":981.31,"body":"which is amazing. You know has"},{"speaker":"Chris Dy","startTime":977.95,"endTime":981.31,"body":"the picture of somebody with a"},{"speaker":"Chris Dy","startTime":981.31,"endTime":984.7,"body":"tourniquet on and then a strap"},{"speaker":"Chris Dy","startTime":981.31,"endTime":984.7,"body":"over the tourniquet which I will"},{"speaker":"Chris Dy","startTime":984.7,"endTime":987.76,"body":"do because I don't like stuff"},{"speaker":"Chris Dy","startTime":984.7,"endTime":987.76,"body":"moving around when I'm trying to"},{"speaker":"Chris Dy","startTime":987.76,"endTime":988.48,"body":"do my wrist scope."},{"speaker":"Charles Goldfarb","startTime":988.93,"endTime":991.78,"body":"No, I'm only,"},{"speaker":"Charles Goldfarb","startTime":988.93,"endTime":991.78,"body":"only got love for you that is"},{"speaker":"Charles Goldfarb","startTime":991.81,"endTime":993.1,"body":"the only way of doing it."},{"speaker":"Chris Dy","startTime":994.6,"endTime":997.48,"body":"Okay, so we've got the"},{"speaker":"Chris Dy","startTime":994.6,"endTime":997.48,"body":"wrist in traction you said 10 to"},{"speaker":"Chris Dy","startTime":997.48,"endTime":1000.66,"body":"12 pounds, finger traps on which"},{"speaker":"Chris Dy","startTime":997.48,"endTime":1000.66,"body":"fingers?"},{"speaker":"Charles Goldfarb","startTime":1000.93,"endTime":1002.4,"body":"Just middle"},{"speaker":"Charles Goldfarb","startTime":1000.93,"endTime":1002.4,"body":"and ring. That's it."},{"speaker":"Chris Dy","startTime":1002.94,"endTime":1004.71,"body":"Okay. Does it ever"},{"speaker":"Chris Dy","startTime":1002.94,"endTime":1004.71,"body":"vary based on where you're"},{"speaker":"Chris Dy","startTime":1004.71,"endTime":1005.37,"body":"trying to get to?"},{"speaker":"Charles Goldfarb","startTime":1005.67,"endTime":1007.5,"body":"Yeah, I guess"},{"speaker":"Charles Goldfarb","startTime":1005.67,"endTime":1007.5,"body":"if it's more radial sided"},{"speaker":"Charles Goldfarb","startTime":1007.5,"endTime":1009.99,"body":"pathology I might go index and"},{"speaker":"Charles Goldfarb","startTime":1007.5,"endTime":1009.99,"body":"middle. I've never used all"},{"speaker":"Charles Goldfarb","startTime":1009.99,"endTime":1013.05,"body":"four, I don't think it's"},{"speaker":"Charles Goldfarb","startTime":1009.99,"endTime":1013.05,"body":"necessary. So it's two fingers,"},{"speaker":"Charles Goldfarb","startTime":1013.05,"endTime":1016.23,"body":"not more than 12 pounds. been"},{"speaker":"Charles Goldfarb","startTime":1013.05,"endTime":1016.23,"body":"happy with the two central"},{"speaker":"Charles Goldfarb","startTime":1016.23,"endTime":1016.83,"body":"digits."},{"speaker":"Chris Dy","startTime":1017.52,"endTime":1019.71,"body":"I've been told never"},{"speaker":"Chris Dy","startTime":1017.52,"endTime":1019.71,"body":"to commit the sin of drawing"},{"speaker":"Chris Dy","startTime":1019.8,"endTime":1022.53,"body":"your mark landmarks on a patient"},{"speaker":"Chris Dy","startTime":1019.8,"endTime":1022.53,"body":"until your in traction is that"},{"speaker":"Chris Dy","startTime":1022.53,"endTime":1023.04,"body":"correct?"},{"speaker":"Charles Goldfarb","startTime":1023.19,"endTime":1024.15,"body":"Absolutely."},{"speaker":"Chris Dy","startTime":1024.75,"endTime":1025.71,"body":"What do you draw?"},{"speaker":"Charles Goldfarb","startTime":1026.19,"endTime":1029.37,"body":"I depends on"},{"speaker":"Charles Goldfarb","startTime":1026.19,"endTime":1029.37,"body":"who's with me. I draw a"},{"speaker":"Charles Goldfarb","startTime":1029.37,"endTime":1034.47,"body":"transverse almost always three,"},{"speaker":"Charles Goldfarb","startTime":1029.37,"endTime":1034.47,"body":"four portal. And I draw where I"},{"speaker":"Charles Goldfarb","startTime":1034.47,"endTime":1040.02,"body":"expect the six R portal to be"},{"speaker":"Charles Goldfarb","startTime":1034.47,"endTime":1040.02,"body":"although I always confirm that"},{"speaker":"Charles Goldfarb","startTime":1040.02,"endTime":1042.54,"body":"with needle localization prior"},{"speaker":"Charles Goldfarb","startTime":1040.02,"endTime":1042.54,"body":"to making that decision."},{"speaker":"Chris Dy","startTime":1043.62,"endTime":1045.03,"body":"Why transverse for"},{"speaker":"Chris Dy","startTime":1043.62,"endTime":1045.03,"body":"three, four."},{"speaker":"Charles Goldfarb","startTime":1045.33,"endTime":1047.94,"body":"It looks much"},{"speaker":"Charles Goldfarb","startTime":1045.33,"endTime":1047.94,"body":"better postop I don't think it"},{"speaker":"Charles Goldfarb","startTime":1047.94,"endTime":1051.39,"body":"matters, it doesn't matter a"},{"speaker":"Charles Goldfarb","startTime":1047.94,"endTime":1051.39,"body":"darn bit for access. It heals"},{"speaker":"Charles Goldfarb","startTime":1051.39,"endTime":1053.31,"body":"better. It's in Langer's lines,"},{"speaker":"Charles Goldfarb","startTime":1051.39,"endTime":1053.31,"body":"it looks better."},{"speaker":"Chris Dy","startTime":1054.12,"endTime":1057.03,"body":"And then in terms of"},{"speaker":"Chris Dy","startTime":1054.12,"endTime":1057.03,"body":"getting to your mid carpal joint"},{"speaker":"Chris Dy","startTime":1057.03,"endTime":1058.98,"body":"down the line, we'll talk about"},{"speaker":"Chris Dy","startTime":1057.03,"endTime":1058.98,"body":"that in a second. Do you go"},{"speaker":"Chris Dy","startTime":1058.98,"endTime":1061.62,"body":"through the same incision that"},{"speaker":"Chris Dy","startTime":1058.98,"endTime":1061.62,"body":"you've made for three four?"},{"speaker":"Charles Goldfarb","startTime":1061.77,"endTime":1065.28,"body":"Same incision,"},{"speaker":"Charles Goldfarb","startTime":1061.77,"endTime":1065.28,"body":"I take a curved hemostat, small,"},{"speaker":"Charles Goldfarb","startTime":1065.28,"endTime":1068.7,"body":"curved hemostat. And I go a"},{"speaker":"Charles Goldfarb","startTime":1065.28,"endTime":1068.7,"body":"little more ulnar and a little"},{"speaker":"Charles Goldfarb","startTime":1068.7,"endTime":1072.87,"body":"more distally such that I'm in"},{"speaker":"Charles Goldfarb","startTime":1068.7,"endTime":1072.87,"body":"line with the third metacarpal"},{"speaker":"Charles Goldfarb","startTime":1072.99,"endTime":1077.46,"body":"about a centimeter distal to my"},{"speaker":"Charles Goldfarb","startTime":1072.99,"endTime":1077.46,"body":"three, four, joint entry spot."},{"speaker":"Chris Dy","startTime":1078.3,"endTime":1079.2,"body":"Insufflate the joint?"},{"speaker":"Charles Goldfarb","startTime":1079.53,"endTime":1082.38,"body":"No doesn't"},{"speaker":"Charles Goldfarb","startTime":1079.53,"endTime":1082.38,"body":"help. I was taught to do it that"},{"speaker":"Charles Goldfarb","startTime":1082.38,"endTime":1084.45,"body":"way. It doesn't change a darn"},{"speaker":"Charles Goldfarb","startTime":1082.38,"endTime":1084.45,"body":"thing. It doesn't make it"},{"speaker":"Charles Goldfarb","startTime":1084.45,"endTime":1087.96,"body":"easier. It doesn't you don't,"},{"speaker":"Charles Goldfarb","startTime":1084.45,"endTime":1087.96,"body":"you can't put fluid in there"},{"speaker":"Charles Goldfarb","startTime":1087.96,"endTime":1090.57,"body":"that will separate the bones."},{"speaker":"Charles Goldfarb","startTime":1087.96,"endTime":1090.57,"body":"There, you're not there. You're"},{"speaker":"Charles Goldfarb","startTime":1090.57,"endTime":1096.54,"body":"not increasing the joint to"},{"speaker":"Charles Goldfarb","startTime":1090.57,"endTime":1096.54,"body":"nerve or joint artery distance."},{"speaker":"Charles Goldfarb","startTime":1096.6,"endTime":1097.71,"body":"Totally unnecessary."},{"speaker":"Chris Dy","startTime":1098.36,"endTime":1101.72,"body":"I like it because it"},{"speaker":"Chris Dy","startTime":1098.36,"endTime":1101.72,"body":"helps me or the trainee who's"},{"speaker":"Chris Dy","startTime":1101.72,"endTime":1104.24,"body":"establishing the portals"},{"speaker":"Chris Dy","startTime":1101.72,"endTime":1104.24,"body":"understand exactly where we need"},{"speaker":"Chris Dy","startTime":1104.24,"endTime":1108.05,"body":"to go. I recognize that putting"},{"speaker":"Chris Dy","startTime":1104.24,"endTime":1108.05,"body":"in a wrist or arthroscope into"},{"speaker":"Chris Dy","startTime":1108.05,"endTime":1111.35,"body":"three four is kind of like tying"},{"speaker":"Chris Dy","startTime":1108.05,"endTime":1111.35,"body":"your shoes for you. But for the"},{"speaker":"Chris Dy","startTime":1111.35,"endTime":1113.99,"body":"rest of us. We like to have a"},{"speaker":"Chris Dy","startTime":1111.35,"endTime":1113.99,"body":"little guidance."},{"speaker":"Charles Goldfarb","startTime":1114.17,"endTime":1116.73,"body":"Oh my god,"},{"speaker":"Charles Goldfarb","startTime":1114.17,"endTime":1116.73,"body":"it's totally unnecessary. Yeah,"},{"speaker":"Charles Goldfarb","startTime":1116.791,"endTime":1120.389,"body":"no, no, no problem. I mean,"},{"speaker":"Charles Goldfarb","startTime":1116.791,"endTime":1120.389,"body":"unless you're a dry scoper like"},{"speaker":"Charles Goldfarb","startTime":1120.45,"endTime":1124.291,"body":"some of our friends are but no,"},{"speaker":"Charles Goldfarb","startTime":1120.45,"endTime":1124.291,"body":"no problem at all. I just don't"},{"speaker":"Charles Goldfarb","startTime":1124.352,"endTime":1125.45,"body":"think it helps me."},{"speaker":"Chris Dy","startTime":1126.05,"endTime":1129.125,"body":"Okay, so take me"},{"speaker":"Chris Dy","startTime":1126.05,"endTime":1129.125,"body":"through exactly how that how"},{"speaker":"Chris Dy","startTime":1129.193,"endTime":1133.43,"body":"you're establishing the portal"},{"speaker":"Chris Dy","startTime":1129.193,"endTime":1133.43,"body":"like every nitty gritty detail."},{"speaker":"Charles Goldfarb","startTime":1133.94,"endTime":1136.494,"body":"Skin incision,"},{"speaker":"Charles Goldfarb","startTime":1133.94,"endTime":1136.494,"body":"transverse to the dermis and"},{"speaker":"Charles Goldfarb","startTime":1136.553,"endTime":1140.296,"body":"epidermis only. Blunt dissection"},{"speaker":"Charles Goldfarb","startTime":1136.553,"endTime":1140.296,"body":"down to the dorsal distal rim,"},{"speaker":"Charles Goldfarb","startTime":1140.355,"endTime":1143.801,"body":"or the distal dorsal rim of the"},{"speaker":"Charles Goldfarb","startTime":1140.355,"endTime":1143.801,"body":"radius. And then using the"},{"speaker":"Charles Goldfarb","startTime":1143.86,"endTime":1147.306,"body":"curvature of the hemostat I pop"},{"speaker":"Charles Goldfarb","startTime":1143.86,"endTime":1147.306,"body":"over and into the joint, I"},{"speaker":"Charles Goldfarb","startTime":1147.365,"endTime":1151.048,"body":"spread reasonably aggressive."},{"speaker":"Charles Goldfarb","startTime":1147.365,"endTime":1151.048,"body":"You don't want your portal being"},{"speaker":"Charles Goldfarb","startTime":1151.108,"endTime":1154.672,"body":"huge, because then the scope"},{"speaker":"Charles Goldfarb","startTime":1151.108,"endTime":1154.672,"body":"will just slide in and out. And"},{"speaker":"Charles Goldfarb","startTime":1154.731,"endTime":1158.296,"body":"that's not stable. But you also"},{"speaker":"Charles Goldfarb","startTime":1154.731,"endTime":1158.296,"body":"don't want to struggle every"},{"speaker":"Charles Goldfarb","startTime":1158.355,"endTime":1160.91,"body":"time you you choose to pull your"},{"speaker":"Charles Goldfarb","startTime":1158.355,"endTime":1160.91,"body":"scope out."},{"speaker":"Chris Dy","startTime":1161.72,"endTime":1164.57,"body":"For the for the former"},{"speaker":"Chris Dy","startTime":1161.72,"endTime":1164.57,"body":"Gelberman trainees Is this the"},{"speaker":"Chris Dy","startTime":1164.624,"endTime":1168.55,"body":"Gelberman, like a person spread"},{"speaker":"Chris Dy","startTime":1164.624,"endTime":1168.55,"body":"or is this. Where is it on that spectrum?"},{"speaker":"Charles Goldfarb","startTime":1169.09,"endTime":1172.325,"body":"Yeah, if a 10"},{"speaker":"Charles Goldfarb","startTime":1169.09,"endTime":1172.325,"body":"is like your biggest spread"},{"speaker":"Charles Goldfarb","startTime":1172.404,"endTime":1174.14,"body":"ever, this is a seven."},{"speaker":"Chris Dy","startTime":1174.14,"endTime":1174.77,"body":"Okay, got it."},{"speaker":"Charles Goldfarb","startTime":1174.77,"endTime":1177.07,"body":"Yeah, so good,"},{"speaker":"Charles Goldfarb","startTime":1174.77,"endTime":1177.07,"body":"but not great one. And then I"},{"speaker":"Charles Goldfarb","startTime":1177.122,"endTime":1180.363,"body":"proceed with a assuming I can"},{"speaker":"Charles Goldfarb","startTime":1177.122,"endTime":1180.363,"body":"see and there's not too many air"},{"speaker":"Charles Goldfarb","startTime":1180.415,"endTime":1183.447,"body":"bubbles or just things that are"},{"speaker":"Charles Goldfarb","startTime":1180.415,"endTime":1183.447,"body":"irritants. I start with my"},{"speaker":"Charles Goldfarb","startTime":1183.5,"endTime":1186.584,"body":"diagnostic arthroscopy, which I"},{"speaker":"Charles Goldfarb","startTime":1183.5,"endTime":1186.584,"body":"do the same way every time,"},{"speaker":"Charles Goldfarb","startTime":1186.636,"endTime":1188.78,"body":"which I can talk through if it's"},{"speaker":"Charles Goldfarb","startTime":1186.636,"endTime":1188.78,"body":"helpful."},{"speaker":"Chris Dy","startTime":1188.8,"endTime":1190.79,"body":"Yeah, let's do it, so"},{"speaker":"Chris Dy","startTime":1188.8,"endTime":1190.79,"body":"same way every time."},{"speaker":"Charles Goldfarb","startTime":1190.97,"endTime":1194.0,"body":"Yep. So you're"},{"speaker":"Charles Goldfarb","startTime":1190.97,"endTime":1194.0,"body":"looking right at the membranous"},{"speaker":"Charles Goldfarb","startTime":1194.066,"endTime":1198.15,"body":"portion of the SL ligament and"},{"speaker":"Charles Goldfarb","startTime":1194.066,"endTime":1198.15,"body":"the ligament of Testut volarly,"},{"speaker":"Charles Goldfarb","startTime":1198.216,"endTime":1202.3,"body":"when you look radially you're"},{"speaker":"Charles Goldfarb","startTime":1198.216,"endTime":1202.3,"body":"looking at the scaphoid facet of"},{"speaker":"Charles Goldfarb","startTime":1202.366,"endTime":1206.252,"body":"the distal radius, and the"},{"speaker":"Charles Goldfarb","startTime":1202.366,"endTime":1206.252,"body":"proximal and a little bit of the"},{"speaker":"Charles Goldfarb","startTime":1206.318,"endTime":1210.468,"body":"proximal waist of the scaphoid."},{"speaker":"Charles Goldfarb","startTime":1206.318,"endTime":1210.468,"body":"You can see a little bit of the"},{"speaker":"Charles Goldfarb","startTime":1210.534,"endTime":1214.025,"body":"styloid. And then most"},{"speaker":"Charles Goldfarb","startTime":1210.534,"endTime":1214.025,"body":"importantly, I like to confirm"},{"speaker":"Charles Goldfarb","startTime":1214.091,"endTime":1218.373,"body":"the radioscaphocapitate and long"},{"speaker":"Charles Goldfarb","startTime":1214.091,"endTime":1218.373,"body":"radial lunate ligaments. So from"},{"speaker":"Charles Goldfarb","startTime":1218.439,"endTime":1222.391,"body":"volar radial heading centrally,"},{"speaker":"Charles Goldfarb","startTime":1218.439,"endTime":1222.391,"body":"short radial lunate ligament"},{"speaker":"Charles Goldfarb","startTime":1222.457,"endTime":1226.014,"body":"also visible essentially"},{"speaker":"Charles Goldfarb","startTime":1222.457,"endTime":1226.014,"body":"straight ahead. I always pull"},{"speaker":"Charles Goldfarb","startTime":1226.08,"endTime":1230.164,"body":"the scope back, drop my hand, so"},{"speaker":"Charles Goldfarb","startTime":1226.08,"endTime":1230.164,"body":"I'm looking up. So I'm seeing"},{"speaker":"Charles Goldfarb","startTime":1230.23,"endTime":1234.315,"body":"the dorsal SL, which is perhaps"},{"speaker":"Charles Goldfarb","startTime":1230.23,"endTime":1234.315,"body":"the most important ligament on"},{"speaker":"Charles Goldfarb","startTime":1234.38,"endTime":1238.333,"body":"the radial side. If all that"},{"speaker":"Charles Goldfarb","startTime":1234.38,"endTime":1238.333,"body":"looks good, I move ulnarly. And"},{"speaker":"Charles Goldfarb","startTime":1238.399,"endTime":1242.219,"body":"then I'm looking at the proximal"},{"speaker":"Charles Goldfarb","startTime":1238.399,"endTime":1242.219,"body":"aspect of the lunate. I'm"},{"speaker":"Charles Goldfarb","startTime":1242.285,"endTime":1245.974,"body":"looking at the lunate facet of"},{"speaker":"Charles Goldfarb","startTime":1242.285,"endTime":1245.974,"body":"the distal radius and I'm"},{"speaker":"Charles Goldfarb","startTime":1246.04,"endTime":1250.124,"body":"heading over towards the gold"},{"speaker":"Charles Goldfarb","startTime":1246.04,"endTime":1250.124,"body":"which is the ulnar wrist and the"},{"speaker":"Charles Goldfarb","startTime":1250.19,"endTime":1250.52,"body":"TFCC."},{"speaker":"Chris Dy","startTime":1251.36,"endTime":1254.27,"body":"Is there anything"},{"speaker":"Chris Dy","startTime":1251.36,"endTime":1254.27,"body":"you're doing on the radial side"},{"speaker":"Chris Dy","startTime":1254.27,"endTime":1256.76,"body":"before you establish portal on"},{"speaker":"Chris Dy","startTime":1254.27,"endTime":1256.76,"body":"the other side?"},{"speaker":"Charles Goldfarb","startTime":1258.17,"endTime":1261.05,"body":"Other than"},{"speaker":"Charles Goldfarb","startTime":1258.17,"endTime":1261.05,"body":"just making you know, assuming"},{"speaker":"Charles Goldfarb","startTime":1261.05,"endTime":1263.87,"body":"we're dealing with owner said"},{"speaker":"Charles Goldfarb","startTime":1261.05,"endTime":1263.87,"body":"risky No, I'm just just taking a"},{"speaker":"Charles Goldfarb","startTime":1263.87,"endTime":1266.93,"body":"look to make sure I'm not"},{"speaker":"Charles Goldfarb","startTime":1263.87,"endTime":1266.93,"body":"missing anything. If I do see"},{"speaker":"Charles Goldfarb","startTime":1266.93,"endTime":1269.3,"body":"significant synovitis or"},{"speaker":"Charles Goldfarb","startTime":1266.93,"endTime":1269.3,"body":"something like that. I want to"},{"speaker":"Charles Goldfarb","startTime":1269.3,"endTime":1273.41,"body":"know why because that's pretty"},{"speaker":"Charles Goldfarb","startTime":1269.3,"endTime":1273.41,"body":"uncommon. But otherwise I just"},{"speaker":"Charles Goldfarb","startTime":1274.28,"endTime":1277.88,"body":"move move to establish my six"},{"speaker":"Charles Goldfarb","startTime":1274.28,"endTime":1277.88,"body":"our portal with Anita"},{"speaker":"Charles Goldfarb","startTime":1277.88,"endTime":1281.33,"body":"localization, incision blunt"},{"speaker":"Charles Goldfarb","startTime":1277.88,"endTime":1281.33,"body":"dissection, placement of my"},{"speaker":"Charles Goldfarb","startTime":1281.33,"endTime":1282.17,"body":"shaver in the joint."},{"speaker":"Chris Dy","startTime":1283.19,"endTime":1287.9,"body":"Okay, so you've got"},{"speaker":"Chris Dy","startTime":1283.19,"endTime":1287.9,"body":"your shaver in the joint now. Do"},{"speaker":"Chris Dy","startTime":1287.9,"endTime":1292.1,"body":"you? Let's say you are wet"},{"speaker":"Chris Dy","startTime":1287.9,"endTime":1292.1,"body":"arthroscopy, so no dry"},{"speaker":"Chris Dy","startTime":1292.1,"endTime":1294.8,"body":"arthroscopy, because you don't"},{"speaker":"Chris Dy","startTime":1292.1,"endTime":1294.8,"body":"want to burn in Blaze, anything"},{"speaker":"Chris Dy","startTime":1294.8,"endTime":1298.28,"body":"that doesn't need to be handled"},{"speaker":"Chris Dy","startTime":1294.8,"endTime":1298.28,"body":"as such. You know, when you're"},{"speaker":"Chris Dy","startTime":1298.28,"endTime":1302.09,"body":"looking at this, are you using"},{"speaker":"Chris Dy","startTime":1298.28,"endTime":1302.09,"body":"your shaver to assess things"},{"speaker":"Chris Dy","startTime":1302.09,"endTime":1304.28,"body":"like the TFCC are using a probe?"},{"speaker":"Charles Goldfarb","startTime":1305.09,"endTime":1307.01,"body":"I think you"},{"speaker":"Charles Goldfarb","startTime":1305.09,"endTime":1307.01,"body":"could do either, I'm actually"},{"speaker":"Charles Goldfarb","startTime":1307.01,"endTime":1311.03,"body":"been using a probe more, it"},{"speaker":"Charles Goldfarb","startTime":1307.01,"endTime":1311.03,"body":"really does give you a better"},{"speaker":"Charles Goldfarb","startTime":1311.03,"endTime":1315.71,"body":"sense of stability. So when I"},{"speaker":"Charles Goldfarb","startTime":1311.03,"endTime":1315.71,"body":"look at the TFCC, I start with a"},{"speaker":"Charles Goldfarb","startTime":1315.71,"endTime":1320.33,"body":"trampoline sign. And this is one"},{"speaker":"Charles Goldfarb","startTime":1315.71,"endTime":1320.33,"body":"of those tests where you need to"},{"speaker":"Charles Goldfarb","startTime":1320.33,"endTime":1323.33,"body":"establish your own personal"},{"speaker":"Charles Goldfarb","startTime":1320.33,"endTime":1323.33,"body":"parameters of what's normal,"},{"speaker":"Charles Goldfarb","startTime":1323.33,"endTime":1327.17,"body":"what's not normal. Really the"},{"speaker":"Charles Goldfarb","startTime":1323.33,"endTime":1327.17,"body":"TFCC should be like a military"},{"speaker":"Charles Goldfarb","startTime":1327.17,"endTime":1333.08,"body":"made bed, really taught intense"},{"speaker":"Charles Goldfarb","startTime":1327.17,"endTime":1333.08,"body":"without laxity. If there is"},{"speaker":"Charles Goldfarb","startTime":1333.08,"endTime":1333.8,"body":"laxity doesn't"},{"speaker":"Chris Dy","startTime":1333.8,"endTime":1335.57,"body":"like a trainee on"},{"speaker":"Chris Dy","startTime":1333.8,"endTime":1335.57,"body":"their first day of the Goldfarb"},{"speaker":"Chris Dy","startTime":1335.57,"endTime":1336.05,"body":"rotation,"},{"speaker":"Charles Goldfarb","startTime":1337.34,"endTime":1338.66,"body":"the laid back"},{"speaker":"Charles Goldfarb","startTime":1337.34,"endTime":1338.66,"body":"Goldfarb road"},{"speaker":"Chris Dy","startTime":1338.99,"endTime":1342.02,"body":"Oh, yeah, sure. A"},{"speaker":"Chris Dy","startTime":1338.99,"endTime":1342.02,"body":"stranger at the golf our"},{"speaker":"Chris Dy","startTime":1342.02,"endTime":1343.22,"body":"rotation of seven years ago."},{"speaker":"Charles Goldfarb","startTime":1344.09,"endTime":1347.69,"body":"The Yeah, so"},{"speaker":"Charles Goldfarb","startTime":1344.09,"endTime":1347.69,"body":"you're if you have laxity when"},{"speaker":"Charles Goldfarb","startTime":1347.69,"endTime":1350.9,"body":"you do the trampoline test. So"},{"speaker":"Charles Goldfarb","startTime":1347.69,"endTime":1350.9,"body":"you're bouncing your your"},{"speaker":"Charles Goldfarb","startTime":1351.86,"endTime":1354.53,"body":"instrument on the on the TFCC."},{"speaker":"Charles Goldfarb","startTime":1351.86,"endTime":1354.53,"body":"You don't necessarily know"},{"speaker":"Charles Goldfarb","startTime":1354.53,"endTime":1357.29,"body":"what's going on, but you know"},{"speaker":"Charles Goldfarb","startTime":1354.53,"endTime":1357.29,"body":"something's not right. And that"},{"speaker":"Charles Goldfarb","startTime":1357.29,"endTime":1359.42,"body":"can be a central tear. That"},{"speaker":"Charles Goldfarb","startTime":1357.29,"endTime":1359.42,"body":"could be a peripheral tear, that"},{"speaker":"Charles Goldfarb","startTime":1359.42,"endTime":1362.33,"body":"could be a subsurface or phobias"},{"speaker":"Charles Goldfarb","startTime":1359.42,"endTime":1362.33,"body":"there. But you know, something's"},{"speaker":"Charles Goldfarb","startTime":1362.33,"endTime":1365.15,"body":"not right. So I do that."},{"speaker":"Chris Dy","startTime":1366.53,"endTime":1370.46,"body":"They're all trampoline"},{"speaker":"Chris Dy","startTime":1366.53,"endTime":1370.46,"body":"tests. Do. Is there anything? Is"},{"speaker":"Chris Dy","startTime":1370.46,"endTime":1372.8,"body":"there any sort of internal"},{"speaker":"Chris Dy","startTime":1370.46,"endTime":1372.8,"body":"control? Is there any other"},{"speaker":"Chris Dy","startTime":1372.8,"endTime":1375.86,"body":"tissue in there that you can"},{"speaker":"Chris Dy","startTime":1372.8,"endTime":1375.86,"body":"push on to give you a good"},{"speaker":"Chris Dy","startTime":1375.86,"endTime":1376.43,"body":"sense?"},{"speaker":"Charles Goldfarb","startTime":1377.0,"endTime":1380.45,"body":"No, I really"},{"speaker":"Charles Goldfarb","startTime":1377.0,"endTime":1380.45,"body":"don't think there is. So it is"},{"speaker":"Charles Goldfarb","startTime":1380.45,"endTime":1384.47,"body":"it is, you know, and there's age"},{"speaker":"Charles Goldfarb","startTime":1380.45,"endTime":1384.47,"body":"related degradation, I would say"},{"speaker":"Charles Goldfarb","startTime":1384.47,"endTime":1386.45,"body":"and there's different changes"},{"speaker":"Charles Goldfarb","startTime":1384.47,"endTime":1386.45,"body":"over time, but now."},{"speaker":"Chris Dy","startTime":1387.35,"endTime":1389.84,"body":"Okay. All right. Then"},{"speaker":"Chris Dy","startTime":1387.35,"endTime":1389.84,"body":"what else? What else do you use"},{"speaker":"Chris Dy","startTime":1389.84,"endTime":1391.34,"body":"to assess? Well, there's"},{"speaker":"Charles Goldfarb","startTime":1391.34,"endTime":1393.71,"body":"always"},{"speaker":"Charles Goldfarb","startTime":1391.34,"endTime":1393.71,"body":"synovitis on the owner side of"},{"speaker":"Charles Goldfarb","startTime":1393.71,"endTime":1396.02,"body":"the wrist, and especially in the"},{"speaker":"Charles Goldfarb","startTime":1393.71,"endTime":1396.02,"body":"freestyle, it resets the"},{"speaker":"Charles Goldfarb","startTime":1396.02,"endTime":1399.77,"body":"freestyle recess is essentially"},{"speaker":"Charles Goldfarb","startTime":1396.02,"endTime":1399.77,"body":"do owner. There's always"},{"speaker":"Charles Goldfarb","startTime":1399.77,"endTime":1402.41,"body":"synovitis there because I think"},{"speaker":"Charles Goldfarb","startTime":1399.77,"endTime":1402.41,"body":"that's what's contributing to"},{"speaker":"Charles Goldfarb","startTime":1402.47,"endTime":1405.17,"body":"your pain. You know, the"},{"speaker":"Charles Goldfarb","startTime":1402.47,"endTime":1405.17,"body":"synovitis develops because of"},{"speaker":"Charles Goldfarb","startTime":1405.17,"endTime":1408.86,"body":"pathology and incentivizes what"},{"speaker":"Charles Goldfarb","startTime":1405.17,"endTime":1408.86,"body":"I believe is causing the pain"},{"speaker":"Charles Goldfarb","startTime":1408.92,"endTime":1411.59,"body":"and incentivizes what I believe"},{"speaker":"Charles Goldfarb","startTime":1408.92,"endTime":1411.59,"body":"the corticosteroid injection"},{"speaker":"Charles Goldfarb","startTime":1411.59,"endTime":1415.49,"body":"takes away and then by the time"},{"speaker":"Charles Goldfarb","startTime":1411.59,"endTime":1415.49,"body":"you're back in the or it's back."},{"speaker":"Charles Goldfarb","startTime":1415.49,"endTime":1417.95,"body":"So you bring it and then you're"},{"speaker":"Charles Goldfarb","startTime":1415.49,"endTime":1417.95,"body":"really looking for what's going"},{"speaker":"Charles Goldfarb","startTime":1417.95,"endTime":1421.13,"body":"on and so you can look vulgarly"},{"speaker":"Charles Goldfarb","startTime":1417.95,"endTime":1421.13,"body":"and what you're looking for"},{"speaker":"Charles Goldfarb","startTime":1421.13,"endTime":1425.0,"body":"Volvo is a good understanding of"},{"speaker":"Charles Goldfarb","startTime":1421.13,"endTime":1425.0,"body":"the owner to control and own the"},{"speaker":"Charles Goldfarb","startTime":1425.0,"endTime":1428.15,"body":"loonie ligaments. And if you're"},{"speaker":"Charles Goldfarb","startTime":1425.0,"endTime":1428.15,"body":"one who believes the male"},{"speaker":"Charles Goldfarb","startTime":1428.15,"endTime":1431.15,"body":"experience, there can be a split"},{"speaker":"Charles Goldfarb","startTime":1428.15,"endTime":1431.15,"body":"tear between those two ligaments"},{"speaker":"Charles Goldfarb","startTime":1431.15,"endTime":1435.02,"body":"i i don't see that often. But I"},{"speaker":"Charles Goldfarb","startTime":1431.15,"endTime":1435.02,"body":"trust the people who report it"},{"speaker":"Charles Goldfarb","startTime":1435.41,"endTime":1437.75,"body":"sounds good car believes"},{"speaker":"Charles Goldfarb","startTime":1435.41,"endTime":1437.75,"body":"strongly. That's a commonly"},{"speaker":"Charles Goldfarb","startTime":1437.75,"endTime":1441.23,"body":"missed diagnosis. So always look"},{"speaker":"Charles Goldfarb","startTime":1437.75,"endTime":1441.23,"body":"for it. And you're getting"},{"speaker":"Charles Goldfarb","startTime":1441.23,"endTime":1443.93,"body":"you're using your probe you're"},{"speaker":"Charles Goldfarb","startTime":1441.23,"endTime":1443.93,"body":"using your kind of historical"},{"speaker":"Charles Goldfarb","startTime":1443.93,"endTime":1448.37,"body":"context to see if there's"},{"speaker":"Charles Goldfarb","startTime":1443.93,"endTime":1448.37,"body":"pathology, inflammation, volere"},{"speaker":"Charles Goldfarb","startTime":1448.37,"endTime":1453.89,"body":"and owner. We're looking door so"},{"speaker":"Charles Goldfarb","startTime":1448.37,"endTime":1453.89,"body":"an owner right under the ECU"},{"speaker":"Charles Goldfarb","startTime":1453.89,"endTime":1457.13,"body":"tendon, so it's pretty uncommon"},{"speaker":"Charles Goldfarb","startTime":1453.89,"endTime":1457.13,"body":"to have a straight owner tear,"},{"speaker":"Charles Goldfarb","startTime":1457.13,"endTime":1460.19,"body":"most of the tears are really"},{"speaker":"Charles Goldfarb","startTime":1457.13,"endTime":1460.19,"body":"dorsal and owner and you're"},{"speaker":"Charles Goldfarb","startTime":1460.19,"endTime":1464.21,"body":"looking for a separation between"},{"speaker":"Charles Goldfarb","startTime":1460.19,"endTime":1464.21,"body":"the TFCC and the dorsal capsule,"},{"speaker":"Charles Goldfarb","startTime":1464.57,"endTime":1468.77,"body":"and sometimes that can scar in"},{"speaker":"Charles Goldfarb","startTime":1464.57,"endTime":1468.77,"body":"and so the tissue may not look"},{"speaker":"Charles Goldfarb","startTime":1468.77,"endTime":1471.92,"body":"completely normal. You may put"},{"speaker":"Charles Goldfarb","startTime":1468.77,"endTime":1471.92,"body":"your shaver in that area, it's"},{"speaker":"Charles Goldfarb","startTime":1471.92,"endTime":1475.46,"body":"really hard to injure the TFCC"},{"speaker":"Charles Goldfarb","startTime":1471.92,"endTime":1475.46,"body":"with a shaver and so I'm okay"},{"speaker":"Charles Goldfarb","startTime":1475.46,"endTime":1479.96,"body":"trying to clean that area up and"},{"speaker":"Charles Goldfarb","startTime":1475.46,"endTime":1479.96,"body":"see if there's a tear. Central"},{"speaker":"Charles Goldfarb","startTime":1479.96,"endTime":1483.89,"body":"tears or radio sided tears are"},{"speaker":"Charles Goldfarb","startTime":1479.96,"endTime":1483.89,"body":"usually obvious, but you need to"},{"speaker":"Charles Goldfarb","startTime":1483.89,"endTime":1487.31,"body":"make sure you don't miss one."},{"speaker":"Charles Goldfarb","startTime":1483.89,"endTime":1487.31,"body":"And if there is a tear in either"},{"speaker":"Charles Goldfarb","startTime":1487.31,"endTime":1491.48,"body":"of those locations, presumably"},{"speaker":"Charles Goldfarb","startTime":1487.31,"endTime":1491.48,"body":"the dorsal part of the TFCC and"},{"speaker":"Charles Goldfarb","startTime":1491.48,"endTime":1495.68,"body":"the volar. Part of the TFC are"},{"speaker":"Charles Goldfarb","startTime":1491.48,"endTime":1495.68,"body":"okay so you do breed those with"},{"speaker":"Charles Goldfarb","startTime":1495.68,"endTime":1498.92,"body":"a shaver with a biter and you"},{"speaker":"Charles Goldfarb","startTime":1495.68,"endTime":1498.92,"body":"want to just try to stabilize"},{"speaker":"Charles Goldfarb","startTime":1498.92,"endTime":1502.37,"body":"them so that there's less kind"},{"speaker":"Charles Goldfarb","startTime":1498.92,"endTime":1502.37,"body":"of wiggliness or rubbing,"},{"speaker":"Charles Goldfarb","startTime":1502.49,"endTime":1505.16,"body":"because I do think that can"},{"speaker":"Charles Goldfarb","startTime":1502.49,"endTime":1505.16,"body":"contribute to pain. You don't"},{"speaker":"Charles Goldfarb","startTime":1505.16,"endTime":1507.65,"body":"stitch a central tear because"},{"speaker":"Charles Goldfarb","startTime":1505.16,"endTime":1507.65,"body":"there's no blood supply, it"},{"speaker":"Charles Goldfarb","startTime":1507.65,"endTime":1511.49,"body":"won't heal radial sided tears,"},{"speaker":"Charles Goldfarb","startTime":1507.65,"endTime":1511.49,"body":"almost no one repairs them"},{"speaker":"Charles Goldfarb","startTime":1511.49,"endTime":1514.25,"body":"because there's no need to and"},{"speaker":"Charles Goldfarb","startTime":1511.49,"endTime":1514.25,"body":"it's actually pretty tricky to"},{"speaker":"Charles Goldfarb","startTime":1514.25,"endTime":1514.7,"body":"do. So."},{"speaker":"Chris Dy","startTime":1515.66,"endTime":1517.97,"body":"That's the longest and"},{"speaker":"Chris Dy","startTime":1515.66,"endTime":1517.97,"body":"most passionately you've ever"},{"speaker":"Chris Dy","startTime":1517.97,"endTime":1521.3,"body":"talked on the podcast in almost"},{"speaker":"Chris Dy","startTime":1517.97,"endTime":1521.3,"body":"two years, we've been doing"},{"speaker":"Chris Dy","startTime":1521.3,"endTime":1521.63,"body":"this."},{"speaker":"Charles Goldfarb","startTime":1522.23,"endTime":1524.6,"body":"I'm just"},{"speaker":"Charles Goldfarb","startTime":1522.23,"endTime":1524.6,"body":"getting started. So so"},{"speaker":"Chris Dy","startTime":1524.63,"endTime":1528.35,"body":"how do you how do you"},{"speaker":"Chris Dy","startTime":1524.63,"endTime":1528.35,"body":"assess you published on this the"},{"speaker":"Chris Dy","startTime":1528.35,"endTime":1531.17,"body":"hook the hook test? Like tell me"},{"speaker":"Chris Dy","startTime":1528.35,"endTime":1531.17,"body":"what that how that plays into"},{"speaker":"Chris Dy","startTime":1531.17,"endTime":1533.39,"body":"your algorithm here? And I'll"},{"speaker":"Chris Dy","startTime":1531.17,"endTime":1533.39,"body":"describe it first."},{"speaker":"Charles Goldfarb","startTime":1533.72,"endTime":1535.25,"body":"Yeah, so I'll"},{"speaker":"Charles Goldfarb","startTime":1533.72,"endTime":1535.25,"body":"describe it, then I'll give you"},{"speaker":"Charles Goldfarb","startTime":1535.25,"endTime":1540.08,"body":"my my two cents. So trying to"},{"speaker":"Charles Goldfarb","startTime":1535.25,"endTime":1540.08,"body":"understand whether whether or"},{"speaker":"Charles Goldfarb","startTime":1540.08,"endTime":1544.7,"body":"not there's a subsurface tear of"},{"speaker":"Charles Goldfarb","startTime":1540.08,"endTime":1544.7,"body":"the TFC is tricky. Some would"},{"speaker":"Charles Goldfarb","startTime":1544.7,"endTime":1547.88,"body":"advocate a D or uj. arthroscopy,"},{"speaker":"Charles Goldfarb","startTime":1544.7,"endTime":1547.88,"body":"I think that's really hard to do"},{"speaker":"Charles Goldfarb","startTime":1547.88,"endTime":1551.9,"body":"and visualize well, some would"},{"speaker":"Charles Goldfarb","startTime":1547.88,"endTime":1551.9,"body":"advocate a straight owner like a"},{"speaker":"Charles Goldfarb","startTime":1551.9,"endTime":1555.2,"body":"six you portal, which has its"},{"speaker":"Charles Goldfarb","startTime":1551.9,"endTime":1555.2,"body":"own risk of nerve methodology or"},{"speaker":"Charles Goldfarb","startTime":1555.2,"endTime":1558.5,"body":"nerve injury. But I think a hook"},{"speaker":"Charles Goldfarb","startTime":1555.2,"endTime":1558.5,"body":"test is really great. So the"},{"speaker":"Charles Goldfarb","startTime":1558.5,"endTime":1560.96,"body":"hook test is basically your"},{"speaker":"Charles Goldfarb","startTime":1558.5,"endTime":1560.96,"body":"probe goes in the six, our"},{"speaker":"Charles Goldfarb","startTime":1560.96,"endTime":1564.17,"body":"portal, and you're trying to get"},{"speaker":"Charles Goldfarb","startTime":1560.96,"endTime":1564.17,"body":"a hook underneath the owner side"},{"speaker":"Charles Goldfarb","startTime":1564.17,"endTime":1568.01,"body":"of the TFCC. And if there is not"},{"speaker":"Charles Goldfarb","startTime":1564.17,"endTime":1568.01,"body":"a phobia attachment, you can"},{"speaker":"Charles Goldfarb","startTime":1568.01,"endTime":1571.97,"body":"lift the TFCC up. And again,"},{"speaker":"Charles Goldfarb","startTime":1568.01,"endTime":1571.97,"body":"it's a test based on your"},{"speaker":"Charles Goldfarb","startTime":1571.97,"endTime":1576.65,"body":"experience. But you can, you"},{"speaker":"Charles Goldfarb","startTime":1571.97,"endTime":1576.65,"body":"know, make that diagnosis. The"},{"speaker":"Charles Goldfarb","startTime":1576.65,"endTime":1580.16,"body":"suction test is also an"},{"speaker":"Charles Goldfarb","startTime":1576.65,"endTime":1580.16,"body":"interesting one, it's not always"},{"speaker":"Charles Goldfarb","startTime":1580.16,"endTime":1583.55,"body":"positive, even if there is"},{"speaker":"Charles Goldfarb","startTime":1580.16,"endTime":1583.55,"body":"likely a phobia tear. But if you"},{"speaker":"Charles Goldfarb","startTime":1583.55,"endTime":1587.51,"body":"put the shaver in and turn on"},{"speaker":"Charles Goldfarb","startTime":1583.55,"endTime":1587.51,"body":"the suction and the whole TFCC"},{"speaker":"Charles Goldfarb","startTime":1587.51,"endTime":1591.47,"body":"rises, then there's nothing,"},{"speaker":"Charles Goldfarb","startTime":1587.51,"endTime":1591.47,"body":"keeping it down to the all"},{"speaker":"Charles Goldfarb","startTime":1591.47,"endTime":1596.0,"body":"night. And that's a clear"},{"speaker":"Charles Goldfarb","startTime":1591.47,"endTime":1596.0,"body":"positive sign of a filial tear."},{"speaker":"Chris Dy","startTime":1597.05,"endTime":1598.97,"body":"Before I get to my"},{"speaker":"Chris Dy","startTime":1597.05,"endTime":1598.97,"body":"next question, we asked you how"},{"speaker":"Chris Dy","startTime":1599.03,"endTime":1601.49,"body":"when you're doing your normal"},{"speaker":"Chris Dy","startTime":1599.03,"endTime":1601.49,"body":"scope, how much suction do you"},{"speaker":"Chris Dy","startTime":1601.49,"endTime":1605.0,"body":"have on do you ever have suction"},{"speaker":"Chris Dy","startTime":1601.49,"endTime":1605.0,"body":"on I mean, is it just a small"},{"speaker":"Chris Dy","startTime":1605.0,"endTime":1606.8,"body":"bit, the full suction the whole"},{"speaker":"Chris Dy","startTime":1605.0,"endTime":1606.8,"body":"time."},{"speaker":"Charles Goldfarb","startTime":1606.98,"endTime":1610.07,"body":"So I turn"},{"speaker":"Charles Goldfarb","startTime":1606.98,"endTime":1610.07,"body":"suction on whenever I shave, and"},{"speaker":"Charles Goldfarb","startTime":1610.07,"endTime":1613.73,"body":"I use the suction install, I"},{"speaker":"Charles Goldfarb","startTime":1610.07,"endTime":1613.73,"body":"turn on maximum. And I use it to"},{"speaker":"Charles Goldfarb","startTime":1613.73,"endTime":1618.23,"body":"bring the tissue that needs to"},{"speaker":"Charles Goldfarb","startTime":1613.73,"endTime":1618.23,"body":"be to Brita to the shaver. And"},{"speaker":"Charles Goldfarb","startTime":1618.23,"endTime":1620.09,"body":"then I use it for this and"},{"speaker":"Charles Goldfarb","startTime":1618.23,"endTime":1620.09,"body":"otherwise I don't use it."},{"speaker":"Chris Dy","startTime":1620.99,"endTime":1624.56,"body":"So what's the"},{"speaker":"Chris Dy","startTime":1620.99,"endTime":1624.56,"body":"importance of a subsurface"},{"speaker":"Chris Dy","startTime":1624.62,"endTime":1625.73,"body":"foveal? Tear?"},{"speaker":"Charles Goldfarb","startTime":1626.42,"endTime":1629.09,"body":"I'll start by"},{"speaker":"Charles Goldfarb","startTime":1626.42,"endTime":1629.09,"body":"saying the first 10 years of my"},{"speaker":"Charles Goldfarb","startTime":1629.09,"endTime":1635.36,"body":"practice, I wasn't aware. And I"},{"speaker":"Charles Goldfarb","startTime":1629.09,"endTime":1635.36,"body":"would say most or all of us"},{"speaker":"Charles Goldfarb","startTime":1635.36,"endTime":1639.77,"body":"weren't aware that that was a"},{"speaker":"Charles Goldfarb","startTime":1635.36,"endTime":1639.77,"body":"real entity. Except for in"},{"speaker":"Charles Goldfarb","startTime":1639.77,"endTime":1643.25,"body":"massive traumas and things like"},{"speaker":"Charles Goldfarb","startTime":1639.77,"endTime":1643.25,"body":"that. And if you can't see it,"},{"speaker":"Charles Goldfarb","startTime":1643.61,"endTime":1647.12,"body":"you know, we didn't fix it. So I"},{"speaker":"Charles Goldfarb","startTime":1643.61,"endTime":1647.12,"body":"was never taught to fix it. I"},{"speaker":"Charles Goldfarb","startTime":1647.12,"endTime":1651.74,"body":"don't know how many fovea tears"},{"speaker":"Charles Goldfarb","startTime":1647.12,"endTime":1651.74,"body":"I may have missed. I gradually"},{"speaker":"Charles Goldfarb","startTime":1651.74,"endTime":1655.67,"body":"became aware and learn to"},{"speaker":"Charles Goldfarb","startTime":1651.74,"endTime":1655.67,"body":"recognize these tears over the"},{"speaker":"Charles Goldfarb","startTime":1655.67,"endTime":1659.3,"body":"last 10 years or eight years or"},{"speaker":"Charles Goldfarb","startTime":1655.67,"endTime":1659.3,"body":"something like that. What's"},{"speaker":"Charles Goldfarb","startTime":1659.3,"endTime":1661.46,"body":"remarkable, and here's the most"},{"speaker":"Charles Goldfarb","startTime":1659.3,"endTime":1661.46,"body":"controversial thing I'm going to"},{"speaker":"Charles Goldfarb","startTime":1661.46,"endTime":1666.44,"body":"say is that I do a lot of"},{"speaker":"Charles Goldfarb","startTime":1661.46,"endTime":1666.44,"body":"scopes, at least I think my"},{"speaker":"Charles Goldfarb","startTime":1666.44,"endTime":1671.99,"body":"volume is high. I probably on"},{"speaker":"Charles Goldfarb","startTime":1666.44,"endTime":1671.99,"body":"average, do two risk scopes a"},{"speaker":"Charles Goldfarb","startTime":1671.99,"endTime":1676.1,"body":"week for owner side of risk. And"},{"speaker":"Charles Goldfarb","startTime":1671.99,"endTime":1676.1,"body":"I've actually looked at the"},{"speaker":"Charles Goldfarb","startTime":1676.1,"endTime":1678.29,"body":"numbers recently. So that's"},{"speaker":"Charles Goldfarb","startTime":1676.1,"endTime":1678.29,"body":"about rights and there's more"},{"speaker":"Charles Goldfarb","startTime":1678.77,"endTime":1682.82,"body":"but but I would say two is a"},{"speaker":"Charles Goldfarb","startTime":1678.77,"endTime":1682.82,"body":"safe number. When I do a TFCC"},{"speaker":"Charles Goldfarb","startTime":1682.82,"endTime":1687.89,"body":"repair 75% of them are now"},{"speaker":"Charles Goldfarb","startTime":1682.82,"endTime":1687.89,"body":"Ferrovial repairs may be higher"},{"speaker":"Charles Goldfarb","startTime":1688.49,"endTime":1697.37,"body":"versus peripheral repairs."},{"speaker":"Charles Goldfarb","startTime":1688.49,"endTime":1697.37,"body":"That's remarkable. And certainly"},{"speaker":"Charles Goldfarb","startTime":1697.37,"endTime":1700.4,"body":"I may have a little bit of a"},{"speaker":"Charles Goldfarb","startTime":1697.37,"endTime":1700.4,"body":"lower threshold for performing"},{"speaker":"Charles Goldfarb","startTime":1700.4,"endTime":1703.4,"body":"that kind of repair. If I get a"},{"speaker":"Charles Goldfarb","startTime":1700.4,"endTime":1703.4,"body":"weird trampoline sign if I get a"},{"speaker":"Charles Goldfarb","startTime":1703.4,"endTime":1706.52,"body":"positive hook test if I have a"},{"speaker":"Charles Goldfarb","startTime":1703.4,"endTime":1706.52,"body":"positive suction test, if I have"},{"speaker":"Charles Goldfarb","startTime":1706.52,"endTime":1710.9,"body":"preoperative suggestion of"},{"speaker":"Charles Goldfarb","startTime":1706.52,"endTime":1710.9,"body":"instability, but it's real. I do"},{"speaker":"Charles Goldfarb","startTime":1710.9,"endTime":1713.87,"body":"not think I'm over calling it"},{"speaker":"Charles Goldfarb","startTime":1710.9,"endTime":1713.87,"body":"and I'll keep going on my"},{"speaker":"Charles Goldfarb","startTime":1713.87,"endTime":1717.11,"body":"passionate diatribe. You know"},{"speaker":"Charles Goldfarb","startTime":1713.87,"endTime":1717.11,"body":"Marty Boyer and I used to have"},{"speaker":"Charles Goldfarb","startTime":1717.11,"endTime":1720.8,"body":"these discussions in our anatomy"},{"speaker":"Charles Goldfarb","startTime":1717.11,"endTime":1720.8,"body":"session, because Martin because"},{"speaker":"Charles Goldfarb","startTime":1720.8,"endTime":1724.4,"body":"used it used to be that we only"},{"speaker":"Charles Goldfarb","startTime":1720.8,"endTime":1724.4,"body":"did an outside in repair and"},{"speaker":"Charles Goldfarb","startTime":1724.4,"endTime":1727.76,"body":"that will be a small incision"},{"speaker":"Charles Goldfarb","startTime":1724.4,"endTime":1727.76,"body":"near the ECU. You use the ECU"},{"speaker":"Charles Goldfarb","startTime":1727.76,"endTime":1731.15,"body":"sub sheath as the stabilizing"},{"speaker":"Charles Goldfarb","startTime":1727.76,"endTime":1731.15,"body":"post and you put a switch"},{"speaker":"Charles Goldfarb","startTime":1731.15,"endTime":1734.81,"body":"through the TFCC classic still"},{"speaker":"Charles Goldfarb","startTime":1731.15,"endTime":1734.81,"body":"very appropriate when it when it"},{"speaker":"Charles Goldfarb","startTime":1734.81,"endTime":1738.8,"body":"calls when it's called for GFDL"},{"speaker":"Charles Goldfarb","startTime":1734.81,"endTime":1738.8,"body":"started talking about using"},{"speaker":"Charles Goldfarb","startTime":1738.8,"endTime":1744.14,"body":"suture anchors, or even meniscus"},{"speaker":"Charles Goldfarb","startTime":1738.8,"endTime":1744.14,"body":"repair kits that like deploy a"},{"speaker":"Charles Goldfarb","startTime":1744.14,"endTime":1749.21,"body":"little, a little device to"},{"speaker":"Charles Goldfarb","startTime":1744.14,"endTime":1749.21,"body":"repair the TFCC. But unless"},{"speaker":"Charles Goldfarb","startTime":1749.21,"endTime":1753.98,"body":"you're using an anchor, or an"},{"speaker":"Charles Goldfarb","startTime":1749.21,"endTime":1753.98,"body":"animal down to bone, or unless"},{"speaker":"Charles Goldfarb","startTime":1753.98,"endTime":1758.66,"body":"you are bringing the TFCC down"},{"speaker":"Charles Goldfarb","startTime":1753.98,"endTime":1758.66,"body":"the bone, the other TFC repairs"},{"speaker":"Charles Goldfarb","startTime":1758.72,"endTime":1761.81,"body":"do not provide stability. They"},{"speaker":"Charles Goldfarb","startTime":1758.72,"endTime":1761.81,"body":"might help pain, but they don't"},{"speaker":"Charles Goldfarb","startTime":1761.81,"endTime":1766.64,"body":"help stability. And so this"},{"speaker":"Charles Goldfarb","startTime":1761.81,"endTime":1766.64,"body":"fovea repair is a stabilizer it"},{"speaker":"Charles Goldfarb","startTime":1766.64,"endTime":1770.48,"body":"does make a fundamental"},{"speaker":"Charles Goldfarb","startTime":1766.64,"endTime":1770.48,"body":"difference to the stability of"},{"speaker":"Charles Goldfarb","startTime":1770.48,"endTime":1771.14,"body":"the deer year."},{"speaker":"Chris Dy","startTime":1771.98,"endTime":1775.61,"body":"So what what types of"},{"speaker":"Chris Dy","startTime":1771.98,"endTime":1775.61,"body":"tears either characteristics of"},{"speaker":"Chris Dy","startTime":1775.61,"endTime":1779.39,"body":"the tear itself or disability"},{"speaker":"Chris Dy","startTime":1775.61,"endTime":1779.39,"body":"Why is it one of the tears or"},{"speaker":"Chris Dy","startTime":1779.39,"endTime":1782.69,"body":"injuries that aren't addressable"},{"speaker":"Chris Dy","startTime":1779.39,"endTime":1782.69,"body":"with the fovea repair before we"},{"speaker":"Chris Dy","startTime":1782.69,"endTime":1784.73,"body":"get into your technique on the"},{"speaker":"Chris Dy","startTime":1782.69,"endTime":1784.73,"body":"fovea repair"},{"speaker":"Charles Goldfarb","startTime":1785.54,"endTime":1789.47,"body":"straightforward"},{"speaker":"Charles Goldfarb","startTime":1785.54,"endTime":1789.47,"body":"Central or essential TFCC or"},{"speaker":"Charles Goldfarb","startTime":1789.47,"endTime":1794.78,"body":"perhaps related to own a carpal"},{"speaker":"Charles Goldfarb","startTime":1789.47,"endTime":1794.78,"body":"impaction peripheral tear. I"},{"speaker":"Charles Goldfarb","startTime":1794.78,"endTime":1797.87,"body":"mean, I don't think it'd be"},{"speaker":"Charles Goldfarb","startTime":1794.78,"endTime":1797.87,"body":"wrong to treat a peripheral tear"},{"speaker":"Charles Goldfarb","startTime":1797.87,"endTime":1801.29,"body":"with a fovea repair but I don't"},{"speaker":"Charles Goldfarb","startTime":1797.87,"endTime":1801.29,"body":"Do you need to do it? And then"},{"speaker":"Charles Goldfarb","startTime":1801.29,"endTime":1805.13,"body":"you can just read it or do it Do"},{"speaker":"Charles Goldfarb","startTime":1801.29,"endTime":1805.13,"body":"or do a outside and repair?"},{"speaker":"Chris Dy","startTime":1805.49,"endTime":1807.62,"body":"Do you see peripheral?"},{"speaker":"Chris Dy","startTime":1805.49,"endTime":1807.62,"body":"Do you see peripheral tears with"},{"speaker":"Chris Dy","startTime":1807.62,"endTime":1810.8,"body":"instability? Are they typically"},{"speaker":"Chris Dy","startTime":1807.62,"endTime":1810.8,"body":"Fulvio tears that have"},{"speaker":"Chris Dy","startTime":1810.8,"endTime":1811.46,"body":"instability?"},{"speaker":"Charles Goldfarb","startTime":1811.7,"endTime":1814.01,"body":"It's folio"},{"speaker":"Charles Goldfarb","startTime":1811.7,"endTime":1814.01,"body":"tears that have instability. And"},{"speaker":"Charles Goldfarb","startTime":1814.01,"endTime":1817.16,"body":"it's rare. I don't want to"},{"speaker":"Charles Goldfarb","startTime":1814.01,"endTime":1817.16,"body":"misrepresent this. It's rare"},{"speaker":"Charles Goldfarb","startTime":1817.16,"endTime":1820.76,"body":"that you do a Dr. EJ shocking."},{"speaker":"Charles Goldfarb","startTime":1817.16,"endTime":1820.76,"body":"And it is moving all over the"},{"speaker":"Charles Goldfarb","startTime":1820.76,"endTime":1823.67,"body":"place. And even if you do a good"},{"speaker":"Charles Goldfarb","startTime":1820.76,"endTime":1823.67,"body":"piano key where the patient puts"},{"speaker":"Charles Goldfarb","startTime":1823.67,"endTime":1825.95,"body":"both hands down on the table,"},{"speaker":"Charles Goldfarb","startTime":1823.67,"endTime":1825.95,"body":"and you tell him to push into"},{"speaker":"Charles Goldfarb","startTime":1825.95,"endTime":1828.86,"body":"the table, it's rare that you"},{"speaker":"Charles Goldfarb","startTime":1825.95,"endTime":1828.86,"body":"see a big difference between the"},{"speaker":"Charles Goldfarb","startTime":1828.86,"endTime":1832.37,"body":"owner mobilizing on one side"},{"speaker":"Charles Goldfarb","startTime":1828.86,"endTime":1832.37,"body":"versus the other. But it's just"},{"speaker":"Charles Goldfarb","startTime":1832.37,"endTime":1835.52,"body":"a sense and the patient will"},{"speaker":"Charles Goldfarb","startTime":1832.37,"endTime":1835.52,"body":"tell you, if you if you ask them"},{"speaker":"Charles Goldfarb","startTime":1835.52,"endTime":1836.72,"body":"and listen, the patient will"},{"speaker":"Charles Goldfarb","startTime":1835.52,"endTime":1836.72,"body":"tell you."},{"speaker":"Chris Dy","startTime":1837.98,"endTime":1841.04,"body":"So tell me about how"},{"speaker":"Chris Dy","startTime":1837.98,"endTime":1841.04,"body":"you do your folio repair in"},{"speaker":"Chris Dy","startTime":1841.07,"endTime":1842.09,"body":"2021."},{"speaker":"Charles Goldfarb","startTime":1842.9,"endTime":1845.93,"body":"Yeah, so there"},{"speaker":"Charles Goldfarb","startTime":1842.9,"endTime":1845.93,"body":"are different techniques and I I"},{"speaker":"Charles Goldfarb","startTime":1845.96,"endTime":1848.66,"body":"have really mainly use one"},{"speaker":"Charles Goldfarb","startTime":1845.96,"endTime":1848.66,"body":"technique, sometimes you can"},{"speaker":"Charles Goldfarb","startTime":1848.66,"endTime":1852.32,"body":"freehand it, being very careful"},{"speaker":"Charles Goldfarb","startTime":1848.66,"endTime":1852.32,"body":"to protect that sensory branch,"},{"speaker":"Charles Goldfarb","startTime":1852.32,"endTime":1855.41,"body":"the older nerve, and when I"},{"speaker":"Charles Goldfarb","startTime":1852.32,"endTime":1855.41,"body":"freehand it, I make an incision,"},{"speaker":"Charles Goldfarb","startTime":1855.44,"endTime":1859.49,"body":"an extended six U incision"},{"speaker":"Charles Goldfarb","startTime":1855.44,"endTime":1859.49,"body":"protect the sensory nerve. And"},{"speaker":"Charles Goldfarb","startTime":1859.49,"endTime":1862.22,"body":"then you can place a needle"},{"speaker":"Charles Goldfarb","startTime":1859.49,"endTime":1862.22,"body":"dorsal and vulner to the"},{"speaker":"Charles Goldfarb","startTime":1862.22,"endTime":1866.48,"body":"styloid. And bring those up and"},{"speaker":"Charles Goldfarb","startTime":1862.22,"endTime":1866.48,"body":"under the TFCC and put a"},{"speaker":"Charles Goldfarb","startTime":1866.48,"endTime":1870.23,"body":"horizontal mattress suture and"},{"speaker":"Charles Goldfarb","startTime":1866.48,"endTime":1870.23,"body":"tie it over the owner side of"},{"speaker":"Charles Goldfarb","startTime":1870.23,"endTime":1875.09,"body":"the OMA but what I almost always"},{"speaker":"Charles Goldfarb","startTime":1870.23,"endTime":1875.09,"body":"do is is what we most people"},{"speaker":"Charles Goldfarb","startTime":1875.09,"endTime":1878.75,"body":"call an owner tunnel approach."},{"speaker":"Charles Goldfarb","startTime":1875.09,"endTime":1878.75,"body":"So you make an incision, just"},{"speaker":"Charles Goldfarb","startTime":1878.75,"endTime":1885.65,"body":"proximal to the styloid. Work"},{"speaker":"Charles Goldfarb","startTime":1878.75,"endTime":1885.65,"body":"volar to the ECU down to bone,"},{"speaker":"Charles Goldfarb","startTime":1885.95,"endTime":1889.88,"body":"you place a K wire through the"},{"speaker":"Charles Goldfarb","startTime":1885.95,"endTime":1889.88,"body":"bone and not a horizontal angle"},{"speaker":"Charles Goldfarb","startTime":1889.88,"endTime":1894.83,"body":"and not a very vertical angle."},{"speaker":"Charles Goldfarb","startTime":1889.88,"endTime":1894.83,"body":"And you drill to the fovea is"},{"speaker":"Charles Goldfarb","startTime":1894.83,"endTime":1898.37,"body":"where the fovea is essentially"},{"speaker":"Charles Goldfarb","startTime":1894.83,"endTime":1898.37,"body":"where the styloid meets the flat"},{"speaker":"Charles Goldfarb","startTime":1898.37,"endTime":1901.79,"body":"part of the distal Oma. And so"},{"speaker":"Charles Goldfarb","startTime":1898.37,"endTime":1901.79,"body":"your your goal is to exit the K"},{"speaker":"Charles Goldfarb","startTime":1901.79,"endTime":1906.8,"body":"wire right at that point, the"},{"speaker":"Charles Goldfarb","startTime":1901.79,"endTime":1906.8,"body":"shorter the tunnel, the more"},{"speaker":"Charles Goldfarb","startTime":1906.8,"endTime":1912.35,"body":"ability you have to place a wide"},{"speaker":"Charles Goldfarb","startTime":1906.8,"endTime":1912.35,"body":"horizontal matters suture. The"},{"speaker":"Charles Goldfarb","startTime":1912.35,"endTime":1917.03,"body":"longer and steeper the tunnel,"},{"speaker":"Charles Goldfarb","startTime":1912.35,"endTime":1917.03,"body":"it's very hard to separate your"},{"speaker":"Charles Goldfarb","startTime":1917.03,"endTime":1919.7,"body":"sutures and so you can more"},{"speaker":"Charles Goldfarb","startTime":1917.03,"endTime":1919.7,"body":"vertical the tunnel the more"},{"speaker":"Charles Goldfarb","startTime":1919.7,"endTime":1923.72,"body":"vertical the tunnel, so I shoot"},{"speaker":"Charles Goldfarb","startTime":1919.7,"endTime":1923.72,"body":"for a short oblique tunnel"},{"speaker":"Charles Goldfarb","startTime":1923.72,"endTime":1925.49,"body":"rather than a very vertical"},{"speaker":"Charles Goldfarb","startTime":1923.72,"endTime":1925.49,"body":"tunnel."},{"speaker":"Chris Dy","startTime":1926.449,"endTime":1929.749,"body":"Do you ever use the"},{"speaker":"Chris Dy","startTime":1926.449,"endTime":1929.749,"body":"the the aiming arms that are"},{"speaker":"Chris Dy","startTime":1929.749,"endTime":1930.589,"body":"supplied for that?"},{"speaker":"Charles Goldfarb","startTime":1931.22,"endTime":1934.28,"body":"I don't find"},{"speaker":"Charles Goldfarb","startTime":1931.22,"endTime":1934.28,"body":"those helpful anymore? I think"},{"speaker":"Charles Goldfarb","startTime":1934.28,"endTime":1937.22,"body":"they can be there's nothing"},{"speaker":"Charles Goldfarb","startTime":1934.28,"endTime":1937.22,"body":"wrong with them at all. But I"},{"speaker":"Charles Goldfarb","startTime":1937.22,"endTime":1938.27,"body":"don't I don't use them now."},{"speaker":"Chris Dy","startTime":1938.9,"endTime":1942.2,"body":"Okay, so then you've"},{"speaker":"Chris Dy","startTime":1938.9,"endTime":1942.2,"body":"inserted so you've drilled this"},{"speaker":"Chris Dy","startTime":1942.2,"endTime":1945.8,"body":"tunnel with K wire? How are you?"},{"speaker":"Charles Goldfarb","startTime":1946.31,"endTime":1948.23,"body":"I'm sorry. So"},{"speaker":"Charles Goldfarb","startTime":1946.31,"endTime":1948.23,"body":"I placed the keyword confirmed"},{"speaker":"Charles Goldfarb","startTime":1948.23,"endTime":1951.47,"body":"by CRM radiograph over drill it"},{"speaker":"Charles Goldfarb","startTime":1948.23,"endTime":1951.47,"body":"with about a three millimeter"},{"speaker":"Charles Goldfarb","startTime":1951.47,"endTime":1955.73,"body":"drill bit. And then essentially,"},{"speaker":"Charles Goldfarb","startTime":1951.47,"endTime":1955.73,"body":"the technique that said I use is"},{"speaker":"Charles Goldfarb","startTime":1955.73,"endTime":1959.27,"body":"the Arthrex that I don't work"},{"speaker":"Charles Goldfarb","startTime":1955.73,"endTime":1959.27,"body":"with our techs and essentially"},{"speaker":"Charles Goldfarb","startTime":1959.27,"endTime":1966.35,"body":"put the suture through the TFCC."},{"speaker":"Charles Goldfarb","startTime":1959.27,"endTime":1966.35,"body":"You pulled out your six our"},{"speaker":"Charles Goldfarb","startTime":1966.35,"endTime":1971.33,"body":"portal, and then you put a"},{"speaker":"Charles Goldfarb","startTime":1966.35,"endTime":1971.33,"body":"essentially a loop through the"},{"speaker":"Charles Goldfarb","startTime":1971.33,"endTime":1975.14,"body":"TFCC in a horizontal mattress"},{"speaker":"Charles Goldfarb","startTime":1971.33,"endTime":1975.14,"body":"type fashion, pull the loop out"},{"speaker":"Charles Goldfarb","startTime":1975.17,"endTime":1978.11,"body":"of the six our portal, then you"},{"speaker":"Charles Goldfarb","startTime":1975.17,"endTime":1978.11,"body":"put your suture through the loop"},{"speaker":"Charles Goldfarb","startTime":1978.11,"endTime":1980.48,"body":"and pull it all down through"},{"speaker":"Charles Goldfarb","startTime":1978.11,"endTime":1980.48,"body":"your tunnel, and you've got a"},{"speaker":"Charles Goldfarb","startTime":1980.48,"endTime":1981.65,"body":"great horizontal mattress."},{"speaker":"Chris Dy","startTime":1982.7,"endTime":1986.03,"body":"So you talked about"},{"speaker":"Chris Dy","startTime":1982.7,"endTime":1986.03,"body":"having a wide mattress, how wide"},{"speaker":"Chris Dy","startTime":1986.03,"endTime":1987.11,"body":"is the right width?"},{"speaker":"Charles Goldfarb","startTime":1989.0,"endTime":1991.94,"body":"Well, a you"},{"speaker":"Charles Goldfarb","startTime":1989.0,"endTime":1991.94,"body":"don't want it to pull through."},{"speaker":"Charles Goldfarb","startTime":1991.97,"endTime":1996.38,"body":"And sometimes the TFCC can get,"},{"speaker":"Charles Goldfarb","startTime":1991.97,"endTime":1996.38,"body":"you know less substantial over"},{"speaker":"Charles Goldfarb","startTime":1996.38,"endTime":1999.77,"body":"time, but it's usually a pretty"},{"speaker":"Charles Goldfarb","startTime":1996.38,"endTime":1999.77,"body":"sturdy structure. I hope that is"},{"speaker":"Charles Goldfarb","startTime":1999.77,"endTime":2003.55,"body":"at least two to three"},{"speaker":"Charles Goldfarb","startTime":1999.77,"endTime":2003.55,"body":"millimeters wide. That mattress"},{"speaker":"Charles Goldfarb","startTime":2003.55,"endTime":2005.47,"body":"and usually it's just one"},{"speaker":"Charles Goldfarb","startTime":2003.55,"endTime":2005.47,"body":"mattress I have done to"},{"speaker":"Charles Goldfarb","startTime":2005.47,"endTime":2010.87,"body":"mattresses on occasion for"},{"speaker":"Charles Goldfarb","startTime":2005.47,"endTime":2010.87,"body":"strength purposes or for kind of"},{"speaker":"Charles Goldfarb","startTime":2010.87,"endTime":2014.95,"body":"size of tear or size of patient."},{"speaker":"Charles Goldfarb","startTime":2010.87,"endTime":2014.95,"body":"But usually it's one strong"},{"speaker":"Charles Goldfarb","startTime":2014.98,"endTime":2019.57,"body":"suture. It's firewire because"},{"speaker":"Charles Goldfarb","startTime":2014.98,"endTime":2019.57,"body":"it's Arthrex. And then you"},{"speaker":"Charles Goldfarb","startTime":2019.6,"endTime":2022.12,"body":"basically you can do whatever"},{"speaker":"Charles Goldfarb","startTime":2019.6,"endTime":2022.12,"body":"you want to, to anchor the"},{"speaker":"Charles Goldfarb","startTime":2022.12,"endTime":2024.61,"body":"suture. I usually just use a"},{"speaker":"Charles Goldfarb","startTime":2022.12,"endTime":2024.61,"body":"little anchor into the"},{"speaker":"Chris Dy","startTime":2024.61,"endTime":2027.13,"body":"bone. What's the"},{"speaker":"Chris Dy","startTime":2024.61,"endTime":2027.13,"body":"caliber of that suture? Is it a"},{"speaker":"Chris Dy","startTime":2027.25,"endTime":2027.97,"body":"two? Oh,"},{"speaker":"Charles Goldfarb","startTime":2028.0,"endTime":2029.17,"body":"it's a it's a"},{"speaker":"Charles Goldfarb","startTime":2028.0,"endTime":2029.17,"body":"two? Oh,"},{"speaker":"Chris Dy","startTime":2029.23,"endTime":2032.11,"body":"yeah. Yeah. And then"},{"speaker":"Chris Dy","startTime":2029.23,"endTime":2032.11,"body":"when you're anchoring it down."},{"speaker":"Chris Dy","startTime":2032.11,"endTime":2035.08,"body":"Do you have any pearls for"},{"speaker":"Chris Dy","startTime":2032.11,"endTime":2035.08,"body":"tensioning? Or how you position"},{"speaker":"Chris Dy","startTime":2035.47,"endTime":2038.65,"body":"the form the wrist as you're"},{"speaker":"Chris Dy","startTime":2035.47,"endTime":2038.65,"body":"doing it to keep it on traction"},{"speaker":"Chris Dy","startTime":2038.65,"endTime":2040.18,"body":"all the time? What are your"},{"speaker":"Chris Dy","startTime":2038.65,"endTime":2040.18,"body":"pearls for that?"},{"speaker":"Charles Goldfarb","startTime":2040.36,"endTime":2042.49,"body":"Yeah, great"},{"speaker":"Charles Goldfarb","startTime":2040.36,"endTime":2042.49,"body":"question. If you put this stitch"},{"speaker":"Charles Goldfarb","startTime":2042.49,"endTime":2046.57,"body":"suture ease centrically I always"},{"speaker":"Charles Goldfarb","startTime":2042.49,"endTime":2046.57,"body":"worry that I'll lose rotation"},{"speaker":"Charles Goldfarb","startTime":2046.84,"endTime":2050.35,"body":"and my sutures never, it's not"},{"speaker":"Charles Goldfarb","startTime":2046.84,"endTime":2050.35,"body":"always perfectly in the middle"},{"speaker":"Charles Goldfarb","startTime":2050.35,"endTime":2053.2,"body":"of the distal ulna, but I"},{"speaker":"Charles Goldfarb","startTime":2050.35,"endTime":2053.2,"body":"haven't lost rotations that's"},{"speaker":"Charles Goldfarb","startTime":2054.19,"endTime":2058.18,"body":"point 1.2 is always tension it"},{"speaker":"Charles Goldfarb","startTime":2054.19,"endTime":2058.18,"body":"with no finger traction. So I'm"},{"speaker":"Charles Goldfarb","startTime":2058.18,"endTime":2061.9,"body":"sitting there attended 12 pounds"},{"speaker":"Charles Goldfarb","startTime":2058.18,"endTime":2061.9,"body":"of traction I released that I"},{"speaker":"Charles Goldfarb","startTime":2061.9,"endTime":2067.96,"body":"apply maximum traction on the"},{"speaker":"Charles Goldfarb","startTime":2061.9,"endTime":2067.96,"body":"suture as I put the anchor into"},{"speaker":"Charles Goldfarb","startTime":2067.96,"endTime":2071.8,"body":"the bone, and as I put the"},{"speaker":"Charles Goldfarb","startTime":2067.96,"endTime":2071.8,"body":"anchor into the bone, I release"},{"speaker":"Charles Goldfarb","startTime":2071.83,"endTime":2077.65,"body":"my hold on the suture and just"},{"speaker":"Charles Goldfarb","startTime":2071.83,"endTime":2077.65,"body":"push it into the bone. And it's"},{"speaker":"Charles Goldfarb","startTime":2077.65,"endTime":2080.08,"body":"been pretty good. Again, I"},{"speaker":"Charles Goldfarb","startTime":2077.65,"endTime":2080.08,"body":"haven't overtightened haven't"},{"speaker":"Charles Goldfarb","startTime":2080.08,"endTime":2084.64,"body":"lost rotation and it seems to do"},{"speaker":"Charles Goldfarb","startTime":2080.08,"endTime":2084.64,"body":"the job and the idea is that"},{"speaker":"Charles Goldfarb","startTime":2084.64,"endTime":2087.82,"body":"you're you're you're kind of"},{"speaker":"Charles Goldfarb","startTime":2084.64,"endTime":2087.82,"body":"irritated just to own it with"},{"speaker":"Charles Goldfarb","startTime":2087.82,"endTime":2091.18,"body":"that drill hole. Sometimes I'll"},{"speaker":"Charles Goldfarb","startTime":2087.82,"endTime":2091.18,"body":"put a shaver down on the on the"},{"speaker":"Charles Goldfarb","startTime":2091.18,"endTime":2094.81,"body":"distal aspect of the owner"},{"speaker":"Charles Goldfarb","startTime":2091.18,"endTime":2094.81,"body":"before I put my suture to quote"},{"speaker":"Charles Goldfarb","startTime":2094.81,"endTime":2097.99,"body":"unquote roughing it up, but"},{"speaker":"Charles Goldfarb","startTime":2094.81,"endTime":2097.99,"body":"you're hoping that that TFCC"},{"speaker":"Charles Goldfarb","startTime":2097.99,"endTime":2102.37,"body":"adheres back down the bone which"},{"speaker":"Charles Goldfarb","startTime":2097.99,"endTime":2102.37,"body":"provides stability and heals."},{"speaker":"Chris Dy","startTime":2103.659,"endTime":2107.649,"body":"So for that technique,"},{"speaker":"Chris Dy","startTime":2103.659,"endTime":2107.649,"body":"you describe using that on their"},{"speaker":"Chris Dy","startTime":2107.649,"endTime":2110.949,"body":"tunnel, when would you use that"},{"speaker":"Chris Dy","startTime":2107.649,"endTime":2110.949,"body":"outside? And I think you"},{"speaker":"Chris Dy","startTime":2110.949,"endTime":2115.509,"body":"described it as being a"},{"speaker":"Chris Dy","startTime":2110.949,"endTime":2115.509,"body":"peripheral, not foveal tear that"},{"speaker":"Chris Dy","startTime":2117.039,"endTime":2119.679,"body":"that you're obviously doing more"},{"speaker":"Chris Dy","startTime":2117.039,"endTime":2119.679,"body":"than to breeding. Is that an"},{"speaker":"Chris Dy","startTime":2119.679,"endTime":2121.509,"body":"accurate assumption or a"},{"speaker":"Chris Dy","startTime":2119.679,"endTime":2121.509,"body":"summary?"},{"speaker":"Charles Goldfarb","startTime":2121.66,"endTime":2122.71,"body":"That's exactly"},{"speaker":"Charles Goldfarb","startTime":2121.66,"endTime":2122.71,"body":"right."},{"speaker":"Chris Dy","startTime":2122.769,"endTime":2125.829,"body":"That's exactly and"},{"speaker":"Chris Dy","startTime":2122.769,"endTime":2125.829,"body":"then in terms of exactly how you"},{"speaker":"Chris Dy","startTime":2125.829,"endTime":2129.729,"body":"would do that. You gave a little"},{"speaker":"Chris Dy","startTime":2125.829,"endTime":2129.729,"body":"bit of a description earlier for"},{"speaker":"Chris Dy","startTime":2129.729,"endTime":2131.649,"body":"somebody who's learning how to"},{"speaker":"Chris Dy","startTime":2129.729,"endTime":2131.649,"body":"do it. How would you do it?"},{"speaker":"Charles Goldfarb","startTime":2132.37,"endTime":2135.46,"body":"Yeah, so I use"},{"speaker":"Charles Goldfarb","startTime":2132.37,"endTime":2135.46,"body":"my six our portal. So I always"},{"speaker":"Charles Goldfarb","startTime":2135.46,"endTime":2138.31,"body":"make that portal longitudinally"},{"speaker":"Charles Goldfarb","startTime":2135.46,"endTime":2138.31,"body":"in case I need to extend extend"},{"speaker":"Charles Goldfarb","startTime":2138.31,"endTime":2141.52,"body":"my six our portal, I look out"},{"speaker":"Charles Goldfarb","startTime":2138.31,"endTime":2141.52,"body":"for that transverse branch of"},{"speaker":"Charles Goldfarb","startTime":2141.52,"endTime":2145.99,"body":"the sensory owner nerve as"},{"speaker":"Charles Goldfarb","startTime":2141.52,"endTime":2145.99,"body":"uncommonly present but I look"},{"speaker":"Charles Goldfarb","startTime":2145.99,"endTime":2150.43,"body":"out for it. I dissect down to"},{"speaker":"Charles Goldfarb","startTime":2145.99,"endTime":2150.43,"body":"the ECU sub sheath at the joint"},{"speaker":"Charles Goldfarb","startTime":2150.43,"endTime":2156.37,"body":"level, I open the ECU sheath and"},{"speaker":"Charles Goldfarb","startTime":2150.43,"endTime":2156.37,"body":"sub sheath and put up a rag Nell"},{"speaker":"Charles Goldfarb","startTime":2156.37,"endTime":2160.03,"body":"retract of the small end of a"},{"speaker":"Charles Goldfarb","startTime":2156.37,"endTime":2160.03,"body":"rag now to pull the ECU more"},{"speaker":"Charles Goldfarb","startTime":2160.03,"endTime":2164.59,"body":"owner Li. And then I use a"},{"speaker":"Charles Goldfarb","startTime":2160.03,"endTime":2164.59,"body":"meniscus mender is called the"},{"speaker":"Charles Goldfarb","startTime":2164.59,"endTime":2168.73,"body":"meniscus mender to it's a right"},{"speaker":"Charles Goldfarb","startTime":2164.59,"endTime":2168.73,"body":"medical first generation"},{"speaker":"Charles Goldfarb","startTime":2168.73,"endTime":2172.72,"body":"meniscus repair set, but it has"},{"speaker":"Charles Goldfarb","startTime":2168.73,"endTime":2172.72,"body":"perfectly small size needles."},{"speaker":"Charles Goldfarb","startTime":2172.72,"endTime":2176.26,"body":"They're curved, is inexpensive."},{"speaker":"Charles Goldfarb","startTime":2172.72,"endTime":2176.26,"body":"And essentially I put those"},{"speaker":"Charles Goldfarb","startTime":2176.26,"endTime":2180.64,"body":"through the ECU sub sheet and"},{"speaker":"Charles Goldfarb","startTime":2176.26,"endTime":2180.64,"body":"into the TFCC. And again, I"},{"speaker":"Charles Goldfarb","startTime":2180.64,"endTime":2183.91,"body":"create a horizontal mattress"},{"speaker":"Charles Goldfarb","startTime":2180.64,"endTime":2183.91,"body":"suture. I pull it down to the"},{"speaker":"Charles Goldfarb","startTime":2183.91,"endTime":2186.55,"body":"ECU sub sheet and type"},{"speaker":"Chris Dy","startTime":2187.18,"endTime":2189.25,"body":"is that device that"},{"speaker":"Chris Dy","startTime":2187.18,"endTime":2189.25,"body":"I'm saying this in all"},{"speaker":"Chris Dy","startTime":2189.25,"endTime":2191.47,"body":"seriousness? Is that device"},{"speaker":"Chris Dy","startTime":2189.25,"endTime":2191.47,"body":"still widely available?"},{"speaker":"Charles Goldfarb","startTime":2191.919,"endTime":2194.049,"body":"It is? It"},{"speaker":"Charles Goldfarb","startTime":2191.919,"endTime":2194.049,"body":"absolutely is. I think it's only"},{"speaker":"Charles Goldfarb","startTime":2194.049,"endTime":2196.329,"body":"used to my knowledge for the"},{"speaker":"Charles Goldfarb","startTime":2194.049,"endTime":2196.329,"body":"wrist but who knows."},{"speaker":"Chris Dy","startTime":2196.959,"endTime":2200.679,"body":"Okay, good. And then"},{"speaker":"Chris Dy","startTime":2196.959,"endTime":2200.679,"body":"are there any other repair"},{"speaker":"Chris Dy","startTime":2200.679,"endTime":2204.249,"body":"techniques that we should talk"},{"speaker":"Chris Dy","startTime":2200.679,"endTime":2204.249,"body":"about open? I mean, is there"},{"speaker":"Chris Dy","startTime":2204.249,"endTime":2208.119,"body":"still a role for an open TSCC"},{"speaker":"Chris Dy","startTime":2204.249,"endTime":2208.119,"body":"repair? I know that's how some"},{"speaker":"Chris Dy","startTime":2208.119,"endTime":2208.689,"body":"people only do"},{"speaker":"Charles Goldfarb","startTime":2208.69,"endTime":2210.55,"body":"it. Yeah, I"},{"speaker":"Charles Goldfarb","startTime":2208.69,"endTime":2210.55,"body":"would say two things. First,"},{"speaker":"Charles Goldfarb","startTime":2210.67,"endTime":2214.27,"body":"there is you know, you can do a"},{"speaker":"Charles Goldfarb","startTime":2210.67,"endTime":2214.27,"body":"straight owner repair with two"},{"speaker":"Charles Goldfarb","startTime":2214.27,"endTime":2216.82,"body":"needles, you know, two needles"},{"speaker":"Charles Goldfarb","startTime":2214.27,"endTime":2216.82,"body":"are cool, they're in the"},{"speaker":"Charles Goldfarb","startTime":2216.82,"endTime":2220.0,"body":"anesthesia set if you ever need"},{"speaker":"Charles Goldfarb","startTime":2216.82,"endTime":2220.0,"body":"one, they all anesthesia always"},{"speaker":"Charles Goldfarb","startTime":2220.0,"endTime":2222.4,"body":"has them. And I think there may"},{"speaker":"Charles Goldfarb","startTime":2220.0,"endTime":2222.4,"body":"be in their lumbar puncture"},{"speaker":"Charles Goldfarb","startTime":2222.4,"endTime":2225.4,"body":"center. But if you ask the right"},{"speaker":"Charles Goldfarb","startTime":2222.4,"endTime":2225.4,"body":"person from the anesthesia"},{"speaker":"Charles Goldfarb","startTime":2225.4,"endTime":2229.21,"body":"supply team, they'll find you"},{"speaker":"Charles Goldfarb","startTime":2225.4,"endTime":2229.21,"body":"two needles. And they are"},{"speaker":"Charles Goldfarb","startTime":2229.21,"endTime":2232.93,"body":"essentially not sharp and so"},{"speaker":"Charles Goldfarb","startTime":2229.21,"endTime":2232.93,"body":"they won't cut your suture. So"},{"speaker":"Charles Goldfarb","startTime":2233.17,"endTime":2237.91,"body":"if you visualize from the six"},{"speaker":"Charles Goldfarb","startTime":2233.17,"endTime":2237.91,"body":"are, you can put your suture in"},{"speaker":"Charles Goldfarb","startTime":2238.03,"endTime":2241.93,"body":"from the three four portal and"},{"speaker":"Charles Goldfarb","startTime":2238.03,"endTime":2241.93,"body":"you can basically create a"},{"speaker":"Charles Goldfarb","startTime":2241.93,"endTime":2247.09,"body":"horizontal mattress and tie it"},{"speaker":"Charles Goldfarb","startTime":2241.93,"endTime":2247.09,"body":"over the ulnar capsule. So you"},{"speaker":"Charles Goldfarb","startTime":2247.12,"endTime":2251.56,"body":"basically take it, you put it"},{"speaker":"Charles Goldfarb","startTime":2247.12,"endTime":2251.56,"body":"through the TFCC, from dorsal to"},{"speaker":"Charles Goldfarb","startTime":2251.56,"endTime":2256.21,"body":"volar and radial to owner and"},{"speaker":"Charles Goldfarb","startTime":2251.56,"endTime":2256.21,"body":"you and then you have a little"},{"speaker":"Charles Goldfarb","startTime":2256.21,"endTime":2258.67,"body":"incision, so you protect that"},{"speaker":"Charles Goldfarb","startTime":2256.21,"endTime":2258.67,"body":"sensory nerve. And then you can"},{"speaker":"Charles Goldfarb","startTime":2258.67,"endTime":2262.63,"body":"hold the suture outside the"},{"speaker":"Charles Goldfarb","startTime":2258.67,"endTime":2262.63,"body":"capsule, pull the needle back,"},{"speaker":"Charles Goldfarb","startTime":2262.93,"endTime":2265.93,"body":"and then push the needle through"},{"speaker":"Charles Goldfarb","startTime":2262.93,"endTime":2265.93,"body":"again, because the needle won't"},{"speaker":"Charles Goldfarb","startTime":2265.93,"endTime":2268.75,"body":"cut the suture. And then all of"},{"speaker":"Charles Goldfarb","startTime":2265.93,"endTime":2268.75,"body":"a sudden you have a nice"},{"speaker":"Charles Goldfarb","startTime":2268.75,"endTime":2271.24,"body":"horizontal mattress which you"},{"speaker":"Charles Goldfarb","startTime":2268.75,"endTime":2271.24,"body":"can tie over the capsule. I"},{"speaker":"Charles Goldfarb","startTime":2271.24,"endTime":2275.44,"body":"don't do that repair very often."},{"speaker":"Charles Goldfarb","startTime":2271.24,"endTime":2275.44,"body":"Because one, true owner sided"},{"speaker":"Charles Goldfarb","startTime":2275.44,"endTime":2278.11,"body":"tears are not that common in my"},{"speaker":"Charles Goldfarb","startTime":2275.44,"endTime":2278.11,"body":"experience. And two, you don't"},{"speaker":"Charles Goldfarb","startTime":2278.11,"endTime":2280.96,"body":"want to close down that pre"},{"speaker":"Charles Goldfarb","startTime":2278.11,"endTime":2280.96,"body":"styloid recess, because if you"},{"speaker":"Charles Goldfarb","startTime":2280.96,"endTime":2285.46,"body":"do that you will lose rotation."},{"speaker":"Charles Goldfarb","startTime":2280.96,"endTime":2285.46,"body":"And then your last question is"},{"speaker":"Charles Goldfarb","startTime":2285.46,"endTime":2290.71,"body":"Yeah, owner sided, open TFCC"},{"speaker":"Charles Goldfarb","startTime":2285.46,"endTime":2290.71,"body":"repairs are absolutely"},{"speaker":"Charles Goldfarb","startTime":2290.71,"endTime":2295.03,"body":"appropriate. And they're really"},{"speaker":"Charles Goldfarb","startTime":2290.71,"endTime":2295.03,"body":"good arthroscopy and good"},{"speaker":"Charles Goldfarb","startTime":2295.03,"endTime":2299.23,"body":"surgeons who choose that"},{"speaker":"Charles Goldfarb","startTime":2295.03,"endTime":2299.23,"body":"technique, I will sometimes do"},{"speaker":"Charles Goldfarb","startTime":2299.23,"endTime":2303.55,"body":"it, I find it difficult to put"},{"speaker":"Charles Goldfarb","startTime":2299.23,"endTime":2303.55,"body":"the sutures exactly where I want"},{"speaker":"Charles Goldfarb","startTime":2303.55,"endTime":2306.91,"body":"them. You can put an anchor in"},{"speaker":"Charles Goldfarb","startTime":2303.55,"endTime":2306.91,"body":"or you can put drill holes"},{"speaker":"Charles Goldfarb","startTime":2306.91,"endTime":2311.05,"body":"through the older styloid but is"},{"speaker":"Charles Goldfarb","startTime":2306.91,"endTime":2311.05,"body":"absolutely appropriate is"},{"speaker":"Charles Goldfarb","startTime":2311.05,"endTime":2313.66,"body":"dealer's choice. And I like it."},{"speaker":"Chris Dy","startTime":2315.13,"endTime":2316.51,"body":"When was the last time"},{"speaker":"Chris Dy","startTime":2315.13,"endTime":2316.51,"body":"you did one,"},{"speaker":"Charles Goldfarb","startTime":2317.11,"endTime":2319.93,"body":"I have done"},{"speaker":"Charles Goldfarb","startTime":2317.11,"endTime":2319.93,"body":"one recently, it was a situation"},{"speaker":"Charles Goldfarb","startTime":2319.93,"endTime":2323.56,"body":"where it was a bad distal radius"},{"speaker":"Charles Goldfarb","startTime":2319.93,"endTime":2323.56,"body":"fracture without an owner"},{"speaker":"Charles Goldfarb","startTime":2323.56,"endTime":2326.44,"body":"styloid fracture, I fixed the"},{"speaker":"Charles Goldfarb","startTime":2323.56,"endTime":2326.44,"body":"radius there was still gross"},{"speaker":"Charles Goldfarb","startTime":2326.44,"endTime":2329.44,"body":"instability. So I made a I made"},{"speaker":"Charles Goldfarb","startTime":2326.44,"endTime":2329.44,"body":"an incision. And there was a"},{"speaker":"Charles Goldfarb","startTime":2329.44,"endTime":2335.14,"body":"massive faux veal tear of the"},{"speaker":"Charles Goldfarb","startTime":2329.44,"endTime":2335.14,"body":"TFCC. So I put I put one anchor"},{"speaker":"Charles Goldfarb","startTime":2335.14,"endTime":2338.68,"body":"and I wondered after the fact"},{"speaker":"Charles Goldfarb","startTime":2335.14,"endTime":2338.68,"body":"that I've done too. And I did it"},{"speaker":"Charles Goldfarb","startTime":2338.68,"endTime":2341.59,"body":"open repair and it was it was"},{"speaker":"Charles Goldfarb","startTime":2338.68,"endTime":2341.59,"body":"fine. It was fine. Where did you"},{"speaker":"Charles Goldfarb","startTime":2341.59,"endTime":2349.9,"body":"put the anchor. In this case, I"},{"speaker":"Charles Goldfarb","startTime":2341.59,"endTime":2349.9,"body":"put the anchor doors to kind of"},{"speaker":"Charles Goldfarb","startTime":2350.02,"endTime":2354.49,"body":"dorsally near the styloid. So my"},{"speaker":"Charles Goldfarb","startTime":2350.02,"endTime":2354.49,"body":"incision was the you know,"},{"speaker":"Charles Goldfarb","startTime":2354.49,"endTime":2356.74,"body":"there's different ways to do it,"},{"speaker":"Charles Goldfarb","startTime":2354.49,"endTime":2356.74,"body":"you can make a straight older"},{"speaker":"Charles Goldfarb","startTime":2356.74,"endTime":2360.1,"body":"incision, or you can make"},{"speaker":"Charles Goldfarb","startTime":2356.74,"endTime":2360.1,"body":"essentially a transverse"},{"speaker":"Charles Goldfarb","startTime":2360.1,"endTime":2364.24,"body":"incision under the ECU tendon."},{"speaker":"Charles Goldfarb","startTime":2360.1,"endTime":2364.24,"body":"And in this case, I was more"},{"speaker":"Charles Goldfarb","startTime":2364.24,"endTime":2369.25,"body":"dorsal. So I put my anchor there"},{"speaker":"Charles Goldfarb","startTime":2364.24,"endTime":2369.25,"body":"and then I did a grasping suture"},{"speaker":"Charles Goldfarb","startTime":2369.25,"endTime":2370.12,"body":"of the TFCC."},{"speaker":"Chris Dy","startTime":2371.619,"endTime":2375.729,"body":"So for you, what would"},{"speaker":"Chris Dy","startTime":2371.619,"endTime":2375.729,"body":"you advise people who are"},{"speaker":"Chris Dy","startTime":2375.729,"endTime":2378.879,"body":"learning how to do this"},{"speaker":"Chris Dy","startTime":2375.729,"endTime":2378.879,"body":"technique and you know, shot"},{"speaker":"Chris Dy","startTime":2378.879,"endTime":2381.639,"body":"because I noticed that in my"},{"speaker":"Chris Dy","startTime":2378.879,"endTime":2381.639,"body":"training, I mainly saw you use"},{"speaker":"Chris Dy","startTime":2381.639,"endTime":2384.669,"body":"the ulnar tunnel technique. I"},{"speaker":"Chris Dy","startTime":2381.639,"endTime":2384.669,"body":"never saw you use a meniscus"},{"speaker":"Chris Dy","startTime":2384.669,"endTime":2387.699,"body":"mender I never saw use it to a"},{"speaker":"Chris Dy","startTime":2384.669,"endTime":2387.699,"body":"needle and I certainly didn't"},{"speaker":"Chris Dy","startTime":2387.699,"endTime":2391.389,"body":"see an open repair. But one of"},{"speaker":"Chris Dy","startTime":2387.699,"endTime":2391.389,"body":"the limitations of growing up in"},{"speaker":"Chris Dy","startTime":2391.389,"endTime":2394.719,"body":"this era of newer techniques is"},{"speaker":"Chris Dy","startTime":2391.389,"endTime":2394.719,"body":"that you don't learn the old"},{"speaker":"Chris Dy","startTime":2394.719,"endTime":2395.619,"body":"school way of doing it."},{"speaker":"Charles Goldfarb","startTime":2397.059,"endTime":2401.889,"body":"There used to"},{"speaker":"Charles Goldfarb","startTime":2397.059,"endTime":2401.889,"body":"be a great course By the by Anna"},{"speaker":"Charles Goldfarb","startTime":2401.949,"endTime":2405.129,"body":"and the hand society for wrist"},{"speaker":"Charles Goldfarb","startTime":2401.949,"endTime":2405.129,"body":"and elbow arthroscopy, and it"},{"speaker":"Charles Goldfarb","startTime":2405.129,"endTime":2407.829,"body":"was a shame that that course is"},{"speaker":"Charles Goldfarb","startTime":2405.129,"endTime":2407.829,"body":"not offered, because a lot of"},{"speaker":"Charles Goldfarb","startTime":2407.829,"endTime":2411.069,"body":"this is just being at a course."},{"speaker":"Charles Goldfarb","startTime":2407.829,"endTime":2411.069,"body":"And I really think it's true a"},{"speaker":"Charles Goldfarb","startTime":2411.069,"endTime":2414.699,"body":"course that focuses on repair"},{"speaker":"Charles Goldfarb","startTime":2411.069,"endTime":2414.699,"body":"techniques and arthroscopic"},{"speaker":"Charles Goldfarb","startTime":2414.699,"endTime":2417.669,"body":"techniques. And, you know,"},{"speaker":"Charles Goldfarb","startTime":2414.699,"endTime":2417.669,"body":"having a good senior partner"},{"speaker":"Charles Goldfarb","startTime":2417.669,"endTime":2423.129,"body":"helps doing the right fellowship"},{"speaker":"Charles Goldfarb","startTime":2417.669,"endTime":2423.129,"body":"helps. But I don't know the"},{"speaker":"Charles Goldfarb","startTime":2423.129,"endTime":2425.169,"body":"answer to your question. I mean,"},{"speaker":"Charles Goldfarb","startTime":2423.129,"endTime":2425.169,"body":"you have to get exposure"},{"speaker":"Charles Goldfarb","startTime":2425.169,"endTime":2428.319,"body":"somehow. And I really think the"},{"speaker":"Charles Goldfarb","startTime":2425.169,"endTime":2428.319,"body":"problem with arthroscopic"},{"speaker":"Charles Goldfarb","startTime":2428.319,"endTime":2433.569,"body":"education is you have to see"},{"speaker":"Charles Goldfarb","startTime":2428.319,"endTime":2433.569,"body":"enough to be comfortable with"},{"speaker":"Charles Goldfarb","startTime":2433.569,"endTime":2437.769,"body":"pathology, because I still think"},{"speaker":"Charles Goldfarb","startTime":2433.569,"endTime":2437.769,"body":"our definitions of what is"},{"speaker":"Charles Goldfarb","startTime":2437.769,"endTime":2440.409,"body":"pathological are not completely"},{"speaker":"Charles Goldfarb","startTime":2437.769,"endTime":2440.409,"body":"clear,"},{"speaker":"Chris Dy","startTime":2440.68,"endTime":2443.5,"body":"at least well, on top"},{"speaker":"Chris Dy","startTime":2440.68,"endTime":2443.5,"body":"of that there is the variability"},{"speaker":"Chris Dy","startTime":2443.5,"endTime":2446.56,"body":"in who's reading them, which I"},{"speaker":"Chris Dy","startTime":2443.5,"endTime":2446.56,"body":"know is the topic of one of our"},{"speaker":"Chris Dy","startTime":2446.56,"endTime":2447.94,"body":"fellows research projects."},{"speaker":"Charles Goldfarb","startTime":2447.94,"endTime":2450.22,"body":"So absolutely."},{"speaker":"Charles Goldfarb","startTime":2447.94,"endTime":2450.22,"body":"We're working hard on that one."},{"speaker":"Chris Dy","startTime":2450.88,"endTime":2453.25,"body":"So is it is the"},{"speaker":"Chris Dy","startTime":2450.88,"endTime":2453.25,"body":"postdoc protocol, the same for"},{"speaker":"Chris Dy","startTime":2453.25,"endTime":2454.99,"body":"all of the different techniques"},{"speaker":"Chris Dy","startTime":2453.25,"endTime":2454.99,"body":"you describe,"},{"speaker":"Charles Goldfarb","startTime":2455.38,"endTime":2458.14,"body":"actually, for"},{"speaker":"Charles Goldfarb","startTime":2455.38,"endTime":2458.14,"body":"me, and there is no science"},{"speaker":"Charles Goldfarb","startTime":2458.14,"endTime":2462.4,"body":"here. For me, it is not, I use a"},{"speaker":"Charles Goldfarb","startTime":2458.14,"endTime":2462.4,"body":"shorter arm splint and cast for"},{"speaker":"Charles Goldfarb","startTime":2462.4,"endTime":2466.45,"body":"a peripheral repair. I just"},{"speaker":"Charles Goldfarb","startTime":2462.4,"endTime":2466.45,"body":"don't think there's much of a"},{"speaker":"Charles Goldfarb","startTime":2466.45,"endTime":2469.57,"body":"risk of that tearing out. So I"},{"speaker":"Charles Goldfarb","startTime":2466.45,"endTime":2469.57,"body":"keep life simple for the"},{"speaker":"Charles Goldfarb","startTime":2469.57,"endTime":2475.36,"body":"patient. For a fovea repair, I"},{"speaker":"Charles Goldfarb","startTime":2469.57,"endTime":2475.36,"body":"use a sugar Tong splint for two"},{"speaker":"Charles Goldfarb","startTime":2475.36,"endTime":2478.57,"body":"weeks and a monster cast for"},{"speaker":"Charles Goldfarb","startTime":2475.36,"endTime":2478.57,"body":"four weeks before I start"},{"speaker":"Charles Goldfarb","startTime":2478.57,"endTime":2478.87,"body":"therapy."},{"speaker":"Chris Dy","startTime":2479.17,"endTime":2482.05,"body":"Wait, hold on. So"},{"speaker":"Chris Dy","startTime":2479.17,"endTime":2482.05,"body":"you're for the terror that what"},{"speaker":"Chris Dy","startTime":2482.05,"endTime":2486.04,"body":"you do, you do not have a bone"},{"speaker":"Chris Dy","startTime":2482.05,"endTime":2486.04,"body":"tunnel, you are less"},{"speaker":"Chris Dy","startTime":2486.04,"endTime":2489.22,"body":"restrictive. But for the repair"},{"speaker":"Chris Dy","startTime":2486.04,"endTime":2489.22,"body":"in which you have a bone tunnel"},{"speaker":"Chris Dy","startTime":2489.22,"endTime":2492.73,"body":"backed up by a suture anchor,"},{"speaker":"Chris Dy","startTime":2489.22,"endTime":2492.73,"body":"you are more restrictive."},{"speaker":"Charles Goldfarb","startTime":2493.3,"endTime":2495.76,"body":"I just don't"},{"speaker":"Charles Goldfarb","startTime":2493.3,"endTime":2495.76,"body":"think the torque is with"},{"speaker":"Charles Goldfarb","startTime":2495.76,"endTime":2500.53,"body":"rotation is much on that"},{"speaker":"Charles Goldfarb","startTime":2495.76,"endTime":2500.53,"body":"peripheral repair. And I worry"},{"speaker":"Charles Goldfarb","startTime":2500.53,"endTime":2505.24,"body":"more a because it's more"},{"speaker":"Charles Goldfarb","startTime":2500.53,"endTime":2505.24,"body":"significant for the fovea repair"},{"speaker":"Charles Goldfarb","startTime":2505.24,"endTime":2508.33,"body":"and I would hate for it to fail."},{"speaker":"Charles Goldfarb","startTime":2505.24,"endTime":2508.33,"body":"I just worry more about it and"},{"speaker":"Charles Goldfarb","startTime":2508.33,"endTime":2512.5,"body":"again, may be nonsensical. I"},{"speaker":"Charles Goldfarb","startTime":2508.33,"endTime":2512.5,"body":"hope a listener will call me out"},{"speaker":"Charles Goldfarb","startTime":2512.5,"endTime":2514.03,"body":"and educate me if they disagree."},{"speaker":"Chris Dy","startTime":2514.39,"endTime":2517.81,"body":"Well, it's clearly"},{"speaker":"Chris Dy","startTime":2514.39,"endTime":2517.81,"body":"worked. So it has worked. Yeah,"},{"speaker":"Chris Dy","startTime":2517.84,"endTime":2520.66,"body":"exactly. And when do you start,"},{"speaker":"Chris Dy","startTime":2517.84,"endTime":2520.66,"body":"you know, for our therapy,"},{"speaker":"Chris Dy","startTime":2520.66,"endTime":2523.66,"body":"colleagues listening, so say"},{"speaker":"Chris Dy","startTime":2520.66,"endTime":2523.66,"body":"your peripheral repair. What's"},{"speaker":"Chris Dy","startTime":2523.66,"endTime":2525.85,"body":"your protocol in terms of"},{"speaker":"Chris Dy","startTime":2523.66,"endTime":2525.85,"body":"initiating motion? When do you"},{"speaker":"Chris Dy","startTime":2525.85,"endTime":2529.9,"body":"get them out of that short arm?"},{"speaker":"Chris Dy","startTime":2525.85,"endTime":2529.9,"body":"splint? Cast? orthosis?"},{"speaker":"Charles Goldfarb","startTime":2530.26,"endTime":2532.12,"body":"Yeah, so it's"},{"speaker":"Charles Goldfarb","startTime":2530.26,"endTime":2532.12,"body":"six weeks, there's actually do"},{"speaker":"Charles Goldfarb","startTime":2532.12,"endTime":2536.05,"body":"you want to be really precise,"},{"speaker":"Charles Goldfarb","startTime":2532.12,"endTime":2536.05,"body":"five weeks and five days later,"},{"speaker":"Charles Goldfarb","startTime":2536.32,"endTime":2540.67,"body":"start therapy in both groups."},{"speaker":"Charles Goldfarb","startTime":2536.32,"endTime":2540.67,"body":"volar resting splint, active and"},{"speaker":"Charles Goldfarb","startTime":2540.67,"endTime":2544.45,"body":"progressive passive motion. Once"},{"speaker":"Charles Goldfarb","startTime":2540.67,"endTime":2544.45,"body":"passive motions restored,"},{"speaker":"Charles Goldfarb","startTime":2544.66,"endTime":2547.21,"body":"strengthening can begin that's"},{"speaker":"Charles Goldfarb","startTime":2544.66,"endTime":2547.21,"body":"usually eight weeks"},{"speaker":"Charles Goldfarb","startTime":2547.39,"endTime":2549.88,"body":"strengthening between eight and"},{"speaker":"Charles Goldfarb","startTime":2547.39,"endTime":2549.88,"body":"12 weeks and depending on how"},{"speaker":"Charles Goldfarb","startTime":2549.88,"endTime":2551.71,"body":"the patient's doing ramp up"},{"speaker":"Charles Goldfarb","startTime":2549.88,"endTime":2551.71,"body":"thereafter."},{"speaker":"Chris Dy","startTime":2552.25,"endTime":2554.62,"body":"So the rehab protocols"},{"speaker":"Chris Dy","startTime":2552.25,"endTime":2554.62,"body":"don't change just the initial"},{"speaker":"Chris Dy","startTime":2554.62,"endTime":2559.33,"body":"mobilization between the two"},{"speaker":"Chris Dy","startTime":2554.62,"endTime":2559.33,"body":"groups. Yes. Okay. And at what"},{"speaker":"Chris Dy","startTime":2559.33,"endTime":2561.61,"body":"point do you sprinkle the holy"},{"speaker":"Chris Dy","startTime":2559.33,"endTime":2561.61,"body":"water on the patient?"},{"speaker":"Charles Goldfarb","startTime":2562.45,"endTime":2565.93,"body":"Every every"},{"speaker":"Charles Goldfarb","startTime":2562.45,"endTime":2565.93,"body":"visit every visit? I have a big"},{"speaker":"Charles Goldfarb","startTime":2565.93,"endTime":2569.92,"body":"bat. Meeting. I need it."},{"speaker":"Chris Dy","startTime":2570.34,"endTime":2573.16,"body":"Fantastic. Well, if at"},{"speaker":"Chris Dy","startTime":2570.34,"endTime":2573.16,"body":"listeners have any other"},{"speaker":"Chris Dy","startTime":2573.16,"endTime":2577.99,"body":"questions about protocols and"},{"speaker":"Chris Dy","startTime":2573.16,"endTime":2577.99,"body":"details for arthroscopy and TFCC"},{"speaker":"Chris Dy","startTime":2577.99,"endTime":2581.17,"body":"repair, send it to us. I'm not"},{"speaker":"Chris Dy","startTime":2577.99,"endTime":2581.17,"body":"going to pretend to try to"},{"speaker":"Chris Dy","startTime":2581.17,"endTime":2584.05,"body":"answer any of them. But we'll"},{"speaker":"Chris Dy","startTime":2581.17,"endTime":2584.05,"body":"ask Chuck. We'll call we'll just"},{"speaker":"Chris Dy","startTime":2584.05,"endTime":2586.63,"body":"change the name of the podcast"},{"speaker":"Chris Dy","startTime":2584.05,"endTime":2586.63,"body":"asked Chuck. So hand"},{"speaker":"Chris Dy","startTime":2586.63,"endTime":2590.05,"body":"podcast@gmail.com as Chuck your"},{"speaker":"Chris Dy","startTime":2586.63,"endTime":2590.05,"body":"arthroscopy questions,"},{"speaker":"Charles Goldfarb","startTime":2590.11,"endTime":2592.33,"body":"yeah. And I"},{"speaker":"Charles Goldfarb","startTime":2590.11,"endTime":2592.33,"body":"hope all you sports lovers out"},{"speaker":"Charles Goldfarb","startTime":2592.33,"endTime":2594.97,"body":"there, which we know is the"},{"speaker":"Charles Goldfarb","startTime":2592.33,"endTime":2594.97,"body":"majority of the listeners. I"},{"speaker":"Charles Goldfarb","startTime":2594.97,"endTime":2600.16,"body":"hope you guys are all happy and"},{"speaker":"Charles Goldfarb","startTime":2594.97,"endTime":2600.16,"body":"satiated. And look, I'm still"},{"speaker":"Charles Goldfarb","startTime":2600.16,"endTime":2603.22,"body":"learning so educate me if you"},{"speaker":"Charles Goldfarb","startTime":2600.16,"endTime":2603.22,"body":"see things differently, please."},{"speaker":"Chris Dy","startTime":2603.52,"endTime":2605.41,"body":"Fantastic. Well, we'll"},{"speaker":"Chris Dy","startTime":2603.52,"endTime":2605.41,"body":"see you next week."},{"speaker":"Charles Goldfarb","startTime":2605.77,"endTime":2609.82,"body":"Thank you."},{"speaker":"Charles Goldfarb","startTime":2605.77,"endTime":2609.82,"body":"Hey, Chris, that was fun. Let's"},{"speaker":"Charles Goldfarb","startTime":2609.82,"endTime":2610.78,"body":"do it again real soon."},{"speaker":"Chris Dy","startTime":2611.02,"endTime":2613.54,"body":"Sounds good. Well, be"},{"speaker":"Chris Dy","startTime":2611.02,"endTime":2613.54,"body":"sure to check us out on Twitter"},{"speaker":"Chris Dy","startTime":2613.57,"endTime":2616.0,"body":"at hand podcast. Hey, Chuck,"},{"speaker":"Chris Dy","startTime":2613.57,"endTime":2616.0,"body":"what's your Twitter handle?"},{"speaker":"Charles Goldfarb","startTime":2616.3,"endTime":2619.15,"body":"Mine is at"},{"speaker":"Charles Goldfarb","startTime":2616.3,"endTime":2619.15,"body":"congenital hand. What about you?"},{"speaker":"Chris Dy","startTime":2619.3,"endTime":2622.78,"body":"Mine is at Chris de MD"},{"speaker":"Chris Dy","startTime":2619.3,"endTime":2622.78,"body":"spelled dy. If you'd like to"},{"speaker":"Chris Dy","startTime":2622.78,"endTime":2626.56,"body":"email us, you can reach us at"},{"speaker":"Chris Dy","startTime":2622.78,"endTime":2626.56,"body":"hand podcast@gmail.com."},{"speaker":"Charles Goldfarb","startTime":2627.099,"endTime":2629.259,"body":"And remember,"},{"speaker":"Charles Goldfarb","startTime":2627.099,"endTime":2629.259,"body":"please subscribe wherever you"},{"speaker":"Charles Goldfarb","startTime":2629.259,"endTime":2630.669,"body":"get your podcast and be"},{"speaker":"Chris Dy","startTime":2630.669,"endTime":2633.009,"body":"sure to leave a review"},{"speaker":"Chris Dy","startTime":2630.669,"endTime":2633.009,"body":"that helps us get the word out."},{"speaker":"Charles Goldfarb","startTime":2633.369,"endTime":2635.679,"body":"Special thanks"},{"speaker":"Charles Goldfarb","startTime":2633.369,"endTime":2635.679,"body":"to Peter Martin for the amazing"},{"speaker":"Charles Goldfarb","startTime":2635.679,"endTime":2639.579,"body":"music. And remember, keep the"},{"speaker":"Charles Goldfarb","startTime":2635.679,"endTime":2639.579,"body":"upper hand come back next"}]}