JHS Spotlight, Part 2: Age and Nerves, Epitendinous Repair, and Weight bearing CT / SLIL Artwork

The Upper Hand: Chuck & Chris Talk Hand Surgery

The Upper Hand Podcast feature Charles Goldfarb and Chris Dy from Washington University Department of Orthopedic Surgery. Our weekly podcast will discuss all things hand surgery, from the technical aspects of what we do (diagnosis, treatment) to our more personal approaches to events and opportunities that hand surgeons experience. We welcome feedback and audience engagement. We are grateful for the muscial contribution of @iamPeterMartin.

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The Upper Hand: Chuck & Chris Talk Hand Surgery

JHS Spotlight, Part 2: Age and Nerves, Epitendinous Repair, and Weight bearing CT / SLIL

March 08, 2026 • Chuck and Chris • Season 7 • Episode 4

0:00 | 30:35

Chuck and Chris begin a new initiative working with The Journal of Hand Surgery on a quarterly journal club. Nash and Macerena will choose the articles from the previous quarter and Chris and Chuck will review the articles and discuss practical implications. This first episode includes discussion of the following articles from Q4 of 2025:

Porche KM, Spinner RJ, Bishop AT, Pulos N, Shin AY. Age-Related Effects on Peripheral Nerve Regeneration. J Hand Surg Am. 2025 Dec;50(12):1498-1504. PMID: 40817901.

Cardenas D, Dogaroiu A, Harirah M, Zhang AY, Odobescu A, Sammer DM. Biomechanical Comparison of Suture Caliber and Number of Passes in Epitendinous Repair. J Hand Surg Am. 2025 Oct;50(10):1278.e1-1278.e6. PMID: 39903150.

Ritchie B, Saini J, Mack ZE, Munn A, Dhaliwal G, Roach KE, Manske SL, White NJ. Weight-Bearing Computed Tomography Analysis of Scapholunate Ligament Injury. J Hand Surg Am. 2025 Nov;50(11):1304-1312. PMID: 40944679.

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The Upper Hand Podcast is sponsored by Checkpoint Surgical, a provider of innovative solutions for peripheral serve surgery. To learn more, visit https://checkpointsurgical.com/.

As always, thanks to @iampetermartin for the amazing introduction and concluding music.

For additional links, the catalog. Please see https://www.ortho.wustl.edu/content/Podcast-Listings/8280/The-Upper-Hand-Podcast.aspx

Quick recap

The meeting focused on reviewing recent articles from the Journal of Hand Surgery, discussing biomechanical aspects of flexor tendon repairs, dynamic CT scans and exploring age-related effects on peripheral nerve regeneration.

They announced a new partnership with the Journal of Hand Surgery, with Greg Merrill taking over as editor-in-chief in 2026, and promoted the upcoming WashU Nerve Course in St. Louis on May 29-30, which includes lectures and a cadaver lab session.

Flexor Tendon Repair Suture Techniques

Charles and Christopher discussed suture techniques for flexor tendon repairs, focusing on the use of 6-strand core sutures and epitendinous sutures. They agreed that a circumferential epitendinous suture provides additional strength, though it can be challenging to achieve. The conversation then shifted to a cadaveric biomechanical study comparing 5-0 and 6-0 proline sutures with different pass numbers. Both Charles and Christopher found the study's straightforward approach and clear results valuable, with the study suggesting that 5-0 proline and 8 passes might be preferable to the traditional 6-0 proline and 6 passes.

Dynamic CT for Scaphalunate Injuries

The meeting focused on a technical study by Brody Ritchie and Neil White from Calgary, which analyzed weight-bearing CT scans of scapholunate ligament injuries in 10 healthy controls and 10 injured patients. The study measured six variables under different loading conditions, including neutral, push-up bar, and forced extension, revealing significant changes in carpal mechanics under load. The authors suggested that dynamic CT could be a helpful diagnostic tool, though the implications for surgical techniques and patient outcomes remain unclear. The discussion highlighted the complexity of scaphalunate ligament injuries and the potential for improved understanding through dynamic loading studies.

Age Effects on Nerve Regeneration

Christopher and Charles discussed a review article by Ken Porchet and the Mayo Clinic plexus team on age-related effects on peripheral nerve regeneration. They highlighted that nerve regeneration is significantly slower in older rats and humans, with implications for patient counseling and surgical timing. Christopher emphasized the importance of nerve transfers and neuroplasticity in older patients, while Charles suggested considering age when setting expectations for nerve decompression procedures. They also briefly touched on social media trends and personal anecdotes before concluding the discussion.