The Upper Hand: Chuck & Chris Talk Hand Surgery

Chuck and Chris discuss the new JBJS article, What's New in Hand Surgery, written by Drs Wager and Suh.  Lots of great content in Part 2 on many topics including distal radius fracture, nerve injury, arthroscopy, arthroplasty and so much more.

Citation
Wager ER and Su N.  What's New in Hand and Wrist Surgery.  JBJS 2025; 107:543-51

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Chuck and Chris discuss the new JBJS article, What's New in Hand Surgery, written by Drs Wager and Suh.  Lots of great content in Part 1 on many topics including scaphoid fractures, SL injuries, and nerve compression.

Citations

Wager ER and Su N.  What's New in Hand and Wrist Surgery.  JBJS 2025; 107:543-51

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Chuck and Wee Lam preview Friday, Day 5 of the IFSSH.  This is the final day but there is plenty of content.  Chuck and Wee also recap the meeting and highlight the 2028 IFSSH Meeting in Singapore!

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

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Chuck and Wee Lam preview Wednesday, Day 4 of the IFSSH, filled with Symposia and Instructional Courses as well as special events including the Swanson Lecture with Pioneer Fu-Chan Wei and the Gala at the National Portrait Gallery Thursday evening.

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

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

Chuck and Wee Lam preview Wednesday, Day 3 of the IFSSH, filled with Symposia and Instructional Courses as well as special events including a Therapist Keynote Speaker: The Innovator in You and the Surgeon Presidential Guest Lecturer, Tony Smith, speaking on his quest to learn more about Sterling Bunnell and the book that has resulted.  Use the App and plan your day carefully because there is an incredible amount of high level content taught by the international speakers.

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Chuck and Wee Lam preview Tuesday, Day 2 of the IFSSH, filled with Symposia and Instructional Courses as well as special events including the Therapist Opening Ceremony and a Therapist Keynote Lecture: Rowing Solo Across the Atlantic Ocean...  Use the App and plan your day carefully because there is an incredible amount of high level content taught by the international speakers.

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

Su...

Chuck and Wee Lam preview the IFSSH beginning with Day 1, filled with Precourses and ending with the Opening Ceremonies and Welcome Reception. There are amazing learning opportunities with the Precourses covering all aspects of hand surgery with an international list of remarkable speakers! Come learn who are the newly recognized Pioneers in Hand Surgery!

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Chuck and Chris discuss a radial nerve palsy associated with a humerus fracture.  We discuss diagnosis, examination, and preliminary treatment options.  Part 2 will follow after the IFSSH meeting.  We also discuss upcoming, IFSSH- related episodes.

Some citations

1: Lieberdorfer A, Shivakumar N, Stonner MM, Brogan DM, Ray WZ, Mackinnon SE, Dy
CJ. Expectant Management, Tendon Transfer, or Nerve Transfer Surgery for Radial
Nerve Injury: A Qualitative Study Exploring Patient Expectations, Goals, and
Treatment Experiences. J Bone Joint Surg Am. 2023 Apr 19;105(8):600-606. doi:
10.2106/JBJS.22.01201. Epub 2023 Feb 16. PMID: 36795855.
 
2: Malikowski T, Micklesen PJ, Robi...

Chuck and Chris welcome Jim Chang from Stanford University for a deep dive on two really amazing topics.  First, we discuss Jim's leadership of the IFSSH Triannual Meeting in Washington DC March 24-28.  And second, we discuss global reconstructive surgery and Jim's work in this area, specifically with Resurg International.  Join us for interesting conversation (and then join us in DC).  Jim had much to share about psychic compensation and 4 tenants to successful international work: finding the right host, being a good guest, making a lasting impact, and not competing with other organizations. 

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Chuck and Chris welcome Jeff Yao and Jeff Friedrich to preview the IFSSH.  We have a fantastic, wide ranging discussion about this leading, triannual meeting of surgeons and therapists.  We follow up that with a discussion of Jeff and Jeff's preferences for treatment of CMC arthritis.

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

Chuck and Chris discuss several listener submitted questions and comments on the CMC joint as well as a case of TFCC pathology.  Our focus is FPL rupture and reconstruction- we discuss interpositional tendon graft and FDS transfer.

Flexor Pollicis Longus Reconstruction After Rupture Following Distal Radius Fixation With Volar Locking Plate: A Technique Guide.
Welbeck A, Goldfarb CA, Calfee RP, Dy CJ.
Tech Hand Up Extrem Surg. 2024 Sep 1;28(3):124-128.  PMID: 38516925

Our surgical follow- up article will be published in JHS Go but is not yet available.

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Chuck and Chris discuss a listener submitted case and use the topic for a deep dive on thumb CMC/ basal joint arthritis and the gold standard of care, the LRTI.  Hear Chuck and Chris' thoughts on the technical aspects of the operation and hear how they differ in their approaches.

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The Upper Hand Podcast is sponsored by Checkpoint Surgical, a provider of innovative solutions for peripheral serve surgery. To...

Chuck and Chris are joined again by Sanj Kakar from the Mayo Clinic.  Sanj is a high volume arthroscopist and luminary in the field.  He is leading the way with contributions to the field and new ways of considering wrist pathology.  If you missed episode 1, we would recommend a listen but each episode stands alone.

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Chuck and Chris celebrate the last episode of 2024 with a 'Future of Hand Surgery' episode.  We prognosticate who will be performing carpal tunnel releases, how we will treat the CMC joint, what wrist arthroscopy will include, how we will repair nerves and tendons, and so much more.  Join us and share your thoughts by email!

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Chuck and Alpesh Patel, Professor of Orthopedic Surgery and Neurosurgery at Northwestern, discuss artificial intelligence and its role in medical practice.  In the first of a two- part discussion, Chuck and Alpesh start with the basics on what AI is and what it can reasonably do and they  start to delve into more details around practical applications.

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The Upper Hand Podcast is sponsored by Checkpoint Surgical, a provider of...

Chuck and Chris have a good discussion based on several questions submitted by Chris Gayton at Ortho South Carolina and share why we are thankful at this time of year.  We discuss when we consider carpal tunnel release and cubital tunnel surgery together, when we consider a distal ulnar tunnel decompression, and the role of dry arthroscopy in the setting of SL ligament injury.

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The Upper Hand Podcast is...

Chuck and Chris discuss advocacy.  In this episode, we start with an adolescent elbow case as a warm up and then pivot to advocacy.  Starting with a simple definition and explaining why it is so important for all of us.  We use practical examples for discussion on all types of advocacy and  why we should all engage in some manner.

Jon Lundy can be reached at jlundy1313@gmail.com


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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 ulna...

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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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 Po...

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 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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See https://checkpointsurgical.com or www.nervemaster.com for information about the company and its products as well as good general information about nerve pathology.

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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As...

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...

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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Please comp...

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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As al...

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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See https://checkpointsurgical.com or www.nervemaster.com for information about the company and its products as well as good general information about nerve pathology.

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

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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See https://checkpointsurgical.com or www.nervemaster.com for information about the company and its products as well as good general information about nerve pathology.

 
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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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