The Upper Hand: Chuck & Chris Talk Hand Surgery

Chuck and Chris welcome Sanj Kakar, MD from the Mayo Clinic to discuss the SL ligament.  We discuss Sanj's path to his current role and his approach to the SL ligament including diagnosis and treatment.  

We refer to
Scapholunate Instability: Diagnosis and Management e Anatomy, Kinematics, and Clinical Assessment. Part I Lauren E. Wessel, MD,* Scott W. Wolfe, MD† 2023 (also part 2)

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Chuck and Chris discuss rock climbing injuries.  We review general hand and wrist injuries but focus on the classic injuries to the fingers and flexor tendon sheath.

We refer to
Upper Extremity Injuries in RockClimbers: Diagnosis and Management byLaura A. Sims, MD.  J Hand Surgery 2022; 47:662-72

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Chuck and Chris provide 7 pearls for graduating fellows before diving into a discussion on spanning plates.  Also in this episode- learn some of the ways that Chris is 'risk averse'.

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Chuck and Chris have a good discussion on FDP tendon avulsions and repair options.  We discuss whether the FDP should always be repaired in the setting of an intact FDS (a great deal of therapy is required and results are rarely excellent) and we discuss how we each repair the FDP.  We also reference a few items:

1) Carroll Tendon Pulling Forceps (this allows easy passage through tendon sheath)
2) Tendon weaver (passer).  Sharp instrument used for tendon weaves with tendon transfer surgery

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Chuck and Chris welcome Steve Frick to discuss leadership.  Steve is an exemplary leader who was Chief of Pediatric Orthopedic Surgery and Vice Chair at Stanford.  He is now headed back to Atrium Health/ OrthoCarolina in a leadership role.  We sat down with Steve at the annual leadership meeting of the AOA- American Orthopedic Association (and apologize for the ambient noise) to discuss his path and his leadership style and principles.

Steve references John Wooden's Pyramid of Success: https://www.thewoodeneffect.com/pyramid-of-success/

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Chuck and Chris talk through the 2024 JBJS 'What's New in Hand Surgery' written by Deb Bohn.  We discuss a number of interesting hand surgery topics including: wrist and hand arthritis, distal radius fracture, scaphoid fractures, metacarpal fractures, pediatric injuries, among other topics.  Great review of an important review of the literature from 2023.

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Chuck and Chris talk through the 2024 JBJS 'What's New in Hand Surgery' written by Deb Bohn.  We discuss only two topics in our part 1- trigger finger and carpal tunnel release.  A few key citations from some really interesting topics:

1. Bookman J, Rocks M, Noh K, Ayalon O, Hacquebord J, Catalano L, Glickel S.Determining the optimal dosage of corticosteroid injection in trigger finger. Hand (NY). 2023 May 16:15589447231170326.
2. Bitar H, Zachrisson AK, Bystr¨om M, Str¨omberg J. Day-by-day symptom relief aftercorticosteroid injection for trigger digit: a randomized controlled
3. Wu RT, Walker ME, Peck CJ, Liu YJ, Hetzler P, Le NK, Smetona J, Thomson JG.Differential pulley release in trigger finger: a prospective, randomized clinical trial.Hand (N Y). 2023 Mar;18(2):244-9.
4. Blazar PE, Zhang D, Bryant JK, Benavent KA, Yeung CM, Earp BE. Patient perceivedoutcomes of recovery after trigger digit release. J Hand Surg Am. 2023May 3:S0363-5023(23)00167-3.
5. Koopman JE, Zweedijk BE, Hundepool CA, Duraku LS, Smit J, Wouters RM, SellesRW, Zuidam JM; Hand-Wrist Study Group. Prevalence and risk factors forpostoperative complications following open A1 pulley release for a trigger finger orthumb. J Hand Surg Am. 2022 Sep;47(9):823-33.
6. Matzon JL, Lebowitz C, Graham JG, Lucenti L, Lutsky KF, Beredjiklian PK. Risk ofinfection in trigger finger release surgery following corticosteroid injection. J HandSurg Am. 2020 Apr;45(4):310-6.
7. Straszewski AJ, Lee CS, Dickherber JL, Wolf JM. Temporal relationship ofcorticosteroid injection and open release for trigger finger and correlation withpostoperative deep infections. J Hand Surg Am. 2022 Nov;47(11):1116.e1-11.
8. Gray AM, Patel AC, Kaplan FTD, Merrell GA, Greenberg JA. Occult amyloiddeposition in older patients presenting with bilateral carpal tunnel syndrome ormultiple trigger digits. J Hand Surg Am. 2023 Jun 22:S0363-5023(23)00258-7.
9. Gannon NP, Ward CM.Results of implementation if amyloidosis screening forpatients undergoing carpal tunnel release. J Hand Surg Am. 2023 Jan 14:S0363-5023(22)00540-8.
10. Nelson JT, Gay SS, Diamond S, Gauger M, Singer RM. Warning signs: occultdiabetes and dysglycemia in the hand surgery patient population. Hand (N Y). 2022Dec 23:15589447221142893.
11. Meyers A, Annunziata MJ, Rampazzo A, Bassiri Gharb B. A systematic review ofthe outcomes of carpal ligament release in severe carpal tunnel syndrome. J HandSurg Am. 2023 Apr;48(4):408.e1-18.
12. Doi K, Marei AE, Mane SA, Hattori Y, Sakamoto S, Sonezaki S, Saeki Y. Reevaluationof the indications for the Camitz procedure in severe carpal tunnelsyndrome. J Hand Surg Am. 2023 May 12:S0363-5023(23)00171-5.
13. Piñal FD. Hand allodynia, lack of finger flexion, and the need for carpal tunnelrelease. J Hand Surg Am. 2023 Apr;48(4):370-6.

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Chuck and Chris catch up on life, travels and cases.  We discuss Chuck's recent mission trip with World Pediatrics and pivot to discuss a few cases including care of the phalanx enchondroma and pain at the pisiform.

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Chuck and Chris welcome Amanda Lovelace who is the Marketing Director for our large orthopedic department.  We share a fantastic first discussion including marketing directions, the importance of personal relationships, how social can be considered, among many other topics.  

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Chuck and Chris begin this episode with a discussion of ray resection and then pivot to discuss practice management and payer mix in our practices as well as the benefits and challenges of workers compensation.

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Chuck and Chris are joined by special guest Macy Stonner who brings her therapy expertise to the topic of finger fractures.  This episode will revisit common fractures and the therapist perspective to outstanding outcomes.

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Chuck and Chris answer a few listener- submitted questions and then take a deep dive into their approach to finger fractures with a specific focus on Kirshner wires, k-wires.

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Chuck and Chris welcome Ryan Nunley to the Podcast.  Ryan is a total joint surgeon who has an amazingly busy clinical practice.  We discuss practice efficiency, handling VIPs, and share updates on computer navigation and robotic surgery.  There is so much we can learn!

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Chuck and Chris discuss patients with dupuytrens disease (in office and in the OR) including our protocols for care after formal surgery. We also discuss some challenges with needle procedures in the office.  We touch on our trial of AI for clinic note generation and look forward to listener comments.  And finally, we touch on leadership with a deep dive on the HBR article: The New Rules of Executive Presence by Sylvia Ann Hewlett.  This article compares leadership criteria from 2012 to 2022 and the differences in priorities are great discussion points.

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Chuck and Chris catch up on with listener submitted questions and then discuss the volar approach to the scaphoid for scaphoid nonunions.

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Chuck and Chris catch up on with listener submitted questions on technical aspects of two procedures: a deep dive on CMC arthroplasty with suture tape suspension and the indications for subcutaneous vs submuscular ulnar nerve transposition.  We close with a brief discussion of  medial epicondyle fractures with ulnar nerve pathology.

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Chuck and Chris welcome 2024 and season #5 with a technical episode on the treatment of Kienbocks disease.  We discuss patient evaluation and surgical considerations including radius shortening, vascularized bone flaps, carpal pinning, and so much more.  

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Chuck and Chris with a bonus, year- end episode with listener questions, CMC fusion case discussion, and an HBR review on the importance of positive energy.  This was a really a catch- up episode and we catch up on Chris' travel, Chuck's b-school, and other timely topics.


HBR: The Best Leaders have Contagious Positive Energy.  Emma Seppala and Kim Cameron.  April 18, 2022.  Reprint HO6ZUL

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Chuck and Chris welcome Tony Smith and Steve McCabe to discuss the founding of the Hand Society and Sterling Bunnell.  The two have been on an amazing journey of primary research to learn more about Sterling Bunnell.  They share insights with us in advance of their expected biography.  Join us for some exciting history of hand surgery.

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Chuck and Chris discuss the adolescent medial epicondyle fracture and a group of patients with a challenging outcome.  This deep dive into the pathology and the technical considerations for treatment help us better understand the fracture, the relationship of the ulnar nerve, and more

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Chuck and Chris build on a hand society symposium led by Don Lalonde- What to Say and What not to Say to patients.  Chuck and Chris discussion tips to build the patient relationship and challenges in doing so.  We look forward to your thoughts and your tips.  We also discuss the medical school tradition of the white coat ceremony!

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Chuck and Chris have a brief discussion about Chuck's Executive MBA program and then take a deep dive on a laceration in the distal forearm- the so- called spaghetti wrist.  We talk details including the technical aspects of the procedure and patient expectations.

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Chuck and Chris are joined my Marschall Berkes, Chief of Orthopaedic Trauma at Washington University Orthopedics to discuss clavicle fractures.  Recognizing that many hand surgeons treat the entire upper extremity including clavicle fractures, Marschall's perspective will be interesting to many listeners.  We discuss indications, approach, technique, etc.

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Chuck and Chris discuss the Hand Society meeting in Toronto including the highlights for each of them.  They also discuss a pediatric elbow case including dome osteotomy treatment.  And, if you listen to the end, you will learn more about the Drake show in Toronto!

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Chuck and Chris discuss a three new Journal of Hand Surgery articles for our podcast journal club.  Join us and share any thoughts!

Isaacs, Nydick, Means, Merrell, Ilyas, Levine and RECON study group.  A multicenter prospective randomized comparison of conduits versus decellularized nerve allografts for digital nerve repairs.  JHS 2023

Guidi, et al Distraction arthroplasty for basal joint arthritis: 10 year follow- up JHS 2023; 48: 796-802

Carroll, et al Endoscopoic versus open carpal tunnel surgery: risk factors and rates of revision surgery.  JHS  2023; 48: 757-63

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Chuck and Chris welcome Macy Stonner back for an in depth discussion of CMC arthritis and post surgical management.  As usual, Macy brings great insights which are pertinent for anyone caring for patients with thumb pain.  We also discuss a listener submitted question on the differences between TMR and RPNI.

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Chuck and Chris start with a brief discussion on coding before taking a deeper dive on acute median nerve repair based on a listener question regarding tension during repair (tension on the nerve, not tension of the surgeon).  We then pivot to volar scaphoid approach and pearls.

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Chuck and Chris start with a deep dive on a few technical points with ulnar nerve surgery.  Next we tackle a listener question on management of hook of the hamate fractures.  And finally, we discuss life as a busy clinician and how we respond to different requests- it can be ok say 'no' to academic/ life requests if there simply is no time.

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Chuck and Chris are joined by a special guest, Megan Conti Mica currently at the University of Chicago.  The three of us catch up a bit with a hand club discussion before diving in to a technical discussion of distal radius malunion.

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Chuck and Chris discuss use a listener submitted case as the basis of a discussion of the PIP joint.  We break down treatment considerations for a dorsally subluxated PIP joint that is stiff in extension.  Dive in with us- complicated discussion!  We also briefly touch on FPL ruptures, the rheumatoid hand (and the disappearing art of treating it).

The stiff finger was a part of our discussion- here is the reference which might be helpful.
Jupiter, Goldfarb, Nagy, Boyer Posttraumatic reconstruction of the hand.
J Bone Joint Surg Am; 2007 Feb;89(2):428-35.  

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Chuck and Chris discuss the 4th of July and fireworks injuries.  We review the most common presentations and treatment including acute and delayed.  We then pivot to review three interesting and recent publications.

Bulstra and the Machine Learning Consortium, "A Machine Learning Algorithm to Estimate the Probability of a True Scaphoid Fracture after Wrist Trauma."  J Hand Surg 2022: 47: 709-718

Schmidt, et al, "Association between radiographic and clinical outcomes following distal radius fractures". J Bone Joint Surgery 2023; 1-12

Loewenstein, et al "Ulnar wrist denervation..."  J Hand Surg 2023; 48: 544-552

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Chuck and Chris spend a few minutes catching up before taking a deep dive into the assessment and care of the scaphoid nonunion.  We discuss general approach before discussing the technical details of fixation.

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Chuck and Chris catch up before and after some major travel and then dive into the impact of patient age on treatment decisions.  We use scaphoid fractures and cubital tunnel as the basis of this discussion.  Do we make inappropriate assumptions about young patients' healing abilities?  And when we operate, do we treat patients differently- what's the evidence?

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Season 4, Episode 15.
 
Chuck and Chris discuss community and what it is so important.  We begin, however, discussing kids, coaching and other activities before pivoting into a discussion on burnout and how community helps!  More and more brunout is a topic that matters.  While time away from work and time with family is one burnout remedy, another is connection or, for the purposes of this discussion, community.  We discuss 7 important communities (actually more) that engage us and give us a connection that matters.  Join us!

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Chuck and Chris share a live podcast from Singapore at the 13th Congress of the Asian Pacific Federation of Societies for Surgery of the Hand, the 9th Congress of the APFSHT, and the 8th APWA.    We are grateful to many for this opportunity, especially Soumen Das De.

We interview Dr. Yuan-Kun Tu from Taiwan who is known internationally for his positive perspective, spirit of giving, and care of patients with brachial plexus injuries and congenital hand differences.  Listen how he uses the violin as one tool for young patients with various hand differences.  He speaks to the role of a doctor and how it should be a mission for life.

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Season 4, Episode 13.  
Chuck and Chris spend the first 20 minutes of this nearly hour- long episode discussing past and future travel- the meetings, the patient care challenges, etc.  Then we pivot to deep dive with a discussion on a case of FPL rupture after volar plating of a distal radius fracture.  While uncommon, this problem can be a real challenge and we discuss  efforts to minimize, diagnosis, and treatment.  Join us!

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Season 4, Episode 12.  
Chuck and Chris welcome two amazing guests: Mireia Esplugas from Barcelona, Spain and David McCombe from Melbourne, Australia.  Our guests join us to discuss the March 2023 special issue of JHS European, Unsolved problems in hand surgery.  David McCombe was the guest editor of this special journal.  We chose two articles to discuss with our guests.  Tham and McCombe authored "Trapeziometacarpal joint arthritis in the young patient" and Salva-Coll, Esplugas, Carreno, and Lluch- Bergada authored "Kienbovks disease: preventing disease progression in early- stage disease."  We enjoyed this collaborative effort between The Upper Hand Podcast, Journal of Hand Surgery European, the British Society for Surgery of the Hand, and FESSH

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Season 4, Episode 11.  
Chuck and Chris welcome Macy Stonner back, our good friend and friendly hand therapist extraordinaire!  Macy will lead our discussion on mallet fingers.  She will share tips and tricks and we will all share our thoughts about this 'routine' but sometimes challenging diagnosis.

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Season 4, Episode 10.  
Chuck and Chris take a deep dive into Deborah Bohn's What's New in Hand Surgery in JBJS, part 2!  Chuck also drops some news on a new endeavor.

JBJS 2023; 105:428-34

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Season 4, Episode 9.  
Chuck and Chris take a deep dive into Deborah Bohn's What's New in Hand Surgery in JBJS.  The article covers key new articles into our favorite research topics in hand surgery.  This is Part 1 of a two part series.

JBJS 2023; 105:428-34

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Season 4, Episode 8.  
Chuck and Chris record a second episode in Las Vegas during the AAOS.    We start by talking Vegas and Chris' dining choices.  We discuss research pathways recognizing Chris's amazing accomplishment of  winning the  Kappa Delta Young Investigator Award.  We share reflections on our recent fellowship interview day (and the remarkable candidates) before discussing a reader- submitted case on AIN palsy. 

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Season 4, Episode 7.  Chuck and Chris gather in Las Vegas during the AAOS meeting and spend some catching up.  The bulk of this podcast is Chris' interview with Lee Dellon, who has retired and is living in Las Vegas.  Dr. Dellon has done a great deal to advance the field of nerve surgery - authoring numerous publication, training many of today's nerve experts, and helping to establish key nerve related groups.  He shares his thoughts on various nerve topics including cubital tunnel syndrome

https://en.wikipedia.org/wiki/A._Lee_Dellon

Dr Dellon also references a new book: https://www.amazon.com/Prosector-Lee-Dellon-MD/dp/B0B2TBHX4H

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Season 4, Episode 6.  Chuck and Chris gratefully review comments from listeners with a few listener questions sprinkled in.  And, we review a few cases with some interesting perspectives on revising an ulnar nerve and lengthening bone (Different cases).

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Season 4, Episode 5.  Chuck and Chris are back, on our new every other week schedule.  In this episode, we discuss take-aways from two recent ASSH Webinars, one on wrist arthroscopy and one on the ulnar nerve.  Then, we take a deep dive on an HBR article, "How to Work with a Workaholic Colleague".  

HBR, Feb 2023, written by Melody Wilding.

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Season 4, Episode 4.  Chuck and Chris discuss major technical changes to their surgical practices as well as a few practice management changes.  Learn how we now approach ulnar nerve transposition, cmc arthritis, and other procedures differently today compared to 5 years ago.  We also share a MAJOR announcement- tune in and learn what's changing about our release schedule!

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Season 4, Episode 3.  Chuck and Chris discuss Chris' visit to the AAHS in South Florida and then discuss practice development.  We brainstorm the best techniques to make others in the community, region, and medical world aware of your interests.  First, of course, take great care of patients.  And then...  Join us and learn more!

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Season 4, Episode 2.  Chuck and Chris return after one week off to catch up and begin a discussion on claw hand. We describe presentation and etiology and start to discuss surgical treatment.  More to come on this topic.

Referenced manuscript: Goldfarb CA and Stern PJ Low Ulnar Nerve Palsy  Journal of the American Society for Surgery of the Hand, Feb 2003, 3:14-26

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Season 4, Episode 1.  In our inaugural episode for season 1, Chuck and Chris welcome Amy Moore and Dominic Power to discuss nerve!  Specifically, in this journal club format we review 4 recent JHS European articles as a format to discuss current concepts in diagnosis and treatment of carpal tunnel syndrome.  Amy and Dom share their extensive experience and insights in this collaborative effort between The Upper Hand Podcast, Journal of Hand Surgery European, the British Society for Surgery of the Hand, and FESSH.  Enjoy!

Carita, et al High- resolution ultrasound in the diagnosis of failed carpal tunnel decompression: a study of 35 cases.  JHS Eur 47:364-68, 2022

Mackenzie, et al.  Carpal tunnel decompression in patients with normal nerve conduction studies.  JHS Eur 45: 260-4, 2020

Asserson, et al.  Return to work following ultrasound guided thread carpal tunnel release versus open carpal tunnel release: a comparative study.  JHS Eur 47: 359-63, 2022

Ratasvuori, et al.  Ultrasonography for the diagnosis of carpal tunnel syndrome: correlation of clinical symptoms, cross- sectional areas and electroneuromyography.  JHS Eur 47: 369-74, 2022


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Season 3, Episode 50.  Chuck and Chris welcome Michael Galvez from Valley Childrens Hospital to discuss DE&I in hand surgery.  Michael co-edited, with Kevin Chung, the latest edition of Hand Clinics with a number of outstanding contributions from hand surgeons across the United States.  This volume of Hand Clinics has insights and practical recommendations for all of us considering the challenges and opportunities around diversity, equity, and inclusion.  Three months of free access at:

https://www.hand.theclinics.com/current

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Season 3, Episode 49.  Chuck and Chris  continue with this 4 part segment on radial nerve injuries.  In this podcast, Macy joins us to discuss her role in patient assessment and her perspective on both tendon transfers and nerve transfers to address radial nerve injury/ palsy.

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Season 3, Episode 48.  Chuck and Chris  continue with this 4 part segment on radial nerve injuries.  In this podcast, we discuss tendon transfers as treatment for the radial nerve injury.  We discuss the three key transfers including wrist extension, thumb extension/ retropulsion, and finger MCP joint extension.  We plan one additional episodes on therapy before and after radial nerve palsy treatment in this series. 


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Season 3, Episode 47.  Chuck and Chris  continue with this 4 part segment on radial nerve injuries.  In this podcast, we discuss nerve transfers as treatment for the radial nerve injury.  We plan additional episodes on tendon transfer and therapy in this series.

References:
Ray WZ, Mackinnon SE. Clinical outcomes following median to radial nerve transfers. J Hand Surg Am. 2011 Feb;36(2):201-8. doi: 10.1016/j.jhsa.2010.09.034. Epub 2010 Dec 18. PMID: 21168979; PMCID: PMC3031762.

Bertelli JA. Nerve Versus Tendon Transfer for Radial Nerve Paralysis Reconstruction. J Hand Surg Am. 2020 May;45(5):418-426. doi: 10.1016/j.jhsa.2019.12.009. Epub 2020 Feb 21. PMID: 32093993.

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Season 3, Episode 46.  Chuck and Chris  begin the first of a 4 part segment on radial nerve palsy.  In this podcast, we discuss diagnosis, evaluation, and initial management of patients with radial nerve palsy.  We plan episodes on tendon transfer, nerve transfer, and therapy in this population.  Note- we apologize for some background noise (kids).


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Season 3, Episode 45.  Chuck and Chris  talk about a new HBR article by Bill Taylor, "Your Competitors Aren’t Always Who You Think They Are".  We explore what this means in healthcare and how we can optimize the patient experience.

https://hbr.org/2022/11/your-competitors-arent-always-who-you-think-they-are

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Season 3, Episode 44.  Chuck and Chris  talk international 'mission' trips with Chuck's trip to St Vincent with the World Pediatric Project just finished.  Grateful to supporters including the Touching Hands of the ASSH and Orthopediatrics as well.  Hear more on thoughts on what makes a great team and a successful trip.

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Season 3, Episode 43.  Chuck and Chris  discuss their current strategies in treating Dupuytrens disease.  In an update from our previous Charlie Eaton interview , we describe our indications, treatment strategies, and outcomes with various procedures.  We focus on open fasciectomy and needle aponeurotomy.

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Season 3, Episode 42.  Chuck and Chris  talk about two topics, completely unrelated!  First, we discuss an important reader- submitted comment regarding fellowship interviews.  And second, we discuss how we handle the common issue of finger injuries and potential amputations.

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Season 3, Episode 39.  Chuck and Chris  talk about Chris' favorite topic, NERVE!  Today we discuss the common peroneal nerve. We discusse how patients come to us, how we assess preoperatively including workup, and the surgery- common peroneal nerve decompression.  

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Season 3, Episode 40.  Chuck and Chris host a live podcast in Boston during the ASSH Annual meeting.  This is our second live podcast and, we hope, a step forward in quality and content after our inaugural effort, the London IFSSH Live Podcast.  Still some audio quality opportunities but we are making progress!

There was great audience questions and this led to good discussion on life, balance, burnout, and other topics.  We had a few audience luminaries jump right in include Jonathan Hobby and previous guest Sam Moghtaderi.  

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Season 3, Episode 39.  Chuck and Chris host a live podcast in Boston during the ASSH Annual meeting.  This is our second live podcast and, we hope, a step forward in quality and content after our inaugural effort, the London IFSSH Live Podcast.  Still some audio quality opportunities but we are making progress!

There was great audience questions and this led to good discussion on life, balance, burnout, and other topics.  We had a few audience luminaries jump right in include Jonathan Hobby and previous guest Sam Moghtaderi.  

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Season 3, Episode 38.  Chuck and Chris welcome Pete Carter back for his story of the founding of the American Society for Surgery of the Hand.  Pete shared this story years ago at the annual meeting of the ASSH and retells it here for us.  A politician, a general, and a duck hunter.

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Season 3, Episode 37.  Chuck and Chris welcome Pete Carter to discuss and introduce the next episode.  In this episode, we introduce Pete and discuss some his personal story and how his interest in the founding of the ASSH developed.

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Season 3, Episode 36.  Chuck and Chris follow- up last week's discussion with Jen Barna from the DocWorking Podcast with more talk about coaching and why it makes sense for many of us.   We also talk more about our personal solutions to resisting burnout.

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Season 3, Episode 35.  Chuck and Chris are joined by DocWorking Podcast host Jen Barna to discuss her podcast and services, discussing  key themes in including coaching, burnout, definitions of success and our individual approaches.  Jen introduces us to her podcast and services in the first half and then we discuss these themes in the second half.

Welcome to the Upper Hand Podcast.                                                                                        0:03
Introduction to Jen Barna, co-host of DocWorking Podcast                                         1:42
Coaching as a normal part of professional development.                                                10:22
Practical steps to consider to fight burnout                                                                             19:24
Success is very individual and you have to be honest with yourself.                          26:51

https://docworking.com
DocWorking provides coaching, courses, and resources designed specifically for physicians, with timely content, easy access, and transformational results...

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Season 3, Episode 34.  Chuck and Chris discuss nuances of the presentation of CMC arthritis with attention paid to hyperextension of the thumb MCP joint.

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Season 3, Episode 33.  Chuck and Chris catch up and review an interesting case with severe elbow arthritis and ulnar nerve pathology.  We discuss the role of the AIN transfer includes Chris' technique as well as treatment of the elbow arthritis while treating cubital tunnel syndrome.

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Season 3, Episode 32.  Chuck and Chris discuss a case of central slip laceration before diving into cubital tunnel syndrome including decision- making for decompression vs transposition and technique preferences. 

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As always, thanks to @iampetermartin for the amazing introduction and conclusion music.
theupperhandpodcast.wustl.edu.  

Season 3, Episode 31.  Chuck and Chris share exciting podcast milestone and announce a new giveaway to celebrate.  And then, we get down to a new topic- capitellar OCD, osteochondral defect, aka osteochondritis dissecans.  We share thoughts on diagnosis and treatment- what works, what doesn't, and so much more.

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theupperhandpodcast.wustl.edu.  

Season 3, Episode 30.  Chuck and Chris answer a listener question regarding national society involvement.  We share our opinions on societies, leadership, leadership training, traveling fellowships, and so much more!

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As always, thanks to @iampetermartin for the amazing introduction and conclusion music.
theupperhandpodcast.wustl.edu.  

Season 3, Episode 29.  Chuck and Chris discuss overcoming uncertainty as based on the HBR article "How to overcome your fear of the unknown" by authors Nathan Furr and Susannah Harmon Furr.  This article from the July-August issue is based on  the book, "The Upside of Uncertainty."  We found the article and its message fascinating and related the key points in this discussion.

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As always, thanks to @iampetermartin for the amazing introduction and conclusion music.
theupperhandpodcast.wustl.edu.  

Season 3, Episode 28.  Chuck and Chris welcome Farshid Guilak to discuss his remarkable research career and his approach to leadership, mentorship, and change.  This fun and interesting discussion of topics is certain to be of interest.  Farsh has a remarkable recor of research success (the only 3 time winner of the Kappa Delta Award) and built a thriving lab through supportive leadership and mentorship.   We discuss these topics and more (work- life balance and generational differences)

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theupperhandpodcast.wustl.edu.  

Season 3, Episode 27.  Chuck and Chris catch up, review some listener questions, and discuss their approaches to the scaphoid proximal pole nonunion, based on experience with literature guidance.

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As always, thanks to @iampetermartin for the amazing introduction and conclusion music.
theupperhandpodcast.wustl.edu.  And thanks to Eric Zhu, aspiring physician and podcast intern.

Season 3, Episode 26.  Chuck and Chris return home and back to the familiar format.  After catching up, we dive into cases before pivoting to listener emails.  We close it out with pearls for the upcoming oral boards (although the tips apply to any question and answer session).

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theupperhandpodcast.wustl.edu.  And thanks to Eric Zhu, aspiring physician and podcast intern.

Season 3, Episode 25.  Chuck and Chris on the road again before we head back home.  This is another episode recorded in Providence, Rhode Island during the AOA Annual Meeting.  We share a few cases and discuss ethics.  Specifically, complications from an outside surgeon or repeated less than ideal outcomes.  Join us and share your thoughts!


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theupperhandpodcast.wustl.edu.  And thanks to Eric Zhu, aspiring physician and podcast intern.

Season 3, Episode 24.  Chuck and Chris on the road again.  This time in Providence, Rhode Island for the AOA Annual Meeting.  We share a few cases and then share a few more social media insights we learned while in London.  Simply put, there is  amazing and impactful social media activity taking place across the world in hand surgery!


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theupperhandpodcast.wustl.edu.  And thanks to Eric Zhu, aspiring physician and podcast intern.

Season 3, Episode 23.  Chuck and Chris host a live podcast in London during the IFSSH meeting.  We tried some new technology and learned a lot!  Great audience (that we need to involve even more next time).  Presented a few cases with good discussion.  Many esteemed guests including Terry Light, Jeff Steppan, Wee Lam, and many others!


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theupperhandpodcast.wustl.edu.  And thanks to Eric Zhu, aspiring physician and podcast intern.

Season 3, Episode 22.  Chuck and Chris welcome hand therapist Macy Stoner back to the show to continue the CMC joint discussion.  Macy shares her thoughts on the role and specific modalities for nonsurgical care as well as thoughts on recovery post CMC arthroplasty.

Article referenced: Outcome of a Hand Orthosis and Hand Therapy for Carpometacarpal Osteoarthritis in Daily Practice: A Prospective Cohort Study.
Tsehaie J, Spekreijse KR, Wouters RM, Slijper HP, Feitz R, Hovius SER, Selles RW.
J Hand Surg Am. 2018 Nov;43(11):1000-1009.e1. doi: 10.1016/j.jhsa.2018.04.014.
PMID: 29776723

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theupperhandpodcast.wustl.edu.  And thanks to Eric Zhu, aspiring physician and podcast intern.

Season 3, Episode 21.  Chuck and Chris welcome hand therapist Macy Stoner back to the show to discuss the CMC joint.  Macy shares her thoughts on the role and specific modalities for nonsurgical care as well as thoughts on recovery post CMC arthroplasty.

Article referenced: Outcome of a Hand Orthosis and Hand Therapy for Carpometacarpal Osteoarthritis in Daily Practice: A Prospective Cohort Study.
Tsehaie J, Spekreijse KR, Wouters RM, Slijper HP, Feitz R, Hovius SER, Selles RW.
J Hand Surg Am. 2018 Nov;43(11):1000-1009.e1. doi: 10.1016/j.jhsa.2018.04.014.
PMID: 29776723

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theupperhandpodcast.wustl.edu.  And thanks to Eric Zhu, aspiring physician and podcast intern.

Season 3, Episode 20.  Chuck and Chris welcome ASSH Annual Meeting 2022 Chairs Glenn Gaston and Peter Rhee.  We discuss the September/ October meeting including all the planning and work that goes into the final product.  We discuss highlights of what we expect to be a fantastic meeting in Boston!

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theupperhandpodcast.wustl.edu.  And thanks to Eric Zhu, aspiring physician and podcast intern.

Season 3, Episode 19.  Chuck and Chris discuss a listener submitted question on the difficult patient.  How to best handle a challenging patient in the clinic.  We share our tips and pearls together with the reality of modern medicine.

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theupperhandpodcast.wustl.edu.  And thanks to Eric Zhu, aspiring physician and podcast intern.

Season 3, Episode 18.  Chuck and Chris use a classic HBR article to discuss generational differences in health care.  Gen Z vs Gen Y vs Boomers- does generation matter?  Are there more similarities than we thought?

How Gen Y and Boomers Will Reshape Your Agenda, by Hewlett, Sherbin, and Sumberg.  July- Aug 2009

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theupperhandpodcast.wustl.edu.  And thanks to Eric Zhu, aspiring physician and podcast intern.

Season 3, Episode 17.  Chuck and Chris discuss academia and education.  We also take a deep dive on a listener submitted case on nerve injury during carpal tunnel release.  We share insights on workup and surgical technique.

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theupperhandpodcast.wustl.edu.  And thanks to Eric Zhu, aspiring physician and podcast intern.

Season 3, Episode 16.  Chuck and Chris with a grab bag of topics including listener emails and a few very interesting surgical cases.  We will discuss the placebo effect and recovery after long bone fracture + a few nerve and elbow cases.

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theupperhandpodcast.wustl.edu.  And thanks to Eric Zhu, aspiring physician and podcast intern.

Season 3, Episode 15.  Chuck and Chris discuss  ECU tendon pathology including tendonitis and instability.  We review pertinent history, physical examination including the ECU Synergy Test, and surgical techniques including transposition of the tendon for instability.

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theupperhandpodcast.wustl.edu.  And thanks to Eric Zhu, aspiring physician and podcast intern.

Season 3, Episode 14.  Chuck and Chris discuss a listener suggestion for an episode: hand surgeries for the non hand surgeon.  We discuss common procedures for the non hand surgeon and provide our opinions on these cases.

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theupperhandpodcast.wustl.edu.  And thanks to Eric Zhu, aspiring physician and podcast intern.

Season 3, Episode 13.  Chuck and Chris review several listener questions and comments and then discuss coding.  We discuss our views on coding, review some cases and incorportate our clinical practice, academia vs private practice and refer to two different manuscripts. 

Coding Practices in Hand Surgery and Their Relationship to Surgeon Compensation Structure
Ryan M. Coyle, MD, , Amr M. Tawfik, BA,  Anna Green, MD,  Brian M. Katt, MD, y Steven Z. Glickel, MD    Journal of Hand Surgery Global Online 3 (2021) 161e166

Use of a pedicled adipose flap as a sling for anterior subcutaneous transposition of the ulnar nerve.  Danoff JR, Lombardi JM, Rosenwasser MP.  J Hand Surg Am. 2014 Mar;39(3):552-5. 

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theupperhandpodcast.wustl.edu.  And thanks to Eric Zhu, aspiring physician and podcast intern.

Season 3, Episode 12.  Chuck and Chris take a deep dive on radial tunnel decompression.  We discuss our preferred surgical technique and the pros and cons of the volar vs dorsal approaches.

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theupperhandpodcast.wustl.edu.  And thanks to Eric Zhu, aspiring physician and podcast intern.

Season 3, Episode 11.  Chuck and Chris discuss a leadership topic based on an HBR article from 2001:  "The Making of a Corporate Athlete" by Jim Loehr and Tony Schwartz.  We discuss the requirements for achieving sustained high achievement as detailed in the prescient article- physical capacity, emotional capacity, mental capacity, and spiritual capacity.  The concept of recovery (aka- avoiding burnout) is discussed.

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As always, thanks to @iampetermartin for the amazing introduction and conclusion music.
theupperhandpodcast.wustl.edu.  And thanks to Eric Zhu, aspiring physician and podcast intern.

Season 3, Episode 10.  Chuck and Chris welcome back Steve Moran to talk hand surgery.  Specifically, we discuss wrist salvage procedures the proximal row carpectomy (PRC) vs. the scaphoid excision and 4-bone fusion.  We talk technical aspects of the both procedures including neurectomies, handling of the capsule, order of operations, etc.

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theupperhandpodcast.wustl.edu.  And thanks to Eric Zhu, aspiring physician and podcast intern.

Season 3, Episode 9.  Chuck and Chris join the Peds Ortho Podcast, the official podcast of POSNA.  We introduce this special podcast which has been published on their channel and share the recording here.  The  podcast description from their site:
Special guests and hosts of "The Upper Hand" Podcast, Dr. Charles Goldfarb and Dr. Chris Dy from Washington University in St. Louis, join the podcast crew for a wide-ranging discussion on upper extremity conditions and the role of information technology in modern orthopaedic care. We review a recent article from the Wash U group about thematic analysis of online message boards for congenital upper extremity differences. Our guests contribute their insights on elbow stiffness and nerve injuries following pediatric trauma, as well as thoughts on bruise location in supracondylar humerus fractures, treatment of Monteggia injuries, cost-consciousness in parents, nerve transfers for brachial plexus birth palsy, and predicting radial head dislocations in MHE.

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As always, thanks to @iampetermartin for the amazing introduction and conclusion music.
theupperhandpodcast.wustl.edu.  And thanks to Eric Zhu, aspiring physician and podcast intern.

Season 3, Episode 8.  Chuck and Chris complete their review of the excellent JBJS Hand Surgery Update which details key manuscripts in 2021.  Written by Deb Bohn and Kelsey Wise, this is a great summary of new, key information in the hand surgery world.    Part 2.

Bohn DC and Wise KL, Whats New in Hand and Wrist Surgery.  JBJS, 2022;0: 1-8

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theupperhandpodcast.wustl.edu.  And thanks to Eric Zhu, aspiring physician and podcast intern.

Season 3, Episode 7.  Chuck and Chris review the excellent JBJS Hand Surgery Update which reviews key manuscripts in 2021.  Written by Deb Bohn and Kelsey Wise, this is a great summary of new, key information in the hand surgery world.  

Bohn DC and Wise KL, Whats New in Hand and Wrist Surgery.  JBJS, 2022;0: 1-8

Chris also references this review article on the ulnar nerve
Goldfarb, C. A., & Stern, P. J. (2003). Low ulnar nerve palsy. Journal of the American Society for Surgery of the Hand, 3(1), 14-26. https://doi.org/10.1053/jssh.2003.50006

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theupperhandpodcast.wustl.edu.  And thanks to Eric Zhu, aspiring physician and podcast intern.

Season 3, Episode 6.  Chuck and Chris talk baseball injuries with a focus on the wrist.  While the season may be delayed, its starting to feel like Spring Training!  We touch on the elbow but focus on three common wrist issues in baseball: hook of the hamate fractures, ECU tendon, and the TFCC.

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As always, thanks to @iampetermartin for the amazing introduction and conclusion music.
theupperhandpodcast.wustl.edu.  And thanks to Eric Zhu, aspiring physician and podcast intern.

Season 3, Episode 5.  Chuck and Chris talk congenital hand surgery.  Do you want to be the expert or do you believe that time spent learning about congenital conditions is a waste of your time.  We unpack it here and emphasize why there is a great deal for all of us to learn from congenital!

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As always, thanks to @iampetermartin for the amazing introduction and conclusion music.
theupperhandpodcast.wustl.edu.  And thanks to Eric Zhu, aspiring physician and podcast intern.

Season 3, Episode 4.  Chuck and Chris take a deep dive on scaphoid excision and 4-bone fusion.  After a brief case introduction, we discuss our decisions, preferences and techniques.  We also briefly discuss other options including proximal row carpectomy and capitate resurfacing.

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As always, thanks to @iampetermartin for the amazing introduction and conclusion music.
theupperhandpodcast.wustl.edu.  And thanks to Eric Zhu, aspiring physician and podcast intern.

Season 3, Episode 3.  Chuck and Chris share thoughts regarding zoom interviews in 2022.  We discuss our opinions on the format and pearls for successful interviewing.  Let us know your thoughts.

Sign up for The Upper Hand Podcast Newsletter: http://eepurl.com/hH5qfT

As always, thanks to @iampetermartin for the amazing introduction and conclusion music.
theupperhandpodcast.wustl.edu.  And thanks to Eric Zhu, aspiring physician and podcast intern.

Season 3, Episode 2.  Chuck and Chris share personal and work New Year's resolutions.  Then we share two interesting cases, one an unexplained nerve issue and the other a difficult PIP joint fracture.  Join us!

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As always, thanks to @iampetermartin for the amazing introduction and conclusion music.
theupperhandpodcast.wustl.edu.  And thanks to Eric Zhu, aspiring physician and podcast intern.

Season 3, Episode 1.  Chuck and Chris are excited for Season 3!  We share some updates and then dive in with a case discussion for our classification- guided approaches to managing Kienbocks Disease.

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As always, thanks to @iampetermartin for the amazing introduction and conclusion music.
theupperhandpodcast.wustl.edu.  And thanks to Eric Zhu, aspiring physician and podcast intern.

Season 2 Episode 48.  Chuck and Chris share and discuss a listener question about hand surgery call.  We then continue to listener submitted segment and share our 3 most memorable cases and lessons for our younger selves.

This is our last episode for 2021.  Looking forward to 2022!

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As always, thanks to @iampetermartin for the amazing introduction and conclusion music.
theupperhandpodcast.wustl.edu.  And thanks to Eric Zhu, aspiring physician and podcast intern.

Season 2 Episode 47.  Chuck and Chris discuss an FPL rupture case and respond to a listener requested segment: 3 Influential Mentors.  Each of us share 3 mentors including why each was so influential to us.

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As always, thanks to @iampetermartin for the amazing introduction and conclusion music.
theupperhandpodcast.wustl.edu.  And thanks to Eric Zhu, aspiring physician and podcast intern.

Season 2 Episode 46.  Chuck and Chris discuss TFCC injuries and repair.  We briefly review examination diagnosis but the deep dive focuses on repair technique.  The importance of foveal TFCC injury and repair is highlighted.

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As always, thanks to @iampetermartin for the amazing introduction and conclusion music.
theupperhandpodcast.wustl.edu.  And thanks to Eric Zhu, aspiring physician and podcast intern.

Season 2 Episode 45.  Chuck and Chris celebrate Thanksgiving by discussing why we feel thankful including specific people (think nurses, medial assistants, and hand therapists) places (ie Division and Department), and surgical instruments! (sounds odd but it flowed well)

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As always, thanks to @iampetermartin for the amazing introduction and conclusion music.
theupperhandpodcast.wustl.edu.  And thanks to Eric Zhu, aspiring physician and podcast intern.

Season 2 Episode 44.  Chuck and Chris welcome Lauren Wessel and her suggestion for a new segment: Half full or Half empty?  Lauren put together a list of controversial concepts and Chris and Chuck weigh in.  And, for those of you who like disagreement, there is plenty!

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As always, thanks to @iampetermartin for the amazing introduction and conclusion music.
theupperhandpodcast.wustl.edu.  And thanks to Eric Zhu, aspiring physician and podcast intern.

Season 2 Episode 43.  Chuck and Chris review 3 new journal articles pertinent to the practice of hand surgery.  Two are focused on steroid injection and the role this treatment has, especially in the treatment of carpal tunnel syndrome.  The third focuses on complications with local only surgery in a large database study. 

Yoshiaki Yamanaka, MD, PhD, Takafumi Tajima, MD, PhD, Yoshitaka Tsujimura, MD, et al (Department of Orthopaedic Surgery, School of Medicine, University of Occupational and Environmental Health, Fukuoka, Japan)
Molecular and Clinical Elucidation of the Mechanism of Action of Steroids in Idiopathic CarpalTunnel Syndrome J Bone Joint Surg Am. 2021;103:1777-87

Nikolas H. Kazmers, MD, MSE, Kate Peacock, MPH, Katelin B. Nickel, MPH, et al (University of Utah and Washington University Data Center) Comparison of Complication Risk Following Trigger Digit Release Performed in the Office Versus the Operating Room: A Population-Based Assessment
J Hand Surg Am. Vol. 46, October 2021

Manfred Hofer, BSc; Jonas Ranstam, PhD; Isam Atroshi, MD, PhD. (Department of Orthopedics, Kristianstad Hospital, Kristianstad, Sweden (Hofer, Atroshi);Department of Clinical Sciences–Orthopedics, Lund University, Lund, Sweden (Ranstam, Atroshi).)  Extended Follow-up of Local Steroid Injection for Carpal Tunnel SyndromeA Randomized Clinical Trial.  JAMA Network Open. 2021;4(10):e2130753. doi:10.1001

As always, thanks to @iampetermartin for the amazing introduction and conclusion music.
theupperhandpodcast.wustl.edu.  And thanks to Eric Zhu, aspiring physician and podcast intern.

Sign up for The Upper Hand Podcast Newsletter: http://eepurl.com/hH5qfT

Episode 42, Season 2.   Chuck and Chris are joined again by Jeff Stepan and Steve Lanier, two previous fellows both in their second year in hand surgery practice.  Jeff and Steve share their experiences starting practice in Chicago, in somewhat different practices.  Jeff is at the University of Chicago, Steve at NorthShore.   They share insights from their successful symposium at the ASSH:  Free Solo: Letting Go of the Rope - Lessons Learned from the First Year in Practice.  Finally, both are in the midst of the Boards process- lots of helpful information!

As always, thanks to @iampetermartin for the amazing introduction and conclusion music.
theupperhandpodcast.wustl.edu.  And thanks to Eric Zhu, aspiring physician and podcast intern.

Survey Link:
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Episoe 41, Season 2.  Chuck and Chris take a deep dive on leadership around The Great Resignation.  Employees across the USA are reconsidering their job, their careers, and their lives and are resigning in unprecedented numbers.  We use 2 HBR articles to frame our discussion.  We hope that listeners will engage and share their experiences.

References mentioned: 
1) The 3 Phases of Making a Major Life Change, Herminia Ibarra. HBR Augst 6, 2021
2) How to Help Your Team Get Out of a Lull, Merete Wedell- Wedellsborg  Oct 12, 2021

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Survey Link:
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As always, thanks to @iampetermartin for the amazing introduction and conclusion music.
theupperhandpodcast.wustl.edu.  And thanks to Eric Zhu, aspiring physician and podcast intern.

Episoe 40, Season 2.  Chuck and Chris are joined by Becky Neiduski, hand therapist and Dean of Health Sciences at Elon University.  This is a live taping of the podcast with a great discussion of flexor tendon injuries including the surgeon and therapist perspective.  Thanks to the ASHT for inviting and for sharing the recording!

We plan a newsletter launch soon.  Subscribe here:  https://wustl.us6.list-manage.com/subscribe?u=c6fe13919f69cbe248767c4e8&id=10e0c1dd85 

Survey Link:
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As always, thanks to @iampetermartin for the amazing introduction and conclusion music.
theupperhandpodcast.wustl.edu.  And thanks to Eric Zhu, aspiring physician and podcast intern.

Episoe 39, Season 2.  Chuck and Chris take a deep dive on another sports topic- thumb UCL repair.  We discuss primary repair and suture tape augmentation.  After a brief case introduction, we discuss the decisions the surgeon considers and the implications for cost and for recovery.

Reference mentioned: 
Michelle  Carlson, et al. Anatomy of the thumb metacarpophalangeal ulnar and radial collateral ligaments.  J Hand Surg Am . 2012 Oct;37(10):2021-6.  

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As always, thanks to @iampetermartin for the amazing introduction and conclusion music.
theupperhandpodcast.wustl.edu.  And thanks to Eric Zhu, aspiring physician and podcast intern.

Episoe 38, Season 2.  Chuck and Chris welcome guest Jorge Orbey to discuss his pathway to success.  Dr. Orbay has started two success companies and, more importantly, has directly impacted patient care with the volar plate and now with the internal elbow stabilizer.  He reflects on his path and provides thoughts for future innovators in hand surgery or any field.  We also learn technical pearls on the volar approach from Dr. Orbay.

We plan a newsletter launch soon.  Subscribe here:  https://wustl.us6.list-manage.com/subscribe?u=c6fe13919f69cbe248767c4e8&id=10e0c1dd85 

Survey Link:
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As always, thanks to @iampetermartin for the amazing introduction and conclusion music.
theupperhandpodcast.wustl.edu.  And thanks to Eric Zhu, aspiring physician and podcast intern.

Episode 37, Season 2.  Chuck and Chris discuss the ASSH Annual Meeting with the definitive recap episode.  Chris attended in person while Chuck attended virtually while holding down the fort in St Louis.  We discuss various sessions, the hybrid format, and lessons learned.  All in all, a great meeting under less than ideal circumstances.

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Survey Link:
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As always, thanks to @iampetermartin for the amazing introduction and conclusion music.
theupperhandpodcast.wustl.edu.  And thanks to Eric Zhu, aspiring physician and podcast intern.

Episode 36, Season 2: Chuck and Chris discuss their approach to a scapholunate ligament injury.  We discuss how we think about and approach these injuries with specifics on surgical approach and technique.

We plan a newsletter launch soon.  Subscribe here:  https://wustl.us6.list-manage.com/subscribe?u=c6fe13919f69cbe248767c4e8&id=10e0c1dd85 

Survey Link:
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As always, thanks to @iampetermartin for the amazing introduction and conclusion music.
theupperhandpodcast.wustl.edu.  And thanks to Eric Zhu, aspiring physician and podcast intern.

Episode 35, Season 2: Chuck and Chris discuss two HBR articles on presentations.  While these reflect on non medical lectures/ presentations, there are many valuable lessons to consider for those in the medical world.  Chris and I considered these lessons in preparation for the upcoming ASSH and ASHT meetings.

HBR articles
"What it takes to give a great presentation", Carmine Gallo 2020
"How to Give a Killer Presentation," by Chris Anderson 2013

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As always, thanks to @iampetermartin for the amazing introduction and conclusion music.
theupperhandpodcast.wustl.edu.  And thanks to Eric Zhu, aspiring physician and podcast intern.

Episode 34, Season 2: Chuck and Chris welcome Amy Moore and John Fowler, the Hand Society (ASSH) 2021 Annual Meeting Chairs, to discuss the San Francisco Meeting in San Francisco.   They share insights the meeting development, the program, the hybrid opportunity and so much more.   We start the discussion with a reader submitted question on loupe choices.

We plan a newsletter launch soon.  Subscribe here:  https://wustl.us6.list-manage.com/subscribe?u=c6fe13919f69cbe248767c4e8&id=10e0c1dd85 

Survey Link:
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As always, thanks to @iampetermartin for the amazing introduction and conclusion music.
theupperhandpodcast.wustl.edu.  And thanks to Eric Zhu, aspiring physician and podcast intern.

Episode 33, Season 2: Chuck and Chris welcome Rachel Pigott and Nora Barrett, the President and Annual Meeting Chair, respectfully, of the American Society of Hand Therapists to discuss the ASHT Annual Meeting in St. Louis, October 7th-10th.   They share insights about the ASHT and specifics about the annual meeting including highlights.   Its going to be a great meeting with some focus on nerve but a complete coverage of all pertinent hand therapist topics.  Note this podcast is abbreviated- the full, uncut version is on You Tube.

As always, thanks to @iampetermartin for the amazing introduction and conclusion music.
theupperhandpodcast.wustl.edu.  And thanks to Eric Zhu, aspiring physician and podcast intern.

Survey Link:
Help Chuck and Chris understand better what you like and what we can improve.  And be entered for drawing to win a mug!  https://bit.ly/349aUvz

Episode 32, Season 2: Chuck and Chris revisit the Wheel of Hand Surgery.  The spin of the wheel generates our discussion and this week we talk 'Never Have I Ever'.  Tune in to learn about dogma, what we do in practice that the literature may not support.  Including tennis elbow amongst other topics.

As always, thanks to @iampetermartin for the amazing introduction and conclusion music.
theupperhandpodcast.wustl.edu.  And thanks to Eric Zhu, aspiring physician and podcast intern.

Survey Link:
Help Chuck and Chris understand better what you like and what we can improve.  And be entered for drawing to win a mug!  https://bit.ly/349aUvz

Episode 34, Season 2: Chuck and Chris bring back "My Toughest Case" and Chris discusses a patient with scleroderma including evaluation and treatment options including sympathectomy.

As always, thanks to @iampetermartin for the amazing introduction and conclusion music.
theupperhandpodcast.wustl.edu.  And thanks to Eric Zhu, aspiring physician and podcast intern.

Survey Link:
Help Chuck and Chris understand better what you like and what we can improve.  And be entered for drawing to win a mug!  https://bit.ly/349aUvz

Episode 33, Season 2: Chuck and Chris welcome Terry Light, a mentor to many, to the show.  Terry shares his medicolegal thoughts on both how to avoid issues as well as when to consider expert witness work.  Many pearls for listeners of all levels and training.

As always, thanks to @iampetermartin for the amazing introduction and conclusion music.
theupperhandpodcast.wustl.edu.  And thanks to Eric Zhu, aspiring physician and podcast intern.

Survey Link:
Help Chuck and Chris understand better what you like and what we can improve.  And be entered for drawing to win a mug!  https://bit.ly/349aUvz

Episode 32, Season 2: Chuck and Chris talk Operating Room (OR) efficiency, specifically about running two rooms.  We discuss tactics, when a surgeon might be ready, and how to make the most of the opportunity.

As always, thanks to @iampetermartin for the amazing introduction and conclusion music.
theupperhandpodcast.wustl.edu.  And thanks to Eric Zhu, aspiring physician and podcast intern.

Survey Link:
Help Chuck and Chris understand better what you like and what we can improve.  And be entered for drawing to win a mug!  https://bit.ly/349aUvz

Episode 31, Season 2: Chuck and Chris introduce a new segment: The Wheel of Hand Surgery.  And, the Wheel guided on discussion this week on SLAC Wrist.  A bit on pathophysiology and more on treatment preferences.  
As always, thanks to @iampetermartin for the amazing introduction and conclusion music.
theupperhandpodcast.wustl.edu.  And thanks to Eric Zhu, aspiring physician and podcast intern.

Survey Link:
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Episode 30, Season 2: Chuck and Chris talk vacations- the science and the practice.  Using HBR references (HBR Article : We All Really Need a Vacation. Here’s How to Make the Most of It. by Art Markman. May 12, 2021) and our own experience/ challenges, we discuss the need for vacation, making the most of the vacation and some of the questions we all consider such as: 
Do you work on vacation?  
Do you answer emails and if you do, when? 
How do you prepare for re- entry? 
Do you leave an out of office email?  
How do you handle postoperative patients?

As always, thanks to @iampetermartin for the amazing introduction and conclusion music.
theupperhandpodcast.wustl.edu.  And thanks to Eric Zhu, aspiring physician and podcast intern.

Survey Link:
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Episode 29, Season 2.   Chuck and Chris start a new segment in their more structured approach.  This is the first episode of "My Hardest (recent) Case". Chuck shares a revision ulnar nerve case post subcutaneous transposition.  Chris and Chuck talk examination, nerve studies, technical approach and expectations.  Listen in!

As always, thanks to @iampetermartin for the amazing introduction and conclusion music.
theupperhandpodcast.wustl.edu.  And thanks to Eric Zhu, aspiring physician and podcast intern.

Survey Link:
Help Chuck and Chris understand better what you like and what we can improve.  And be entered for drawing to win a mug!  https://bit.ly/349aUvz

Episode 28, Season 2.   Chuck and Chris are joined by Jeff Stepan and Steve Lanier, two previous fellows both finishing their first year in hand surgery practice.  Jeff and Steve share their experiences starting practice in Chicago, in somewhat different practices.  Jeff is at the University of Chicago, Steve at NorthShore.  

Jeff and Steve are leading a Symposium at the ASSH on Saturday October 2nd at 9:30am, Free Solo: Letting Go of the Rope - Lessons Learned from the First Year in Practice.  Should be great!

As always, thanks to @iampetermartin for the amazing introduction and conclusion music.
theupperhandpodcast.wustl.edu.  And thanks to Eric Zhu, aspiring physician and podcast intern.

Survey Link:
Help Chuck and Chris understand better what you like and what we can improve.  And be entered for drawing to win a mug!  https://bit.ly/349aUvz

Episode 27, Season 2.   Chuck and Chris are joined by OT Macy Stonner to discuss therapy after finger fracture and therapy for the stiff finger.  Macy shares various tips and pearls to maximize patient outcomes.

We referenced an AAOS ICL published here: Post Traumatic Reconstruction of the Hand.  JBJS 89A: 428- 435,  2007

As always, thanks to @iampetermartin for the amazing introduction and conclusion music.
theupperhandpodcast.wustl.edu.  And thanks to Eric Zhu, aspiring physician and podcast intern.

Survey Link:
Help Chuck and Chris understand better what you like and what we can improve.  And be entered for drawing to win a mug!  https://bit.ly/349aUvz

Episode 26, Season 2.   Chuck and Chris discuss the stiff finger and the basic concepts required in assessment of these fingers.  We discuss the full range of issues from bone status to soft tissues,  tendon mobility to joint contractures. This will be part 1 with a more therapy focused colleague joining for part 2.

We referenced an AAOS ICL published here: Post Traumatic Reconstruction of the Hand.  JBJS 89A: 428- 435,  2007

As always, thanks to @iampetermartin for the amazing introduction and conclusion music.
theupperhandpodcast.wustl.edu.  And thanks to Eric Zhu, aspiring physician and podcast intern.

Survey Link:
Help Chuck and Chris understand better what you like and what we can improve.  And be entered for drawing to win a mug!  https://bit.ly/349aUvz

Episode 25, Season 2.   Chuck and Chris review PIP joint injuries, focusing on fracture/ dislocations and pilon injuries.  These are challenging injuries with a multitude of treatment choices.

As always, thanks to @iampetermartin for the amazing introduction and conclusion music.
theupperhandpodcast.wustl.edu.  And thanks to Eric Zhu, aspiring physician and podcast intern.

Survey Link:
Help Chuck and Chris understand better what you like and what we can improve.  And be entered for drawing to win a mug!  https://bit.ly/349aUvz

Episode 24, Season 2.   Chuck and Chris review 7 personal finance pearls.  This is an overview of critical points focused on a conservative approach to finance.  While it may be most appropriate for residents, fellows, and younger professionals, some tips will benefit everyone.
We welcome feedback.

As always, thanks to @iampetermartin for the amazing introduction and conclusion music.
theupperhandpodcast.wustl.edu.  And thanks to Eric Zhu, aspiring physician and podcast intern.

Survey Link:
Help Chuck and Chris understand better what you like and what we can improve.  And be entered for drawing to win a mug!  https://bit.ly/349aUvz

Episode 23, Season 2.   Chuck and Chris discuss radial tunnel syndrome.  They both believe in the diagnosis although find it uncommon.  We discuss diagnosis, conservative care and surgery.

As always, thanks to @iampetermartin for the amazing introduction and conclusion music.
theupperhandpodcast.wustl.edu.  And thanks to Eric Zhu, aspiring physician and podcast intern.

Survey Link:
Help Chuck and Chris understand better what you like and what we can improve.  And be entered for drawing to win a mug!  https://bit.ly/349aUvz

Episode 22, Season 2.   Chuck and Chris welcome noted pediatric sports medicine physician, Mark Halstead.  Mark has great experience caring for athletes at every level and we spend our talking youth sports, return to play, family dynamics and even pitch counts.  Mark shares pearls on many levels and explains why the athletic trainer relationships are so important.


As always, thanks to @iampetermartin for the amazing introduction and conclusion music.
theupperhandpodcast.wustl.edu.  And thanks to Eric Zhu, aspiring physician and podcast intern.

Survey Link:
Help Chuck and Chris understand better what you like and what we can improve.  And be entered for drawing to win a mug!  https://bit.ly/349aUvz

Episode 21, Season 2.   Chuck and Chris talk lumps and bumps, specifically ganglion cysts.  While the topic may seem mundane, the banter is decidedly not.  Join us and learn about Chris' PTSD and Chuck thermal approach.  A few citations are relavent.

Gross and Gelberman Metacarpal Rotational Osteotomy,  J Hand Surg 1985 10: 105-8

Balazs, Donohue, Drake, et al.  Outcomes of Open DWG excision in active- duty military personnel.  J Hand Surg 2015  40: 1739- 47

Gelberman and Blasingame The Timed Allen Test.  J Trauma 1981 21:477-9


As always, thanks to @iampetermartin for the amazing introduction and conclusion music.
theupperhandpodcast.wustl.edu.  And thanks to Eric Zhu, aspiring physician and podcast intern.

Survey Link:
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Episode 20, Season 2.   Chuck and Chris talk a reality of 2021: hybrid meetings.  We discuss current meetings and how the format might evolve.  And we discuss tips from a recent HBR article:  "How to Nail a Hybrid Presentation' by Sasrah Gershman and Rae Ringer.

As always, thanks to @iampetermartin for the amazing introduction and conclusion music.
theupperhandpodcast.wustl.edu.  And thanks to Eric Zhu, aspiring physician and podcast intern.

Survey Link:
Help Chuck and Chris understand better what you like and what we can improve.  And be entered for drawing to win a mug!  https://bit.ly/349aUvz

Episode 19, Season 2.   Chuck and Chris continue the new segment: deep dives on surgical technique.  We continue with another key procedure- the cubital tunnel decompression.  The focus is the exact technique that we use, from skin incision to treatment of the nerve to handling of the FCU.

Let us know if you like this segment and we welcome suggestions on other procedures to dive into.

As always, thanks to @iampetermartin for the amazing introduction and conclusion music.
theupperhandpodcast.wustl.edu.  And thanks to Eric Zhu, aspiring physician and podcast intern.

Survey Link:
Help Chuck and Chris understand better what you like and what we can improve.  And be entered for drawing to win a mug!  https://bit.ly/349aUvz

Episode 18, Season 2.   Chuck and Chris welcome Rob Kamal from Stanford to discuss distal radius fractures, the new Clinical Practice Guideline(CPG) on distal radius fracture, and quality in outcomes.    We do focus to unwind the CPG and highlight key points with Dr. Kamal who led this effort of the AAOS and ASSH.

As always, thanks to @iampetermartin for the amazing introduction and conclusion music.
theupperhandpodcast.wustl.edu.  And thanks to Eric Zhu, aspiring physician and podcast intern.

Survey Link:
Help Chuck and Chris understand better what you like and what we can improve.  And be entered for drawing to win a mug!  https://bit.ly/349aUvz

Episode 17, Season 2.   Chuck and Chris introduce a new segment: deep dives on surgical technique.  We start with the most basic and yet important procedure in hand surgery, carpal tunnel release.  We share our mini open approach to release the transverse carpal ligament.  And then we pivot to discuss the setup and execution of wrist arthroscopy.  

Let us know if you like this segment and we welcome suggestions on other procedures to dive into.

As always, thanks to @iampetermartin for the amazing introduction and conclusion music.
theupperhandpodcast.wustl.edu.  And thanks to Eric Zhu, aspiring physician and podcast intern.

Survey Link:
Help Chuck and Chris understand better what you like and what we can improve.  And be entered for drawing to win a mug!  https://bit.ly/349aUvz

Episode 16, Season 2.  Chuck and Chris talk about two manuscripts that we both really appreciate.  The first is from HBR on Mentoring,  "Making Mentorship a Team Effort" published on March 17, 2020.  This article suggests that mentoring should be a team effort with a Launch Team, a Cruise Team and a Boost Team.

The other is a recent J Hand Surgery manuscript, a prospective, randomized trial on scaphoid nonunion care. by Hegazy, et al. "Structural Versus Nonstructural Bone Grafting forthe Treatment of Unstable Scaphoid WaistNonunion Without Avascular Necrosis:A Randomized Clinical Trial" 

As always, thanks to @iampetermartin for the amazing introduction and conclusion music.
theupperhandpodcast.wustl.edu.  And thanks to Eric Zhu, aspiring physician and podcast intern.

Survey Link:
Help Chuck and Chris understand better what you like and what we can improve.  And be entered for drawing to win a mug!  https://bit.ly/349aUvz

Episode 15, Season 2.  Chuck and Chris talk about pediatric finger fractures including gamekeepers (aka skiers thumb) and bony mallet fractures.

As always, thanks to @iampetermartin for the amazing introduction and conclusion music.
theupperhandpodcast.wustl.edu.  And thanks to Eric Zhu, aspiring physician and podcast intern.

Survey Link:
Help Chuck and Chris understand better what you like and what we can improve.  And be entered for drawing to win a mug!  https://bit.ly/349aUvz

Episode 14, Season 2.  Chuck and Chris talk about Goldman Sachs work schedule, Chris' recent accomplishment, NCAA basketball and, oh right, pediatric phalanx fractures including extra octave fractures, subcondylar fractures, and Seymour fractures (amongst others).


As always, thanks to @iampetermartin for the amazing introduction and conclusion music.
theupperhandpodcast.wustl.edu.  And thanks to Eric Zhu, aspiring physician and podcast intern.

Survey Link:
Help Chuck and Chris understand better what you like and what we can improve.  And be entered for drawing to win a mug!  https://bit.ly/349aUvz

Episode 13, Season 2.  Chuck and Chris use a new HBR article as the basis for this episode on thinking vs overthinking and share 5 steps to consider.  We talk intuition, perseveration, and other challenges in providing the best care for our patients.  The article link is below, author Melody Wilding.

Article: https://hbr.org/2021/02/how-to-stop-overthinking-everything

As always, thanks to @iampetermartin for the amazing introduction and conclusion music.
theupperhandpodcast.wustl.edu.  And thanks to Eric Zhu, aspiring physician and podcast intern.

Survey Link:
Help Chuck and Chris understand better what you like and what we can improve.  And be entered for drawing to win a mug!  https://bit.ly/349aUvz

Episode 12, Season 2.  Chuck and Chris use Chris' recent JBJS article on 'What's New in Hand Surgery' as a basis of discussing the literature and their approaches to common problems.  This is the third episode which focuses on the CMC joint, Dupuytrens, the scaphoid, and other exciting areas!

Chris' article can be found at JBJS.org

As always, thanks to @iampetermartin for the amazing introduction and conclusion music.
theupperhandpodcast.wustl.edu.  And thanks to Eric Zhu, aspiring physician and podcast intern.

Survey Link:
Help Chuck and Chris understand better what you like and what we can improve.  And be entered for drawing to win a mug!  https://bit.ly/349aUvz

Episode 11, Season 2.  Chuck and Chris use Chris' recent JBJS article on 'What's New in Hand Surgery' as a basis of discussing the literature and their approaches to common problems.  This is the second episode which focuses on nerve and distal radius.

Chris' article can be found at JBJS.org

As always, thanks to @iampetermartin for the amazing introduction and conclusion music.
theupperhandpodcast.wustl.edu.  And thanks to Eric Zhu, aspiring physician and podcast intern.

Survey Link:
Help Chuck and Chris understand better what you like and what we can improve.  And be entered for drawing to win a mug!  https://bit.ly/349aUvz

Episode 10, Season 2.  Chuck and Chris use Chris' recent JBJS article on 'What's New in Hand Surgery' as a basis of discussing the literature and their approaches to common problems.  This episode focuses on carpal and cubital tunnel syndromes.

Chris' article can be found at JBJS.org

As always, thanks to @iampetermartin for the amazing introduction and conclusion music.
theupperhandpodcast.wustl.edu.  And thanks to Eric Zhu, aspiring physician and podcast intern.

Survey Link:
Help Chuck and Chris understand better what you like and what we can improve.  And be entered for drawing to win a mug!  https://bit.ly/349aUvz

Episode 9, Season 2.  Chuck and Chris talk to Rob Gray from Chicago and Orrin Franko from the San Francisco Bay Area on their approaches to marketing.  In this episode, we focus on practice development and marketing with Rob and Chris who are not in the classic academic models.  We learn about their approach to all things marketing including patient reviews.  

robgraymd.com
https://ebhmc.com/dr-franko/
https://surgisurvey.com

As always, thanks to @iampetermartin for the amazing introduction and conclusion music.
theupperhandpodcast.wustl.edu.  And thanks to Eric Zhu, aspiring physician and podcast intern.

Survey Link:
Help Chuck and Chris understand better what you like and what we can improve.  And be entered for drawing to win a mug!  https://bit.ly/349aUvz

Episode 8, Season 2.  Chuck and Chris talk about CMC fracture/ dislocations including the Bennett Fracture and the 4/5 dislocation w hamate fracture.  We share our thoughts and strategies towards fixation and return to sports.

As always, thanks to @iampetermartin for the amazing introduction and conclusion music.
theupperhandpodcast.wustl.edu.  And thanks to Eric Zhu, aspiring physician and podcast intern.

Survey Link:
Help Chuck and Chris understand better what you like and what we can improve.  And be entered for drawing to win a mug!  https://bit.ly/349aUvz

Episode 7, Season 2.  Chuck and Chris talk to Aaron Perlut, cofounder of Elasticity Marketing (https://goelastic.com) and author of "F!!ck Your Formula: Why Following Rules Is the Worst Marketing".  Aaron shares basic marketing principles including start with the "why".  We discuss various principles including online reputation management, SEO (search engine optimization) and the differences between B2B (business to business) marketing and direct to consumer marketing.  Finally, we hit on some age group differences and various online platforms.

As always, thanks to @iampetermartin for the amazing introduction and conclusion music.
theupperhandpodcast.wustl.edu.  And thanks to Eric Zhu, aspiring physician and podcast intern.

Survey Link:
Help Chuck and Chris understand better what you like and what we can improve.  And be entered for drawing to win a mug!  https://bit.ly/349aUvz

Episode 6, Season 2. 
Chuck and Chris discuss a clinical topic between our marketing podcasts.  We share our thoughts on pronator syndrome- its diagnosis, the pertinent anatomy, and treatment.

As always, thanks to @iampetermartin for the amazing introduction and conclusion music.
theupperhandpodcast.wustl.edu.  And thanks to Eric Zhu, aspiring physician and podcast intern.

Survey Link:
Help Chuck and Chris understand better what you like and what we can improve.  And be entered for drawing to win a mug!  https://bit.ly/349aUvz

Episode 5, Season 2. 
Chuck and Chris discuss practice development and marketing.  We share our 'stories' on how our academic practices came to be and our priorities in this process.  We also share some brief thoughts on practice marketing, social media, and the like.

As always, thanks to @iampetermartin for the amazing introduction and conclusion music.
theupperhandpodcast.wustl.edu.  And thanks to Eric Zhu, aspiring physician and podcast intern.

Survey Link:
Help Chuck and Chris understand better what you like and what we can improve.  And be entered for drawing to win a mug!  https://bit.ly/349aUvz

Episode 4, Season 2. 
Chuck and Chris discuss residency and fellowship virtual interviews.  We discuss helpful tips and trends.  These interviews have been fascinating and there are both good and bad qualities to consider.

As always, thanks to @iampetermartin for the amazing introduction and conclusion music.
theupperhandpodcast.wustl.edu.  And thanks to Eric Zhu, aspiring physician and podcast intern.

Survey Link:
Help Chuck and Chris understand better what you like and what we can improve.  And be entered for drawing to win a mug!  https://bit.ly/349aUvz

Episode 3, season 2.  Chuck and Chris talk more about Chris' favorite topic- nerve surgery.  Our 3rd in the series on nerve surgery.  We welcome a very special guest, Amy Moore.  Amy is a plastic surgeon who spent her entire career here at Washington University until about 1 year ago when she relocated to become the Chair of Plastic Surgery at Ohio State.  Amy's knowledge runs deep and better yet, she shares her thoughts clearly and with great conviction.  She has a special expertise and reputation around nerve transfer surgery.

As always, thanks to @iampetermartin for the amazing introduction and conclusion music. And thanks to Eric Zhu, the Upper Hand intern extraordinaire.

theupperhandpodcast.wustl.edu

Survey Link:
Help Chuck and Chris understand better what you like and what we can improve.  And be entered for drawing to win a mug!  https://bit.ly/349aUvz

Episode 1, season 2.  Chuck and Chris talk more about Chris' favorite topic- nerve surgery.  We begin a three part discussion on nerve surgery, focused on the technical aspects of nerve repair including use of allografts, digital nerve repair, and sural nerve grafts.

As always, thanks to @iampetermartin for the amazing introduction and conclusion music. And thanks to Eric Zhu, the Upper Hand intern extraordinaire.

theupperhandpodcast.wustl.edu

Survey Link:
Help Chuck and Chris understand better what you like and what we can improve.  And be entered for drawing to win a mug!  https://bit.ly/349aUvz

Episode 51.  Chuck and Chris talk about Chris' favorite topic- nerve surgery.  We begin a three part discussion on nerve surgery, focused on a single case and some of the technical aspects of the process of ideal nerve repair.  How do you properly assess a nerve before surgery, how do you decide how to excise the damaged segment and how do you technically excise that segment, and much more.  This is the final episode of season 1.

As always, thanks to @iampetermartin for the amazing introduction and conclusion music. And thanks to Eric Zhu, the Upper Hand intern extraordinaire.

theupperhandpodcast.wustl.edu

Survey Link:
Help Chuck and Chris understand better what you like and what we can improve.  And be entered for drawing to win a mug!  https://bit.ly/349aUvz

Episode 50!   Chuck and Chris round out the distal radius fracture series by welcoming Dr. Macyn Stonner to discuss therapy after distal radius fractures.  She will help explain what happens behind closed doors, when therapy is most helpful, when specialized splints can help and she even tackles the topic of 'is therapy always necessary'.

As always, thanks to @iampetermartin for the amazing introduction and conclusion music. And thanks to Eric Zhu, the Upper Hand intern extraordinaire.

theupperhandpodcast.wustl.edu

Survey Link:
Help Chuck and Chris understand better what you like and what we can improve.  And be entered for drawing to win a mug!  https://bit.ly/349aUvz

Episode 49.  Chuck and Chris welcome Asif Ilyas, MD from the Rothman Institute to discuss the opioid epidemic.  Asif is the President of the Rothman Opioid Foundation, check it out here: www.Rothmanopioid.org.  
We discuss hand surgery, training, and a number of topics around the opioid crisis including how we got here, better prescribing habits, multimodal treatment, and more.

As always, thanks to @iampetermartin for the amazing introduction and conclusion music.
theupperhandpodcast.wustl.edu.  And thanks to Eric Zhu, aspiring physician and podcast intern.

Survey Link:
Help Chuck and Chris understand better what you like and what we can improve.  And be entered for drawing to win a mug!  https://bit.ly/349aUvz

Episode 48.  Chuck and Chris discuss a classic manuscript called 'Understanding Academic Medical Centers: Simone's Maxims.  This is from Clinical Cancer Research, Vol 5 2281-2285, 1999.  This is a great piece with important lessons on academia although many are relevant in large private groups as well.  Key thoughts like 'Academic institutions don't love you back'.

As always, thanks to @iampetermartin for the amazing introduction and conclusion music.
theupperhandpodcast.wustl.edu.  And thanks to Eric Zhu, aspiring physician and podcast intern.

Survey Link:
Help Chuck and Chris understand better what you like and what we can improve.  And be entered for drawing to win a mug!  https://bit.ly/349aUvz

Episode 47.  Chuck and Chris continue our discussion of distal radius fractures.  This is part 3 of 3- we discuss fractures that may not be ideally treated with a standard volar locking plate- including radial styloid fractures, volar- ulnar facet, dorsal ulnar facet, and die punch fractures.  We discuss our preferences and strategies.

As always, thanks to @iampetermartin for the amazing introduction and conclusion music.
theupperhandpodcast.wustl.edu.  And thanks to Eric Zhu, aspiring physician and podcast intern.

Survey Link:
Help Chuck and Chris understand better what you like and what we can improve.  And be entered for drawing to win a mug!  https://bit.ly/349aUvz

Episode 46.  Chuck and Chris continue our discussion of distal radius fractures.  This is part 2 of 2- we discuss in the volar approach include our techniques as well as tips and pearls.  We discuss anatomical risks, plate choice, and other issue.

As always, thanks to @iampetermartin for the amazing introduction and conclusion music.
theupperhandpodcast.wustl.edu.  And thanks to Eric Zhu, aspiring physician and podcast intern.


Survey Link:
Help Chuck and Chris understand better what you like and what we can improve.  And be entered for drawing to win a mug!  https://bit.ly/349aUvz

Episode 45.  Chuck and Chris discuss distal radius fractures.  This is part 1 of 2- we discuss in clinic management and general principles.  We discuss surgical indications and criteria. 

As always, thanks to @iampetermartin for the amazing introduction and conclusion music.
theupperhandpodcast.wustl.edu.  And thanks to Eric Zhu, aspiring physician and podcast intern.


Survey Link:
Help Chuck and Chris understand better what you like and what we can improve.  And be entered for drawing to win a mug!  https://bit.ly/349aUvz

Episode 44.  Chuck and Chris discuss leadership during the COVID 19 pandemic.  Maintaining positivity may be challenging and patience is also challenging.  We discuss the importance of being a patient leader during these difficult times.

As always, thanks to @iampetermartin for the amazing introduction and conclusion music.
theupperhandpodcast.wustl.edu.  And thanks to Eric Zhu, aspiring physician and podcast intern.

Article referenced:
Sluss, David Becoming a More Patient Leader.  HBR, Sept 2, 2020

Survey Link:
Help Chuck and Chris understand better what you like and what we can improve.  And be entered for drawing to win a mug!  https://bit.ly/349aUvz

Episode 43.  Chuck and Chris discuss a challenging topic- complex regional pain syndrome (CRPS).  We share how we approach patients with this potential diagnosis and strategies to help patients- under our care or through referral.

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

theupperhandpodcast.wustl.edu


Article referenced:
Jeffrey D Placzek , Martin I Boyer, Richard H Gelberman, Barbara Sopp, Charles A Goldfarb
Nerve decompression for complex regional pain syndrome type II following upper extremity surgery. J Hand Surg Am 2005 Jan;30(1):69-74.

Survey Link:
Help Chuck and Chris understand better what you like and what we can improve.  And be entered for drawing to win a mug!  https://bit.ly/349aUvz

Episode 42.  Chuck and Chris welcome guest Ben Nwachukua to talk about his experience in the NBA Bubble.  Ben shares his thoughts on the success of the process but also on what it took to make it happen.  If you like sports,  like the NBA, or just like an old fashioned success story, you will enjoy Ben's description based on his experience of living in the bubble for the month of August.  

We also touch on Ben's telehealth startup: www.bicmd.com, a soon to launch telehealth platform for musculoskeletal care.

Ben's website is: https://manhattansportsdoc.com


We continue our new feature- mail grab bag.  In this short segment, we will share a reader question and our response.  Hope you like it!

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

theupperhandpodcast.wustl.edu

Episode 41.  Chuck and Chris recap highlights of the ASSH Annual Meeting.  The ASSH pulled off a great meeting.  We run through our favorite parts, what we learned, and highlight 5 of the award winning papers.

We also start a new feature- mail grab bag.  In this short segment, we will share a reader question and our response.  Hope you like it!

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

theupperhandpodcast.wustl.edu

Episode 39.  Chuck and Chris talk to again with Amy Lake from Dallas about a passion project- Hand Camp.  These camps are amazing experiences in which children with hand differences spent time with other kids and other families to learn from one another (and teach us).  Amy has been inspirational in building these camps in Dallas and inspiring others, like us in St Louis, to do the same.  We promise this concept willl get you thinking!

As always, thanks to @iampetermartin for the amazing introduction and conclusion music. And thanks to Eric Zhu, the Upper Hand intern extraordinaire.

theupperhandpodcast.wustl.edu

Important links from show: 
luckyfinproject.org and myselfbelts.com

Episode 40.  Chuck and Chris talk ASSH Annual Meeting.  We got together just after the meeting started to share our thoughts and plans around this virtual meeting.  While this year is very different, many people did much work to make this happen.  Thank you and this will be a great meeting!

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

theupperhandpodcast.wustl.edu

Episode 38.  Chuck and Chris talk to hand therapy geniuses Amy Lake from Dallas and Macy Stonner from St Louis. We talk about the vital therapist- surgeon relationship and all things related.  Fun, engaged conversation with deep insights on what makes these relationships so important.

As always, thanks to @iampetermartin for the amazing introduction and conclusion music. And thanks to Eric Zhu, the Upper Hand intern extraordinaire.

theupperhandpodcast.wustl.edu

Episode 37.  Chuck and Chris have an in depth conversation with Steve Moran of the Mayo Clinic to learn more about his approach in the treatment of Kienbocks disease.  Interesting conversation as while all of us consider multiple options for treatment, Steve and his Mayo Clinic colleagues favor treatment of avascular necrosis of the lunate with vascularized bone grafts while our team, for many patients, favors radius shortening osteotomies.  Patient preference and indications for each patient are the key but understanding the institutional perspective is helpful.

As always, thanks to @iampetermartin for the amazing introduction and conclusion music. And thanks to Eric Zhu, the Upper Hand intern extraordinaire.

theupperhandpodcast.wustl.edu

Episode 36.  Chuck and Chris talk about their medical careers, the impact of their fathers (both surgeons), and how they talk to their kids about medical careers.    We share various stories and opinions.

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

theupperhandpodcast.wustl.edu

Episode 35.  Chuck and Chris talk efficiency.  We meander through practice building to start the podcast and the discuss a recent HBR article by Peter Bregman, "Your To Do List is, in fact, too long."   We discuss why 'trying harder is not the answer'.  We share our efficiency tips, our variable successes and discuss Bregman's suggestion.  Join us and then share your ideas with us!

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

theupperhandpodcast.wustl.edu

Episode 34.  Chuck and Chris continue to talk Dupuytrens Disease, this time with a special guest Charlie Eaton.  Charlie shares his vast experience with Dupuytrens, beginning with his popularization of the needle aponeurotomy procedure and continuing to the current day research program he oversees at dupuytrens.org, the Dupuytrens Foundation and Dupuytrens Research Group. 

This is longer than our typical podcast and more in depth.  For those of you that are passionate about Dupuytrens- it is pure gold!

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

theupperhandpodcast.wustl.edu

Episode 33.  Chuck and Chris continue to talk Dupuytrens Disease. This is the second of 3 episodes on Dupuytrens.  Here we discuss collagenase, the literature, and open fasciectomy.  We also discuss therapy and its role in all interventions.

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

theupperhandpodcast.wustl.edu

Episode 32.  Chuck and Chris talk Dupuytrens Disease. This is the first of 3 episodes on Dupuytrens.  Here we introduce the topic and discuss our patient approach including the increasing role of needle aponeurotomy.

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

theupperhandpodcast.wustl.edu

Episode 31.  Chuck and Chris talk radial sided wrist pain.  Last time we focused on De Quervains tenosynovitis in Part 1 and for this episode we focus on less common topics like intersection syndrome, Wartenbergs syndrome, FCR tendonitis, and a few others.

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

theupperhandpodcast.wustl.edu

Episode 30.  Chuck and Chris talk radial sided wrist pain.  We discuss the pertinent features of the history and the physical examination including key differential diagnoses.  We focus on De Quervains tenosynovitis in Part 1 of radial sided wrist pain.

A few digressions including anti inflammatory medications and general surgical principles around keeping nearby neurovascular structures safe.

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

theupperhandpodcast.wustl.edu

Episode 29.  Chuck and Chris talk about the concept of microstresses and how these impact our daily lives.  We discuss common examples in our lives and how we attempt to address these.  This discussion is based on the work in HBR by Cross, Singer and Dillon, "Don't Let Microstresses Burn You Out'.

 We hope for feedback from listeners.

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

theupperhandpodcast.wustl.edu

Episode 28.  Chuck and Chris talk tennis elbow.  We discuss the our beliefs on effective treatment including therapy, orthoses, injection, and surgery.  Sure to be controversial!

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

theupperhandpodcast.wustl.edu

Episode 27.  Chuck and Chris talk tennis elbow.  We discuss the key pertinent features of the history and the physical examination including key differential diagnoses.  We review the role of nerve studies for radial tunnel as well as the role of diagnostic injection.  We begin the discussion of treatment with therapy. We hope for feedback from listeners.

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

theupperhandpodcast.wustl.edu

Episode 26.  Chuck and Chris talk side gigs or side hustles.  Clearly, our clinical work is consuming but there are benefits to side gigs including simply engaging in pursuits outside of typical medical care and many side gigs can be helpful in minimizin the risk of burnout.  Chuck and Chris discuss 7 common side gigs.  We hope for feedback from listeners.

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

theupperhandpodcast.wustl.edu

Episode 25.  Chuck and Chris discuss education.  In this episode, we review how we view educational changes over the last 20 years, key mentors and role models, how to prepare from the OR, and the benefits of a post- surgery review for each case.  We share thoughts on the value of the cadaver lab (hint: invaluable) as well as the use of video in preparation for the OR and surgical simulation as well.  Finally, we touch on the concept of coaching in surgical education.

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

theupperhandpodcast.wustl.edu

Episode 24, is part 2 of Chuck and Chris' discussion with guest Sam Moghtaderi, MD on wide awake local anesthesia no tourniquet (WALANT) surgery.  We discuss surgical tips and pearls, education, and challenges in the OR and at the system level.  Sam's experience with WALANT provides unique insights for the listeners.

theupperhandpodcast.wustl.edu

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

Episode 23, Chuck and Chris welcome guest Sam Moghtaderi, MD to discuss wide awake local anesthesia no tourniquet (WALANT) surgery.  We discuss specific approaches to the patient consent process, specific surgical tips and pearls, and challenges in the OR and at the system level.  Sam's experience with WALANT provides unique insights for the listeners.

theupperhandpodcast.wustl.edu

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

In Episode 22, Chuck and Chris discuss ulnar sided wrist pain, focusing on treatment of TFCC pathology.  We review the treatment of TFCC tears including arthroscopic and foveal repairs.  We discuss therapy and reasonable expectations after surgery.

We reference the Foveal Repair
J Hand Surg Am 2018 Jul;43(7):680.e1-680.e5.  

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

theupperhandpodcast.wustl.edu

In Episode 21, Chuck and Chris discuss ulnar sided wrist pain, focusing on diagnosis.  We review the differential diagnosis including diagnostic categories and how we work through the history and physical examination.  We discuss key examination maneuvers and diagnostic tests including imaging and injections.

We reference the ECU Synergy Test:
Ruland and Hogan, J Hand Surg Am 2008 Dec;33(10):1777-82.  

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

theupperhandpodcast.wustl.edu

Episode 20.  Chuck and Chris welcome Macyn Stonner, OTD, an amazing hand therapist with Milliken Hand Therapy in the Program of Occupational Therapy at Washington University.  We discuss the challenge of these injuries including our surgical preferences and spend more time with Macy discussing therapy.  Macy pulls back the curtain and shares her approach to treating these patients and working towards the best outcome.

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

theupperhandpodcast.wustl.edu

In Episode 19, Chuck and Chris discuss the diagnosis and assessment of thumb UCL injuries including the role of advanced imaging.  We then discuss our treatment approaches on the operative and nonoperative care including patient counseling.  We focus our operative discussion on the role of the classic repair techniques versus the use of suture tape.

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

theupperhandpodcast.wustl.edu

Episode 18.  Our third guest on the Upper Hand Podcast is Marybeth Ezaki, MD.  Dr. Ezaki is past President of the ASSH and remains the only female president of this organization.  She is a critical thinker in the field of congenital hand surgery and is a mentor to many surgeons who practice in this field.  She shares thoughts on women in surgery, dogma, and the evolution of hand surgery.  

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

theupperhandpodcast.wustl.edu

Episode 17.  Chuck and Chris discuss various dogma in hand surgery including topics such as cubital tunnel syndrome, metacarpal fractures, the development of wrist arthritis, etc.  Join us and weigh on via twitter or email on dogma topics in hand surgery.

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

theupperhandpodcast.wustl.edu

Episode 16: Chuck and Chris discuss patient centered care and decision aides in the context of thumb basal joint arthritis.  This episode also marks our Facebook Live debut for Washington University Orthopedics and the conversation reflects a bit more of a patient focused approach.  We also welcome the debut of a future podcast star- Chris' son Raffi!

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

theupperhandpodcast.wustl.edu

Episode 15.  Our second guest on the Upper Hand Podcast is the current President of the American Society for Surgery of the Hand, Martin I. Boyer, MD.  In our conversation with Dr. Boyer, we learn about his plans for his presidential year, focused on fellow education.  We also learn about the response of the ASSH to COVID-19-  with a concerted and highly effective effort to provide timely information for the membership.

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

theupperhandpodcast.wustl.edu

Episode 15: Chuck and Chris review Chris' JBJS review on the hand surgery literature for 2019.  This is the second part of the discussion of scaphoid nonunions, the role of denervation, tendon, replantation, and a brief discussion of opioids. 

theupperhandpodcast.wustl.edu

As always, in these stressful times, I always recommend more @iampetermartin- jazz piano relaxation.

Episode 14: Chuck and Chris discuss Chris' 2020 JBJS review on the hand surgery literature for 2019.  This is Part I of II with a discussion of thumb CMC arthritis and distal radius fractures, among other topics.

Because of the crazy times, we also give some COVID-19 updates.  

theupperhandpodcast.wustl.edu

And, in these stressful times, I always recommend more @iampetermartin- jazz piano relaxation.

Chris and Chuck review the impact of the COVID-19 pandemic on our community and our practices, our training program, and we share some of the adjustments that have been made.  We recognize the rapid pace of change and the variability from community to community, state to state, and country to country.  

Episode 11 evaluates 7 clinical pearls that Chuck and Chris use to maximize their practice efficiency.  We hope that our discussion of these tips and tricks provide something for you to consider in your own practice.  Really this is Chuck and Chris sharing some of our favorite pearls that we believe make us better hand surgeons (and give us more time for the personal and non- clinical work activities).  And, of course, we hope that our thoughts generate discussion and feedback on twitter @handPodcast or via email.  Thanks as always to @iampetermartin for the tunes.

Our first guest on the Upper Hand Podcast is the Journal of Hand Surgery Editor in Chief, Brent Graham.  We learn about Dr. Graham's training, career, and path to Editor.  We learn more about Dr. Graham's insights into the world of hand surgery and journal editing.  Dr. Graham also hosts a podcast for the Journal of Hand Surgery, so he is no stranger to this medium.   As always, thanks to @iampetermartin for the amazing music.

Episode 10.
7 Wack Gigs explores what we can learn when surgeries don't go quite like we planned.  
Wack definition- "bad, messed up". 
Gig definition- "live musical performance'

We are indebted to @iampetermartin for both his music and the concept of exploring this concept.  We evaluate what we can learn when surgeries veer off the planned path.  We share 7 lessons that Chuck and Chris have learned in this podcast.

In Scaphoid 2, we discuss our most common strategies for operative management, including when and how to go dorsal vs volar, when and how we like to use bone graft, and when angular correction is needed. We review our postoperative protocols for immobilization, therapy, and return to activity.  Technical pearls shared.  Thank you to @iampetermartin for his musical contribution.

Scaphoid 1.  In this episode, we discuss the diagnosis of scaphoid fractures including the role of advanced imaging.  We then discuss our approaches on the operative and nonoperative care including patient counseling.  In this episode, we focus our operative discussion on the dorsal approach including tips and technical tricks for the surgical approach.  Thanks to @iamPeterMartin for the amazing music.

Chris and I talk about the technical aspects of carpal tunnel surgery including our approach, open versus endoscopic, and other controversies.  Thanks to @IamPeterMartin for the amazing jazz piano.

We talk about one of the most common diagnoses in any upper extremity surgeon's practice- carpal tunnel syndrome.  This episode is mostly about our approach to the patient and the steps we take in assessing the patient and making a diagnosis.  We review important considerations such as: key patient complaints, which diagnostic tests help most, and how we use steroid injections.  Thanks to @IamPeterMartin for the amazing jazz piano.

We discuss our general approach to metacarpal fractures, which were recently in the news due to Steph Curry’s injury. We talk through our decision tree, how we treat non-operatively, how we treat surgically, and return to activity/play considerations.

Learn a little more about your co-hosts and why we decided to launch a podcast about hand surgery. Chuck describes his experience with a highly successful patient education blog. Chris describes his failed blog and his hot/cold relationship with Twitter.

In our first episode, we discuss our approaches to the diagnosis and work-up of a patient with cubital tunnel syndrome. We review the pertinent history, our preferred physical exam, and our thoughts regarding diagnostic testing. We also discuss our initial treatment and counseling regarding prognosis and expectations.  Thanks to @IamPeterMartin for his advice and amazing jazz piano.

Episode 2: we continue with the case vignette on cubital tunnel syndrome discussed in the first episode. We discuss our preferences regarding choice of procedure – when we like doing an in situ decompression or an ulnar nerve transposition (and which types). We also get into details regarding our surgical technique and postoperative protocols after each surgery.  Thanks to @IamPeterMartin for his advice and amazing jazz piano.

We just finished hosting residency interviews and we have our fellowship interviews coming up, so we have had some time to reflect on the process. We discuss our recent experiences interviewing candidates for our training programs. Hopefully our insights will be helpful to those on or soon to be on the interview trail!  Thanks to @IamPeterMartin for his advice and amazing jazz piano.