so when I think of a Benic as a congenital hand surgeon a Benic to me means a soft thumb spica what does a Benic in this situation mean it's the

same company as you're used to with the congenital population but it's just a dorsal based soft radial nerve palsy splint that it's not hard right so it's just more comfortable it keeps them in the same position and it's multiple like it comes in and then we mold it either in the microwave run a bit of warm water mold it to them so it's just more comfortable because of the material so it

holds their wrist and neutrals what you're saying does it do anything with the mp joints and

actually it holds their wrist whatever we want it to be so I'll probably put it into 30 degrees of extension and then mp joints and thumb and full extension and then it allows them to have active finger flexion with a little bit of passive extension when they release an object so it's just as functional as the thermoplastic one I

do want to answer to the first question I asked you but Chuck we would be remiss if we didn't talk about our friends over a practice link before we got any further

I agree and I was looking forward to sharing my my appreciation for practice link because the upper hand is sponsored by practicelink.com the most widely used physician job search and career advancement resource

becoming a physician is hard finding the right job doesn't have to be doing practice link for free today at www.practicelink.com now macy I mean it's pretty amazing that you got to hear us do that live but I'm sure you've enjoyed that thoroughly let's get back to the question I wanted an answer to if it's possible just are there any clues that you get on your examination your assessment about who early on who might get better without surgery.

Independent of what nerve studies show this is just my clinical assessment in the clinic their exam so I have a piece of paper that has a radio nerve exam and I go from proximal to distal and I do all the manual muscle testing takes a while in detail and then if they are starting to show that things are coming back then sure I'm like do you want to operate on this right now is it going to be more optimal if we just wait for the natural recovery to come through so it's very much based on a clinical exam starting from the top and then monitoring that from when you first see them documenting it and then their next follow-up yeah that would be like the most obvious objective clinical finding. Now

you mentioned on when you talked about how we decide together about whether somebody is better off with nerve or tendon transfers if they end up being a surgical candidate you mentioned personality and physiologically so can you go a little into more some detail about maybe personality or I want to be

as politically correct as I should but I think that there's sometimes people who get it and people who don't you know and sometimes they just really understand the anatomy they understand what's going on they have realistic expectations of what you're telling them and sometimes people you just have an inkling that they might not be the best people to comply whether that might be behaviorally socioeconomically just various person factors that you're like would they be able to you know have the resources the motivation to go through the extensive nerve transfer rehab you know because that's a huge expense and a big commitment on the patient's end so nerve transfer is kind of like you're in a further long haul tendon transfers is as you know a quicker fix but also has its challenges as well so there's no perfect easy way out. Now

the tendon transfer is what for those of our listeners that are not therapists what does that rehab look like for a tendon transfer in terms of you know you mentioned things like intensity of time like the re-education part of it like how tough is that rehab?

So I think that a patient can make it through the first six weeks following a tendon transfer they're going to be golden it's the hardest part because the way I educate patients about this is you know your muscles have been um realigned to help create this pull of the muscle-intended unit to facilitate wrist extension and finger extension and you really want to maintain that nice tight position for at least a month in a splint to keep it tight if you accidentally or purposefully let your wrist dangle let it drop into flexion let your fingers drop into flexion you could lose that tension and you might over stretch the transfer so I always try to scare them a little bit in the beginning so that they really buy into the idea of full-time splinting for a month because full-time splinting for a month is very burdensome and so if they buy into it I think that they'll be fine so anyway it's the first month is easy in the sense of all you have to do is wear a splint not a lot of exercises other than actively passively flexing the finger IP joints if they're stiff and then they come back around a month and then that's when you start a tendon transfer training so typically you would do very gentle active wrist flexion and a gravity minimized plane with attempted active finger extension you know gentle pronation with wrist extension simultaneously and kind of guiding them through very gentle exercises I always see them once a week for two or three weeks and then every other week and then let them be by 10 weeks 12 weeks they're done nerve transfers as you know it can be a year so it's just a different

lengthy