The Upper Hand: Chuck & Chris Talk Hand Surgery (Chuck and Chris)

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 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 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 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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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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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 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 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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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 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 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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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 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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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 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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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 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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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 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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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 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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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 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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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 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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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 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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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 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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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 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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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 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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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 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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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 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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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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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 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 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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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 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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Survey Link:
Stay tuned- a new, updated survey is coming soon!

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

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

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

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

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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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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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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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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 a number interesting listener submitted questions including comments around our SL ligament episode and the rock climbing episode.  We even take a (brief) deep dive into biomechanics!  We also share out plans for the ASSH Annual Meeting in Minneapolis.

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Chuck joins David Wei, a hand surgeon who leads the Business of Hand Surgery Committee at the ASSH, to discuss a variety of topics.  In what is really an interview of Chuck by David, a variety of topics are discussed. David began and leads the BOHS podcast which is an amazing resource of practical business and private practice topics.  We had a great discussion on business school, the Upper Hand Podcast, Leadership education, and a number of other interesting topics.  Check it out after listening to our super fun discussion.  This is also a clear plug for the Hand P Podcast which takes on interesting and challenging issues for hand surgeons!

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Chuck and Chris review the ASSH meeting, preview the ASHT meeting, and discuss a few tricks and tips for ulnar shortening osteotomy through a case presentation.

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Chuck and Chris discuss Bennett Fractures and Rolando Fractures as well as a few mailbag topics including central TFCC tears (and the role of ulnar shortening) and more on bowstringing from Sam Moghtaderi.

A few citations courtesy of loyal listener Joe McLaughlin.
1)  Hulsizer, et al.  Ulna- shortening osteotomy after failed arthroscopic debridement of the TFCC.  JHS, 1997
2) Nishizuka, et al Simple debridement has little useful value on the clinical course of recalcitrant ulna wrist pain.  The Bone Joint Journal, 2013
3) Kim and Song, A comparison of ulnar shortening osteotomy alone vs combined arthroscopic TFCC debridement and ulnar shortening osteotomy for ulnar impaction syndrome.  Clinics in Orthopedic Surgery, 2011


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Chuck and Chris discuss the Darrach procedure including our indications, alternatives, technical considerations, and more.  We also share our amazing experiences at the ASHT!

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