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Friday, June 15, 2018 · 8:58 a.m. · 21m 07s
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very illuminating talk um we don't have some time for discussion now i'm i'm
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so perhaps if we could uh oscar how to come to the front
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uh and then the audience can ask them some of the burning questions in half
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um perhaps um we could uh start off with a with a f. case discussion about
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what you do uh let's say we have a a a four year old lady
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we can tennis player should be set to watch somebody else she had all investigations including m. r. i.
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which showed a tear and the t. f. c. c. she's had several injections our nostrils could be
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people into a bit more of a t. f. c. c. and you can just you know and you're
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doing what was critical tests that uh mike zones demonstrated interfaces screwed up with all of them
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and she's desperate to get back and play tennis to some are gonna do now
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well i think that could be also it's a cable uh there's always the history which you've given the limits very level up
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coming from a everywhere it's come from everywhere overwhelm aside
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so ah i think with with with k. you can you can drown would got in that particular user to miss
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obviously thinking easy you you may maybe doing some uh positron you draw uh but some are a
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star would try it would've been even go on the cop implement so in that particular case
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you know when you don in alarm you know are we probably i'm the
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user should me more yeah okay but i forgot was giving you should
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attend somebody's done depending and focus on all the models can be different interval
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'cause it is gonna be yeah i'm i'm a white and black
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but um so uh what do this or do you see the sequential focus injections
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but most of the time we got with the uh with the payments
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um even just the easy you but don't go deep into the joint just inject these you look tron again for what is the time driver
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and as soon as you can without then you can work out what to do but the problem strong created in an intervention
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when you don't know what the diagnosis i mean that's the that's the unfortunate aspect of all those others but a lot of people
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do need to be into them what would the what the problems yeah yeah if you want to what you think it
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well i don't actually it's also expensive option back um but i'm
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not back muscle to him to m. g. t. c. u.
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well the degree burns all the zoom see only one of the ah can reject what fun double digit
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remote overalls all but is the is to to do it that's uh do we want
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to jack russell combo was a real subject muscle as a somewhat you from the
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the current colour record which was the grounds she we should go outside
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no transcript anyone or somebody else uh and they've done a it to productivity actually seen on the whole
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i was home over the area are still painful all all those tests that might ushering or painful
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she was second and then find nothing uh uh in the uh first probably well she had chatted
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tear yeah more i so somebody's just the bride it but of course you were there
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as or somebody else adaptive right and i i i think we are we
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are looking in that case uh uh likenesses was that the maybe
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not only that you actually see maybe been for boosting scabbard before rubber sure here so
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basically the lot the paying um uh if we need with your for roughly
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we'll uh uh over every two o. two the chips uh
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to the ready are loaded into them that corporate jointly
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with that we have some uh that's for will personally
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uh we're gonna have some extra information yeah x.
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i would love to say that we don't have patients like that and i'm not
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real and that's not reality i would like take least over the checklist
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like i would have done i'll go through all the all the potential courses
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one by one and i i wouldn't look for the a complimentary ugh
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patients like that they come with a big back plenty of x.
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rays and wise whatever kind of exploration and you think about
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it they have already done one two three times so forget about that and i will i will explore the patient
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and most of the patients in which you and spend like ten minutes exploring
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they say it's the first time that someone has been taken such a long time to explore my wrist
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i see you examined the rest absolutely and i think it's various useful with michael saint we we used we used
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actions and we use diagnostic injections and you may use it without or with no we don't
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or something it's very useful also on with lotus compunction why no mention is with
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no i i agree with the gentleman right here yeah of course say
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a sound clinical exam s. the foundation for anything that we do
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and so if she hasn't had it before yeah another thing is have been trying to get hold
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of penetration the yeah artist could be that she went through if they have stored any
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as does actually see yourself the evaluation of uh of the yeah
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i just copied treatment that she meant to just like michael
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said after skippy is not a modality for diagnostics it's in
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interventions so that's something you should take into consideration for
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one thing that we don't blow ourselves is to have our our respect impressions
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i'm going to finish the uh the uh examination without
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knowing what part of the also is waiting for
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so weak someone until we know exactly that this is you or the result
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recorder all it to work permit or the recorded oh many overlaps
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we know we finish the examination we have to go let's look at all the other issues but we have to find it
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that's so uh like uh the fact that we have to find joy to break it down and look for specific
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the specific that the the place that gives more painful of course you put uh uh it
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crosses to every report to see which is the worst of the of the other ones
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but uh i think you know come back to the question of a more ah if
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you're patient with all impressions of rooms that you strongly suspected simpler more ah
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in that particular case a positive do whatever the pathology that you can get in the file you do number ah
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it will be a bit more all be posed which which is with both
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confirmed dollars but also confirms on is really the more ah but still
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when you got a question but there's we you have no idea what to get what's on well them of the it's okay to what is to know more ah
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then you can come back to the whole of things on the same or ah that they can find the the the the radiologist and then you can stop you really can
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views and also have no idea which really don't make so that's why i think that it more
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as over done and it overactive oh yeah yeah somebody has happened up there and and and
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and i think if one one very good thing about that is that a musty process because the the patient
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is says that this is really positive for him or she a review rate taking care of him
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like to be provocative but when we don't know what we're dealing with
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we can anyway you value i get more information as my with one of those get
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that but otherwise you any other way to get information is this thing more
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and it's one thing to talk about diagnostic up crossing the button to you can actually work this out
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what we see outside seagate drive see it from the top and the bottom
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in private i don't think we get that from information from our prosperity
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and you can see this our plans for the other thing is the use of all to so
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well actually say anything with i'll just send annoying with looking at is it not me
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so i um i think i might not come but let let me just ask the audience eh how many have the peep
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to restore trust me ooh regularly do a isolated just a radio on a
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joint portal to look at the distal brady only joint show of hands
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alright so now we talk about the rest i just get a being the gold standard for t. f. c. c. t. s.
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but if we're not looking in india ha portal we're really not seen the full picture with
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regard to the t. f. c. c. or do you have any other comment on that
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michael and worked
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good morning um uh_huh it was an excellent up a four eight o'clock in the morning
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yeah just continue that only a sensation that you'll have one question for you a lot of them
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uh we don't take uh as many patients uh with pool
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and i understand that the pull into the that you're
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describing it to basically on looks attention completion
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the position i see that most of those can heat i'm backing them need this well so uh
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i would say our to understand that there would be a lot of a condom only show on
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the proximal ball any heating them make it in about twenty to thirty percent of the patients
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more patients of the normal population they do have a question yes
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why uh there s. so many condom lesions on the proximal honey that do not have any
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yeah
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okay
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yeah okay that go to the for purposes of appearing
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what does that mean that rubber hammer if you're earlier when the ball is but
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are are are are the two places that for or of but i forgot it only hear
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about here is one thing uh a bus was uh you can have both do
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from a a normal over also the question of the uh uh would be uh would take for
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granted that think we have a condemnation of bucks mobile though would be painful one scene in
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patients that need that that we section of that person mobile have made that to relieve pain
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that that actually in that this is very unlikely uh being a saying uh but uh
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the thing i think that maybe that wasn't within the segment
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within you that that in my in my experience
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uh there's a lot of on the side that pain at the you can not the find anything but
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um they complain of being around the basic form and uh actually
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that they need to be used in my opinion by a
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tension of the financial capital moneys to realise the being that would
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provoke extension pronunciation in cases of a local can deal
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and my question is do you seal cooled ganglia producing being on the on the medial aspect that of wreath
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i know i'm i'm gonna it a lot then i need to
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put the lessons or whatever uh forget however probably work yes
00:11:52
um this person's gonna be easy the let's okay you go from the
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oh lastly analyse how um how can a i'll
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commending all closing the visitor it'll join
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technically you're creating some more thickness in the pits right research and isn't it
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yes
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uh well no we don't mind the
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if that if if we're keeping the uh the place of the purpose of
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our uh uh together with work with your with your with your mind
00:12:31
or remember by a lower verb scroll server would believe that's good for the
00:12:36
trucks or copper wires not to produce but not the you know
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we don't know how those people don't have morning we'll want to overcome with nothing but
00:12:49
anyone got any easier questions yeah yeah well i have a question for the panel and
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there seem to be a lot of controversy as to how commonly he see attend tonight just says
00:13:00
and in the audience how many people would say that easy ten tonight is is a common diagnosis that you see it on the site address pain
00:13:08
alright a huge amount oh it's so let me ask um how many of it panel and the audience
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would say that he's you tend to night it's it's primarily it's a it's a primary guidance is
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well believe that it's it's secondary diagnosis due to inherent other side
00:13:24
interest instability an easy is over compensating what would you see
00:13:30
let me sort of a saying that uh as i said the little supported these use common but i think if you and laws of
00:13:36
god think critically it's not the common and i'm hoping also question again make sure it will be much less and going up
00:13:43
why because i think that will assure that payment in rain supervision m. famous over the snuff box
00:13:49
is to use the problem but can often be construed as you see you but the true yes
00:13:53
you you get the obvious on what is the bodies on what is it very uncommon
00:13:58
yes the operations with paying on forced a straight you use you for
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real deviation and it's not fiction little little strays east coast line
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um and i think a lot of those present was want to put an egyptian because you're going through the easiest actually
00:14:12
um and if we think it's easy but uh i don't think it's easy so i'm on utterances that i
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i
00:14:26
so in the in the in the case of a um to use you to get a certain that goes with the second because
00:14:32
i think they have quite a few common uh courses such as the assume a couple of but in very injuries but also
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uh on this all started nonunion uh but and the novice
00:14:42
either inflammatory conditions that may be really doctors on august
00:14:46
but to use huge amounts of from repeats of usage i think it's very
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very uncommon in that case would be probably probably think it's real income
00:14:54
um for uh for us is usually associated to the where my father was a
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scribe uh others all insertion of that uses it that goes just to uh
00:15:07
a radio side of uh is you channel applause or some better so
00:15:13
that by going more for a brick a loser therefore will
00:15:17
but it it doesn't deserve a because the the job to the border the ligament
00:15:23
and uh you you can have instability you or you you can have sort works issue or instability
00:15:30
if that were the differences that that got because a lot of war
00:15:33
but like this and have duplicate not rubber of this move work
00:15:39
i i i think i think you're right in the terms that a easy you problems are not so frequent depending on the type of
00:15:47
patient i wouldn't expect brownies you then the night this one a problem
00:15:50
in a sixty year old lady which is not active obviously
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i would expect an is you problem if and the
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expiration him says that probably these huge intimated
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in and young tennis player for example so i think it's different we're putting everything on
00:16:06
on the same box and it's not the same box so i i i agree with you
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and i agree with elizabeth and also with mark that you may have happened them problem
00:16:14
because you're already using the pendant trying to avoid another problem so when you have
00:16:18
to explore another sorry pain you have to explore the whole reduced obviously
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obviously and you have to explore other source carefully and because it's a very common source of pain
00:16:28
and because of the c. u. problems and talking about that you may have one already use but you wouldn't
00:16:33
have had very sensitive to structure which is close to these you which is the source of the problem
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and these maybe the t. f. c. for example they make these maybe the yeah yeah on our
00:16:44
style not or these maybe assumption whatever so i i also agree with you i ah
00:16:53
oh yes peter excess of of work i wonder if you have any comments on a more like dynamic they were loading
00:17:02
yeah the the examinations like a a because i use a lot of the
00:17:09
images to x. rays taken just to the where the rest their hand
00:17:15
so do you have any tricks or tapes or even in a c. t. you
00:17:20
can do the the loading well the the the turning and so on
00:17:24
this is anyone using the two doesn't it has any value
00:17:31
hi you'll have to come and visit me in stock common if humans because i'm installing a mini c. t.
00:17:35
for loaded c. t. i. testing of their wrist and yeah and ankle joint so come and see me
00:17:43
right yeah but i completely agree we're doing is that big explorations and that doesn't make sense
00:17:49
it is waiting alderson maybe you very useful for making it a bit
00:17:58
i i would like to ask michael sense you have such great success with
00:18:03
cortisone injections at how would how do you do your question injections
00:18:09
i think you um so it was also say other talk yesterday
00:18:15
we're people teaching duties with the natural history great type
00:18:20
showing a uh it doesn't appear within six months it's not gonna get better to the word of you
00:18:26
know the study with excess that but that we're keeping the places you might last six months plus
00:18:31
do you like to see but that would give them one tools which one over top
00:18:35
i just record them all that we rejected which could with everybody it'll be much richer person to that but
00:18:43
um the point limit is that a reject a lot of course and and uh what we do is we basically injector
00:18:51
e. g. basically the budget was on wrestling position
00:18:55
and uh uh literally come over the uh the your top of only hit
00:18:59
and just on the ball aspect of it used to use this subject
00:19:02
um and go the subspace the sample when you'd wanna do a to place you'll you'll be able to get to your flute
00:19:09
still sitting out of the uh from the results of the research basically uh i'm putting it in just over the omitted
00:19:15
to try to get on top of the easy you uh the t. l. c. and i mean for this this should be good interval you
00:19:21
you uh you will still be good and in the most important news when you jack to
00:19:25
his resistance and certainly in the uh t. c. uh uh just to produce you
00:19:30
in that uh space and sony there's actually no resistance opposing easily painlessly and
00:19:35
a very easy addition to give you just need to you know
00:19:38
with some local and just make sure you in the right spot before you just watch the
00:19:42
uh for them it's very easy to should take literally take fifteen seconds or so
00:19:50
alright one i think we run ran out of time sorry i wanted to give
00:19:55
you about talking to you from me a book within a um since and
00:20:01
grind a finding that they that baby legal constable schools in the the f. c.
00:20:06
c. area over like you know to the your common about that differential
00:20:11
uh between the density of make interceptors in that the f. c. c. s. compared to the ligaments in the campus
00:20:18
i added the t. f. c. c. actually and compared to the rest
00:20:22
in general has more free nerve endings that has specialised mchenry sectors
00:20:27
if you look at the rest like humans over on the primary make and receptor that you find is the
00:20:31
roof teeny receptor which is one that is constantly monitoring your rest position whereas in the t. f.
00:20:37
c. c. the primary nerve ending is the free nerve ending which is the painful nerve fibre so for
00:20:43
some reason we are built to alert to a lot of pain with regard to that region
00:20:50
mm kay there are i think we want to uh wrap it up there we just
00:20:54
kept at the end about time to thank you very much for us because her
Conference Program
A-1153 Introduction
David Shewring, UK
June 15, 2018 · 8:01 a.m.
A-1154 Anatomy of the Distal Radioulnar Joint and Ulnocarpal Complex
Elisabet Hagert, Stockholm, Sweden
June 15, 2018 · 8:01 a.m.
284 views
A-1155 The Common Culprits (start)
Alex Lluch, Barcelona, Spain
June 15, 2018 · 8:11 a.m.
155 views
A-1155 The Common Culprits (main)
June 15, 2018 · 8:13 a.m.
138 views
A-1156 Assessment and Investigation
Michael Solomons, South Africa
June 15, 2018 · 8:23 a.m.
126 views
