The Upper Hand: Chuck & Chris Talk Hand Surgery

Interview 13: Chuck and Chris Welcome Mark Halstead, Peds Sports Medicine Physician

May 30, 2021 Chuck and Chris and Dr. Mark Halstead Season 2 Episode 22
The Upper Hand: Chuck & Chris Talk Hand Surgery
Interview 13: Chuck and Chris Welcome Mark Halstead, Peds Sports Medicine Physician
Show Notes Transcript

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.

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Charles Goldfarb:

Welcome to the upper hand where Chuck and Chris talk hand surgery.

Chris Dy:

We are two hand surgeons at Washington University in St. Louis here to talk about all aspects of hand surgery from technical to personal.

Charles Goldfarb:

Thank you for subscribing wherever you get your podcasts.

Chris Dy:

And be sure to leave a review that helps us get the word out.

Charles Goldfarb:

Oh, Hi, Chris.

Chris Dy:

Hey, Chuck, how are you?

Charles Goldfarb:

I'm doing really well. How are you?

Chris Dy:

I'm well, it sounds like you're saying you're a little tired. anything different about today than other days?

Charles Goldfarb:

Well, you know, I have taken up the peloton. You told me how wonderful it was and how it would change my life. And maybe it has, maybe it has, but I rode my real bicycle to work today. And it was pretty great. I've done it before. So it's not totally new. But it was great. About 30 minutes to work. 30 minutes back, it was great.

Chris Dy:

You know, you were at the Shriners Hospital today.

Charles Goldfarb:

I was at the Shriners Hospital. So it's really nice. I can ride pretty much through the park almost all the way there. So it makes it easy makes it safe. I like it.

Chris Dy:

That would terrify me.

Charles Goldfarb:

Why?

Chris Dy:

I don't know. I just I would worry about you know, we see so many bicyclists struck by vehicles, random car doors being flung open.

Charles Goldfarb:

Let's be clear, I ride in nice weather. When it's light out, although Friday, I'm gonna try to ride again, I'll have to leave about 5:15 to get to six o'clock conference. And I don't ride when it's too cold or too hot. You know have the all criteria that needs to be met. So it was fine.

Chris Dy:

Very, very strict inclusion criteria.

Charles Goldfarb:

Very, very strict. We have a guest today who we are super excited about. So let's do a couple of things quickly. And we'll welcome our guest who I know is going to be awesome.

Chris Dy:

Fantastic. Well, speaking of guests, you know, our last guest was from Stanford University. And one of his colleagues actually emailed both of us to tell us how much he loves the podcast.

Charles Goldfarb:

Yes, he did. So I would like to share Jeff Yao's comments about our podcast, he says, I just wanted to let you know that I totally binge listened to your podcast over the last few weeks. Really enjoyable exclamation point. Love the format and the content my fellows are listening too. I'm a little bummed that I made it to the end and I'm fully caught up. Please keep it up. How awesome is that?

Chris Dy:

It's fantastic. And you forgot the best part he did say that he's a little disappointed that I have not broken out into any Backstreet Boys karaoke, a la our time and Seoul. And Jeff and I spent a few days in Seoul, Korea together as part of a hand society traveling. Traveling group, which was fantastic. So Jeff, thank you for telling everybody about our podcast, getting your fellows listening. It's great to know that we're reaching a number of people.

Charles Goldfarb:

It is and I'll be honest, I'm very proud to say You're not the first one who has binge listened to our podcast. we've, we've heard that before, Jeff. But it is it's really kind of cool. I have to say thank you.

Chris Dy:

It's great. We appreciate everybody, and we love our listener community. So thank you for, for telling us that you love it too, that that certainly makes it even just a little bit easier to record on a weeknight. I had an interesting case.

Charles Goldfarb:

Chris, please tell me about it.

Chris Dy:

So it's actually a case from a while ago that I was thinking about as I prepare for a case that's coming up. And whenever you see that dorsal ulnar corner fragment on the distal radius fracture, do you get excited about that? Is that a fragment that you go after? as part of your fixation strategy? You know, whether it's a volar, or dorsal approach?

Charles Goldfarb:

Well, you know, essentially, because we have talked about that in the podcast. And I must admit, I probably approach it a little differently, since our conversations about it. Historically, I've not been overly impressed by that fragment, as long as it's relatively small, but David Brogan's work and our discussions and makes me more aware of that dorsal ulnar fragment. So I have to say I pay closer attention to it now than historically I have done.

Chris Dy:

You know, I think that I had a case, probably, I think, six months or so ago, that I went after that fragment, because mainly because of David's paper and some concern about the way that the fracture in the carpus was displacing on the X ray. And I did a you know, perform my standard volar approach and apply to volar plate. But then I also made a small accessory dorsal ulnar approach and used a separate interfragmentary screw for that piece. And I was very satisfied with that. And the situation hasn't come up until a case I have coming up at some point in the future. And I'm wondering whether to go after that fragment. So when you go after that fragment, do you base your entire strategy dorsally or do your standard volar approach then maybe either get a dental pick or a finger on that fragment dorsal ulnar and then put a screw from volar to dorsal.

Charles Goldfarb:

Not to give a vague answer, but my vague answer is, it depends. It depends on the size of the fragment my confidence in my ability to reduce it closed, I have to say I typically do approach these from volar. And either try to capture with a longer volar screw or make a separate incision for a dorsal screw because if the fragments big enough, and we can obtain and maintain the reduction in a closed fashion. I'm very comfortable with trying to hit it with a screw. But it really does depend on the specifics of the fragment.

Chris Dy:

Yeah, I think that that fracture matters to me if I think it's going to change my post op rehab. So if I can capture that fragment and not worry about the carpus, subluxation dorsally, or any DREJ instability, I'll tend to be a little more aggressive about that fragment. So I can put them in my, you know, standard volar plate move early kind of protocol.

Charles Goldfarb:

Yeah. For me, it's really more about the DREJ. And again, that's what David taught us. And that's what we have to pay attention to how, what percent of that joint does this fragment encompass? So I think it's a really important topic, the volar owner fragment gets so much attention today, and so the the stepsister should not be ignored.

Chris Dy:

Well, let's hop into our guest.

Charles Goldfarb:

I would love to introduce I was trying to remember how long Mark Halstead and I have worked together. It's definitely been at least 10 years, but I'm not sure exactly how many When did you join the faculty?

Mark Halstead:

17 years ago now. Well, actually, no. Yes. 17. 17 this month.

Chris Dy:

Well, Chuck, Chuck, I'll be very clear. I mean, this is an audio media. But you know, Mark has a lot more hair than you.

Charles Goldfarb:

I've got a couple more years of faculty experience and a lot less hair. That is very true. I am jealous of that. But seriously, Mark, thanks for joining us. So Mark is an associate professor here at Washington University. He is a non operative sports physician, I do want to know whether that is the way you prefer to be introduced. I've interacted with Mark most commonly in the care of the athlete, and that's athletes at every level. Mark's experience is amazing. So he worked with the St. Louis Rams, he's worked with the Cardinals. He works with numerous high schools, and obviously Washington University. He's the medical director of the young athletes center. And really, you know, your expertise is broad based, which we're grateful for. But your concussion work, probably, for me at least is where I feel you have most carved out a niche. So, welcome. Thanks for joining us. And Chris will add one more tiny pearl that is really relevant to this podcast.

Chris Dy:

So I can't I can't one of the faculty after Mark had really established himself and you know, every time I look at our CME programs, and anything that we do nationally, Mark's name is prominent. He's really well known in these areas as one of our sports medicine experts. And Mark has taken the mantle of going after those side hustles so he has the pediatric sports medicine podcast. You can check that out at www.pediatricsportsmedicinepodcast.com, that's all together no dashes, no spaces, and then the healthy young athlete podcast which is at www.healthyyoungathletepodcast.com. Can you tell us a little bit about you know, your podcast? And of course, welcome to the show.

Mark Halstead:

Well, thanks for having me. It's great to be with you guys. I listen as well. I am impressed that you have a listener who binge listen to your podcast because you guys have a lot more episodes than I do. And I just can't imagine sitting down and binging and getting all those in because that's a lot to take in, in a short period of time. But But kudos to your listeners. Yeah, the two podcasts that I do. The pediatric sports medicine, podcast, really creative name there. Of course, that one we really focus on just addressing anything pediatric sports related, we cover everything from musculoskeletal topics to right now. This month we're covering since it's Mental Health Awareness Month, we're doing some mental health related topics. That's kind of our focus this month, we kind of theme things a little bit here and there. With that, and we have people outside of the medical profession and obviously inside from standpoint of physicians, athletic trainers, physical therapists, orthopedic surgeons from the standpoint as well as non operative physicians and to answer your question, Chuck, as far as non operative sport surgeon, that's a big debate actually, in our world too. We like the word sports medicine physician, some have even proposed sports and exercise medicine physician, which is what they use actually in Europe, it makes a lot more sense for those that are doing a lot more in the general medical world rather than just sports medicine because we are dealing with people of all ages and all exercise levels. It's not necessarily just the athlete that we're focusing on. And then the other podcast, the healthy young athlete podcast that's actually kind of one that I don't put as much effort into or as much time into because I really kind of taken on the pediatric sports podcast but that one actually is more geared towards towards parents towards coaches towards athletes themselves a lot of answering like the common questions we get in the office. So like my, the last episode we did was when when should my kid get a CT scan after their concussion. So kind of simple little straightforward things like that of the little nuts and nuggets that you need to take home from those clinic visits, potentially, that you may have missed when you were listening to the doctor the first time.

Charles Goldfarb:

I love it. I have a bunch of questions. First, I guess a comment. So when we, Chris and I were looking to launch more than a year ago, you were one of the first people I talked to, and I don't know when your first podcast started. But I you know, we're obviously grateful for the words of wisdom that you gave us. And we've gone a little different route with our cadence of publications and kind of doing it ourselves. I think a little more maybe than you do. And also the fact that we, you know, Chris, and I feed off each other, you know, your ability to do this solo, and I do believe you regularly have guests, but it's not easy doing these things by yourself. I wouldn't think

Mark Halstead:

No, that that's true. It's almost like giving a lecture so that I really honestly haven't done any pediatric sports medicine podcast episodes solo, I've always had somebody there healthy young athlete podcasts, I've done some of my own because they're, they're quick little things. And again, kind of, like explaining the common questions we have in clinic. But you're right, it is a lot easier when you've got people to chat with rather than just talking to yourself. It's I mean, it's, it's no different than giving a zoom lecture in the morning and you don't know who's listening and who's brushing their teeth and doing something else, when that's going on. So I think in that standpoint, it is great having someone to banter with and, and I've always appreciated your guys', discussions with each other, it's always interesting to hear your essays and bantering back and forth.

Chris Dy:

Now, one of the things that we got early on was that we don't disagree enough. And one of the things we disagree about is how much we enjoy interactions with athletic trainers. And I like athletic trainers, just like as much as the other doctor, but just for the purposes of this discussion, you know, I don't, I don't find it to be the most fulfilling experience. But Chuck, and I'm presuming you do? So tell me how you approach that interaction Mark, as somebody who is a sports medicine physician who interacts a lot with these trainers.

Mark Halstead:

Yeah, so I mean, I owe a lot of what I know, in sports medicine, to the athletic trainers that are out there. I mean, there is no not a single place that I have done training at whether it was at Wisconsin as a resident or Vanderbilt as a fellow or here now at WashU working with athletic trainers at all levels that I've not gleaned something on. And from and I think it's, it's, it's a it's an interesting interaction, it's it's, again, the best thing about sports medicine, it's a team, as medical providers, just as it is a team for those that are on the field or on the court. So you know, I think it's it's a two way street there. And and I love having them as my eyes and ears so to speak, for especially for at the high school level, because that's where we may not have as much direct contact with them, because we're not necessarily going to see them at their school at high school level. So I really rely on them to be my eyes and ears and to help give me the kind of the behind the scenes scoop because we don't always get the full story. And I've always had the approach where I really like to directly communicate with the athletic trainers, I tend to send an email to our athletic trainers that after I see one of their kids in our office, that's just what I've done for a long time because I think too much gets lost in translation from athletic trainers, to the athletes to us, and then back the other way. And so then we're miscommunications happen. And then we're really not getting the right treatment and management plan and what's what's the next step for them returning to play. So I've always kind of taken that approach and had that kind of relationship with the athletic trainers that I work with around the St. Louis area.

Charles Goldfarb:

I think that's that's great advice. It is interesting being I guess what I would call a specialist where I don't have the day in and day out interactions with the trainers. For me, and I hope it doesn't come across the wrong way. I feel like my job is to see kids when the trainer, or adults, when the trainers refer them or suggest that they be seen. And then I think the real my real job is to, as you suggested, get back with the trainers and tell them what we thought was going on what we're going to do next and that interaction seems to be really appreciated, which makes me think that it doesn't happen enough. Is that a fair assessment, Mark?

Mark Halstead:

Yeah, I would say that's definitely the case. I mean, I do get comments that from athletic trainers that certainly I tend to communicate more than than others that doesn't, you know, again, that's not necessarily a bad thing. That's just the approach that I've taken. I you know, I think that's an important part and obviously don't do with every single school, every single athletic trainer that's out there we have several that we've had relationships with and in that we Partner with through WashU that we have more of that direct line of communication with but if I know the athletic trainer and I mean, it's helped build my practice. I mean, there's no question about that when you have someone that you are there at the school there and they know who you are, they know kind of how you manage things and how you deal with the athletes and that they know that you're going to get them communication back directly. I think that that kind of builds a lot for your practice and your reputation as far as what you do.

Chris Dy:

Well, maybe I'm wrong about it. You know, I think maybe I've been biased by a couple of interactions that have not been great. But I love what you're saying about having the eyes and ears, and the communication and kind of teamwork aspects. And honestly, that's how I view my interactions with a lot of the hand therapists for the nerve stuff that I do. And obviously, for all the other hand surgery stuff, so I'll reconsider, I'd be open to it.

Charles Goldfarb:

Well, I would say in all seriousness, there's a few things that I've done to help build my practice. And I've mentioned one, which is I call patients after surgery. I think this is probably the second most important thing I've done to build a sports type hand practice. And so these relationships, drive referrals for sure. And my interest in sports, and my willingness to get kids back to play ASAP now safely is obviously it has to be safe. But I really do strive to get kids back in some capacity as quickly as possible. And I think that mentality, rather than dancing around in fear of getting kids back too soon, I really don't have that approach. But I think it's the interactions. And it's the recognition that sports at all levels are just really important. And so as soon as we can get kids back to play safely in some capacity, we have to and Mark, I know you deal with that day in and day out.

Mark Halstead:

Yeah, and and again, I think we're going back to that team kind of approach. I also agree with you, Chris, as far as just the physical therapist, and having that communication there, too, that's valuable as well, especially I'm sure for you guys. postoperatively. And getting that feedback back about how your patients doing as well. But, you know, I think the other part of that too, is I honestly feel that out of everybody in our sports medicine team, the athletic trainers are the hardest working, and the least recognized, the most underpaid. And I think, you know, giving some back to them, and and again, recognizing them and valuing what they do for us, in general in the sports medicine world, I think is important. So you know, again, I, for me, it's it's just part given back from all the education I've received from them. And those relationships I've built with them and various athletic trainers over the years. And it's just been a really great part of my practice.

Chris Dy:

So Mark, I want to ask you a question that's been on my mind. I mean, I consider myself a bit of a lay person with regards to much of the sports medicine issues. But the thing that keeps coming up in a lot of podcasts, news media pieces, is this thing about early specialization of sports, and how we should approach that, you know, because you have, you have somebody like Tiger Woods, who, you know, basically was born with the golf club versus somebody like Roger Federer who played every sport under the sun, even though his mom was a tennis coach, and didn't come to tennis until very late. So how do you approach that in terms of, you know, perhaps as a parent, but also as somebody who deals with a lot of athletes?

Mark Halstead:

Yeah, so I have three teenagers now, one who will be heading off to college this year, a freshman and a sophomore. Two of my three are involved in athletics, my my middle guy is not. But in the big picture, things we never did any of the early sports specialization, I always was of the approach that our family time was more important than traveling around the country, and various states, going to different games, whether that's right or wrong, I, we went on their interest and what they wanted to do. And you know, at the time, there wasn't that much interest now that they've gotten older, you know, they've had interest in running, which is what both my wife and I did in high school, and then what she did in college, so, you know, we really never had any kind of big push, personally in our families. You know, there's there's lots of thought processes. As far as this goes, as far as early sports specialization. I think we're kind of getting different kind of takes as far as it goes, you know, should a kid be doing a repetitive sport at the age of four or five and saying that that's the right thing to go? Probably not. I mean, there are sports, obviously, that lend themselves to having to specialize at a younger age. Gymnastics is a perfect example of that. You don't see many young adult gymnasts that are out there that are performing at a high level consistently. And you know, whether that's a matter of that we because we are starting them so young, and we're breaking them down. I mean, it's a sport that we see plenty of overuse injuries in at that younger age. But I think it's just everybody's got that keeping up with the Jones's philosophy. You know, I start younger, so Well, my kids got to start a little bit younger. I've got this sports enhancement program that's out there. Well, hey, I got to put my kid in that sports enhancement program. But I think one of the things that we come back to a lot in pediatrics is we're missing a lot of the foundation that a lot of these kids have with basic movement skills, which is when we translate to the overuse injuries in our office, we're seeing kids that don't come in with good foundations of core strength, they don't have good foundations of strength in general. And then they're going out there, and they're doing all these sports related activities, and their body's just not ready for it. And then they're breaking down, and they're getting injuries and problems because of that. And we spent a lot of time in the office talking about those things with families, and some of them will buy into it. And they have a lot of questions. Well, why you're saying My child is weak in these areas, they do sports all the time. I'm like, Well, what are you doing to actually do strength training to get that there? And then sometimes that hits home? sometimes it doesn't. But it I mean, it is a problem. There's no question about it. It's just how do we fix it. And I think it's got to be an overall system wide approach to fix this, it's not going to be, you know, a few doctors saying that, hey, this is an issue, it's got to be taken up at the sports organization levels and addressing it there, which they have done some the NBA is a perfect example of that the NBA has a development program that they've put together an appropriate way to get kids into basketball at various levels. So they've been proactive about it compared to other leagues and other sports.

Charles Goldfarb:

Yeah, it's so complicated. Like you I've lived it with a couple of athletes. It's interesting, my youngest has been the least interested in sports, and she actually may have the best mentality and physical skills to have been successful. And she's getting into things a little late, but with no real interest to pursue sports at a, at a college level. But it is interesting, as a parent seeing it from all sides, and it is so complex, because some of the kids absolutely love it, you know, and you can never play too much of whatever sport it is, and other kids, you just get the sense they're being dragged around a little bit. And those those are the ones that get me and when you you're sitting in a room with a parent, and I don't want to pick on gymnastics, and potentially a gymnastics mom or dad and, and a young gymnast, and you see the overuse injuries, and it just pains me and and mom or dad is doing all the talking. And those are the hardest ones for me for sure.

Mark Halstead:

Yeah, and that's always something that we need to consider as physicians, you know, when the kids coming in with injuries, that just the pain that just doesn't seem to want to go away. And you can't find anything objective, you may have done imaging and everything seems normal, but the kid keeps hurting all the time. That's the kid you need to worry about the kid that's burnt out and just really does was trying to find an excuse to get out of their sport. And we certainly see that. And I think it's always important to bring up that question at some point is, do you really want to do this? And I always have had the approach as a pediatrician and trade by training is I always talk to the kids, I always direct my questions to the kids, I will let the parent bring their input in but I always want to hear from the kid first I want their take because they're the ones who know it. The parent doesn't know what their pain is like they don't know where their pain is. They can kind of project and things like that. But it's it's it's much more interesting and valuable to me when you talk to the kid and get the answers from the kid rather than getting it starting from the parent first. I always get a little nervous when it's the parent who's driving the whole conversation in the office. And it's not the kid doesn't get any input.

Charles Goldfarb:

I think that's that's a great point. And that's great advice. And, and it's easier sometimes than others. But I think we have to strive for that that is so true. I think pitch counts are the are you know, for me, it's it's gymnast and baseball players where I see this problem the most. And part of that's because I'm an upper extremity surgeon, and that's where they get their injuries. But talk to us a little about what's your what's your thought process on pitch type, pitch counts, and how well baseball has done with trying to improve the concerns around overthrowing?

Mark Halstead:

Well, I think we've got some good information about there as far as baseball, I mean, the American Sports Medicine Institute down in Alabama has put together some great guidelines, they've had great research over the years. So we know out there from data that's out there that the kids that are throwing more, and the kids that are playing year-round ball. Those are the kids that are going to wind up having more likely to have troubles with shoulder and elbow pain. I mean, it's it's been proven time and time again, you know, when we look at pitch counts, ideally, hopefully that those things are followed. You know, little league baseball, the organization itself has some pretty strict criteria. But you know, in our state, Missouri, there's no Little League Baseball under that umbrella teams. So we're relying on a lot of these clubs around the area here locally, to hopefully endorse and use those pitch count recommendations that are out there and it's not just the pitch count it's also the days of rest. Is your kid both pitching and catching? Which you know I stress with these kids at you know at age 12 you got to make a start making a decision. Are you going to be a pitcher or catcher but probably not both. And I use the analogies you know since we're in Cardinals land for these kids I go you would never see Yadier Molina tell Adam Wainwright, hey, it's my time to get up on the mound there and pitch and vice versa Adam to kick Yadier out of there and get behind the plate and start catching it's, it's just too hard on these kids to do it over and over again. And going back to what I talked about earlier, as far as just the overall strength deficits, we see so many of these kids that don't have any arm care programs in their offseason and they're not doing any strengthening, get their arm ready to throw. And they go out there and they start throwing a time. And then they wonder why they get these overuse injuries and the little league shoulder and Little League elbow that we see so commonly in our office.

Chris Dy:

So mark up to piggyback on that, can you tell us a little bit about how you approach things like the little league elbow and shoulder issues, and we have a lot of hand therapists and obviously a lot of hand surgeons and orthopedic and plastic surgery residents and fellows who listen in So what are some things that we can incorporate into our practice, and also, you know, the common deficiencies that we can address, either when we see them in the office or when we have them in the therapy suite?

Mark Halstead:

Yeah, so you know, obviously with and we'll we'll probably we can address little league elbow, I mean, the only shoulder kind of comes on that is as well. You know, it's going to be your medial epicondyle pain, they're going to be tender in that area, they may have some pain with valgus stressing and what have you. But I think one of the areas and this is where I teach the residents that rotate with me for pediatrics is I always want to make sure that we're assessing their strength of their shoulder and their rotator cuff, and their scapular stabilizers, which tends to be very deficient in these kids in their throwing arm. And parents are amazed when we talk to them about that, but I show them their shoulder blade mechanics as well. And looking at scapular dyskinesis. And addressing those types of things. Because again, if anything along that kinetic chain, and if you're if you're not familiar with the kinetic chain concept, you know anything from the tip of your, your longest finger on your throwing hand down to the tip of your big toe, on your plant leg from throwing, if anything there is not working right or injured, that can affect your throwing mechanics. So if we're not assessing that whole type of that chain, which you know, obviously has a lot of us as specialists, we kind of focus on the area that hurts, we may not address some of those other areas, these kids may be deficient in their core strength, they may have some issues with mechanics that's because of that. And that can lead to that problem. So if you're just looking at the elbow itself, and not looking at those other areas there, you're going to miss some of these things. And then you may just rest them, which is appropriate, we'll we'll rest these kids from throwing the start off with I get them into rehab while they're resting to work on some of those throwers exercises, to get them stronger in those areas there, then I'll reassess them in about four weeks. And then if those kids are doing better, I will then put them through an age appropriate return to throwing program for their position. There's various ones that are published out there that you can use, and I'll have them go through that program first, before we let them get back to full unrestricted play, I do let these kids bat so they can be a DH, I do let them work on fielding skills during that but I don't let them do the throwing during the time of their rest. And I find lots of value also in the the X ray, contralateral X ray, when I'm looking at little league elbow because if you just get the single X ray of the AP and lateral view, you may not notice the widening that's there of the medial epicondylar apophysis, yeah that that contralateral view is very helpful. I mean, nine times out of 10. If you have a radiologist Look at that, they're gonna say that it's normal, even though it may be widened compared to the opposite side. So So I find lots of value, I'll just do a bilateral AP view of each elbow and then a lateral view. And that's kind of my approach from a radiographic standpoint.

Charles Goldfarb:

Yeah, I love a couple of things you said, first of all, you know, in my adult population, I take care of some workers compensation patients. And I get those patients those work comp patients back to work ASAP, in a limited capacity, but get them back into the office, there's mental health benefits, and what you suggested with kids, get them back out there in some capacity as soon as you can. But there's nothing good happens if they're stuck at home. And you don't want them to lose touch with the game. And there's so much they can do to continue to build their skills, and maybe even take advantage whenever I have a basketball player that has a right wrist injury, I let them go you know, put them in a cast if they need a cast, and I let them go and and tell them work on your left. I mean, it's an opportunity. And so I love that concept. The second thing I really appreciate, which resonates with me, probably because I've been guilty is you know, you put an injury in front of a surgeon, especially an orthopedic surgeon not to overly characterize us, and either the bone's broken or it's not. And, you know, we tend we can be and again, maybe I'm self projecting, overly simplistic. And so these types of sports injuries require a little more finesse and an appreciation of the entire kinetic change. And so it changed. And so if I don't have the full understanding, then hopefully I have either a sports partner like yourself, or a physical therapy partner who can again put, you know, put everything together for the kid and for the family. And really engaging the parents I find to be as I'm sure you do as well. The right parents can make all the difference in the world in recovery.

Mark Halstead:

Yeah, absolutely, if you have the right approach to it, you know, I get always a little worried when when it seems like the parents more upset about the kid being out than the kid is upset, that always is a little bit of a red flag to me that we may have a little bit more of a struggle of keeping this kid in check. And I acknowledge with these families, too, it's gotta to be hard for some of these younger kids to to hold them back from certain things. And, and I think that's the important part, you know, from the sports medicine side of things of knowing the sport, if you don't know a sport, and all the demands of that sport, and what things they may be able to still do in that sport that are still okay, then you're right, you may sideline this kid and they don't, they may not be able to do something, or you know, anybody who's athletic, they like to have alternative things to do. You know, I see lots of runners in my practice as well, just in general. And, you know, the the reason why most runners hate going to the doctor is because usually the recommendation is well stop running. So well, then what's my alternative to do and for a lot of these people, that's, that's like their drug. And if they don't get to do it, and they don't get to exercise that's horrible for them. So hey, well, maybe we can let you cross train and do an elliptical or get in the pool and pool run, or do something as an alternative. So I think that's one of the approaches that we do need to take when we're seeing these athletic individuals, as we need to make sure that we're giving them some alternative thing to do. In the meantime, to and that helps pass the time a little bit to from their injury that they're recovering from.

Charles Goldfarb:

Yeah, for sure. So as we wind down, I want to both give you an opportunity and ask if there's anything else you want to say. But I think what I'd like what I really like, and this is sort of putting you on the spot is to ask, you know, you have an audience of hand surgeons and therapists and trainees, what do we need to know that we're not? What do you need to teach us about this population that you wish we knew or wish out? make it personal? Again, wish Chuck knew to do more often? Like what can we do better with this population?

Mark Halstead:

Boy, that's a tough question to put me on the spot for that one, as far as what you can do better, you know, again, and I'm not I'm not blowing smoke here, I've got the great advantage of I got several partners in my, my practice here that that are readily accessible and have been very helpful during my career of something that, hey, if I don't know what's going on, I run it by them. And it's been vice versa, too. So I think that's, that's, I think, first and foremost, if you're in that group, and especially if you're an orthopedic surgeon, you do have some sports medicine physicians, whether they're physiatrists, or the non operative folks like myself, you know, understanding what we do, and how we do it, and how we approach it, and how we can be a value to you and your practices, as well. I think that's, that's, I think, just getting to know our skill set, I think is helpful. If you do have people like that in your practice or in your community, if you're in private practice as an example. I think, you know, like I talked before, I think the most important part is is again, for me always is just listening to the kid. I can't stress that part enough. Again, I've had so many interactions in my office over the last decade and a half where I just see kids get this dejected look on their face when their parent starts dominating discussion about how they're doing and, and it's, it's really frustrating for me and I again, I am automatically turned back to the kid. And I asked them the same question because I want them to answer and I want them to be recognized and understand that, hey, I value their opinion, as their physician just as much as their parent's input. And I think that's valuable. And I think you gain a lot of trust with your pediatric age patients when you do that, rather than just talking with the parent all the time. And that's an easy thing for us to default to. Because we may think that the kid may not understand but we probably are selling a lot of these kids short.

Chris Dy:

So thank you for those words of wisdom. That's Dr. Mark Halstead, everybody. We appreciate having you on. Really check out Mark's podcasts. He's got the pediatric sports medicine, podcast and healthy young athlete podcast. Both of them are on iTunes. I'll read you a little bit of his last five star review for the pediatric sports medicine podcast. It talks about how the podcast is research based and loaded with clinically relevant information. The host that's you mark does a great job asking the guests questions and providing recap and highlights. So clearly, you've got some traction. Great audience, everybody, please check out Mark's podcasts. And, Mark, thank you for enlightening us and we hope to have you on sometime soon.

Mark Halstead:

Yeah, thanks for having me. I got to get some mugs for my podcast as well sometime.

Charles Goldfarb:

Well, we will share with you a mug for the upper hand to inspire you. Awesome. Thanks for joining us. Have a great night.

Mark Halstead:

Thank you.

Charles Goldfarb:

Hey Chris. That was fun. Let's do it again real soon.

Chris Dy:

Sounds good. Well, be sure to check us out on Twitter@handpodcast. Hey, Chuck, what's your Twitter handle?

Charles Goldfarb:

Mine is@congenitalhand. What about you?

Chris Dy:

Mine is @ChrisDyMD spelled d y. And if you'd like to Email us, you can reach us at handpodcast@gmail.com.

Charles Goldfarb:

And remember, please subscribe wherever you get your podcast

Chris Dy:

and be sure to leave a review that helps us get the word out.

Charles Goldfarb:

Special thanks to Peter Martin for the amazing music. And remember, keep the upper hand. Come back next time