You'll Hear It: Full Album Deep Dives with Jazz Musicians - Hand Health With Dr. Charles Goldfarb

Episode Date: April 13, 2020

It's another special guest today as expert hand surgeon Dr. Chuck Goldfarb sits in to advise Peter and Adam on ways you can protect your hands as a musician. And be sure to check out Dr. Chuck's podcast: The Upper Hand, where he and fellow surgeon Chris Dy discuss all things hand surgery (and it features theme music by YHI's own Peter Martin).In light of the worldwide coronavirus pandemic, we understand that money is tight for a lot of people right now. That's why we've decided that for the duration of this crisis, we'll be running a Choose What You Pay campaign at Open Studio. Choose whichever course you want and then let us know how much you're willing to pay - that's it. For more info, click this link.Interested in more music advice? Go here to browse our catalog of jazz lessons and courses available for purchase. And be sure to check out our All Access Pass - every course from Open Studio on every instrument.Let us know what you think by leaving a ⭐⭐⭐⭐⭐⭐⭐ review, or head over to our YouTube channel.Follow us on Facebook | Twitter | Instagram See acast.com/privacy for privacy and opt-out information.

We are live. So we are live here. We're doing a live, you'll hear it. With me, I'm Adam Maness. I'm Peter Martin. And with us today, Charles Goldfarb of the Washington University School of Medicine. Chuck, thank you for being here today.

It is my pleasure. Thanks for having me on. And you are actually at Washington University Medical Center, deep solar distance, deep quarantine in art at work today, right? I mean, they're doing the podcast with us, but actual doctoring is going on.

There is doctoring going on. There's not a lot of doctrine going on for those with elective practices. But there's doctrine going on and I'm going out in office solo. Awesome. So we already get great questions, which we're going to get to in a second. But what we want to talk about is with all of our guests, whatever the hell you want to talk about. But in particular, we have a lot of pianists and just a lot of musicians. And we're always a little bit piano-centric.

but almost every instrument, except for many vocals, uses their hands in interesting ways. And I know you've treated a lot of athletes, a lot of musicians, a lot of, you know, just folks in general, everybody pretty much has hands. But the way we use them in music is, especially as pianists, is very unique

because we're often a lot. And a lot of folks not going through a period of deep practice, which is wonderful in terms of you're sheltering at home, you're stuck at home, and a lot of professional and semi-cultural and aspiring, musicians are spending more time at their instruments than ever, but we're hearing about, you know, some injuries, maybe over that type of thing. And so we want to just, as we have you on the line here, get some of your advice about all that. But I thought I could just sort of

preface things with a little bit of a background on our relationship. And you've done a doctor of my hand when I had an injury that was not related to piano, but was a little bit more related to sports. But if you would, Dr. Chuck, maybe could you just give everybody a little bit of a run through of what your specialties are, because they're super interesting. I know there's certain areas that you really cover in depth. Absolutely. So like you said, I am at Washington University in St. Louis.

I'm a hand surgeon. And my practice is a little unusual. So about a third of my practice is sports and athletes, and I would throw you guys in that category. About a third of my practice is kids born with unusual hand conditions. And about a third of my practice is what I would call bread and butter hand in upper extremity nerve and arthritis and problems like that. And it makes for interesting days with a wide variety of patients and makes it fun, keeps it

fun, treating kids and adults. And I've been here in St. Louis since 2002 practicing. And I think I met you somewhere around there and not too long after that. Yeah, I think 2005, 2006 or so when we first came back to St. Louis. Yeah. Yeah. And also, I should just say in case folks, you probably already realizing, like, wow, okay, he's this wonderfully accomplished accredited doctor, but he's so good on a podcast.

That is not by accident because Dr. Goldfarb, along with one of his partners, has a wonderful podcast called The Upper Hand, one of the great titles to a podcast. And if you get a chance, we're going to link to that both here on the YouTube and the podcast, check that out. And even if you're not an aspire, if you're a young aspiring hand surgeon, this would be like gold. I mean, could you actually skip medical school if you listen to all your episode? Is that legal? That is a great idea. I'm not going to push that one out there, but there's enough quality content perhaps. But it's really cool.

I'm such a fan of a podcast in general and a fan of yours and your podcast. And it's so interesting because what, and I don't even know if you realize this, it gives a little bit of a, it kind of pulls the curtain back a little bit on the world of being a surgeon because you and Chris, Dr. Chris, are at a little bit different places, your partners, but you're at a little bit different places in your career. And so it's a fascinating look at how you guys interact and the different stages you go through talking about residency and fellowships. I learned the difference between a resident and a fellow. And so I'm not going to be calling anybody my resident fellow because it's two different things.

See, I know that. But you guys do it in a really interesting and cool way. And so congrats on that. Thank you. We've heard that Chris is a little younger or a lot younger than I am. He was my fellow, which means one extra year of training doing just hand surgery. people recognize he's a little deferential to me, which is not the goal. The other problem we have is we never disagree, which is a bit of a problem.

You want a little excitement, a little disagreement, so we're working on that. Your biggest fault is you're too agreeable. Well, actually, yeah, I mean, Adam is a little younger than me, but I've been trying to get, he's not deferential at all. He's super, he's not doing it right now because he knows we're friends, but he's usually super domineering with everything and, you know, but anyway. Of course. Cool.

So among your specialties with hands, I noticed you did not mention hand washing, which is very topical. Is that, does that not come under your purview of your practice? You know, it's an interesting subspecialty, but no, I can't claim it. Although I have become a personal expert, I had no idea that you needed to watch for 20 seconds or sing happy birthday twice. But like you, I hope, I'm taking it really seriously and doing it all the time. My hands need lotion, which I've never done in my life. And it's really fascinating. Well, I was going to ask you because actually on a serious note, I've been washing my hands so much.

But it is, I don't know this has happened to you, Adam, but the piano feels different and the keyboard feels different. And I've had, I haven't really had pain, but I've had a little bit of like jarring, just difference and a little bit of discomfort. And I was wanting, the thing with lotion for pianists is tricky, especially if you're playing a lot of keyboards like we are if you can't get to a real piano or whatever is that it gets slippery. So I can't do a lot of lotions, but I've definitely felt a difference in just, it's a tactile difference in the. keyboard. I knew I'd learn something. Yeah, I don't, I think that when I lotion is really on the back of the hand, I'm certainly no expert or I don't use a lot of product anywhere. But I don't know about the fingertips or the pads of the fingers, as we call them. Yeah, I would see how that can be problematic for you guys. Yeah. That's a great idea of the back of the hands. That's a good one for

pianists to try. Yeah, yeah, yeah. So we, you know, we get a lot of questions about is, is there anything that we can do off the keyboard for our hand health, you know, to stay strong, to stay healthy. Is there anything that in general you would recommend to keep your hands in a good spot? It's a great question. It's one. It's actually hard to answer. I guess I've been most familiar with those who play professionally in the symphony, and I've seen a good number of such patients in my office.

And those patients come in for specific problems. As far as general hand health, I think it's a matter of, and this is getting to the point of the whole issue, which is not overdoing it. And you may not overdo it until you've overdone it. But like any athlete, I would say, you know, if you really have a tiresome session and you're going for too long, icing afterwards, taking Motrin. If you have one or two muscles, which are really clamping up on you, really trying to stretch through it as hard, which sounds silly for the hand. but it does make sense and it does work. So those are the things I would say. Ice, if you have a long session, you know,

if you have achiness, it's okay to probably push through it, but if you have sharp pain, stop. That's great. And so it's interesting you say like any athlete talking about musicians, and I think that really resonates with me and a lot of the things that we, you know, from a musical standpoint that Adam and I, you know, advise to, oh, okay, we're still there.

you know that especially the piano well every musical instrument kind of has its specific technical um um uh difficulties and things to overcome and that's when we talk about practicing on an instrument it's usually about overcoming like with piano fingering is a big thing how are you going to finger these things what is your arm position what is you know your shoulders and all the things but a piano is a very it's a big machine with a lot of parts and you need a lot of power to play it so i always think the athletic side of and how you're going to harness your energy to be able to pull that out out does have an athletic, it's kind of a mindset that can be good. We talk about, you know, Adam's really good about talking about breathing and we bring in some meditative kind of things

in terms of how you practice so that mainly you can keep your body from getting, like practicing. A lot of times we get hunched over because it's intense, almost like you're at a computer, you know, when you're really doing in that kind of flow state, but it can, it can lead to a lot of just these kinds of aches and pain, soreness. And then, you know, even probably bigger difficulties is when you're probably seeing the symphony players coming in. I guess is that, I don't want to throw a medical term out there. Is that acute pain, would you call that? When a symphony player comes in?

Yeah. I think it's usually what I would say, acute on chronic. So something may be underlying and then an event or a session makes it a little worse. Okay. You know, the analogy with you guys, I think, would be patients that are labeled workers, compensation or work injuries because they have been typing too much. and that gets to the ergonomics of putting yourself in that position to succeed. So for piano playing, it means not playing piano with your hands up,

making sure the bench is at the right height, make sure your shoulders are in a good position. The wrist should be relatively neutral. So those things are key. And there's a question about sax, you know, playing the saxophone. And again, I guess the shoulders and elbow positions, it's just a matter of not playing in an awkward position. Yeah.

Well, luckily, all those things also help you, you know, sound better. You know, having great positioning, comfortable positioning your body. Just when it's comfortable, you play better. You get a better sound. You play with more control. So listen to your body.

We talk about it all the time about getting a good posture, feet on the floor, you know, straight spine, breathing. And if you feel discomfort somewhere as you're playing, there's probably a position that you shouldn't be in if that keeps happening. And so the doctor just confirmed that for you all. So you can keep listening to what we have to say.

I know, Peter, we always preface that we're not surgeons, but we just got expert reinforcement right there. We can say we're surgeon approved now, right? I think you got a little checkbox in your, with you. Well, and this is going to, for folks that follow us closely at the podcast or Adam and I with Open Studio, it's going to sound like a setup because, Chuck, what you just said, even about the wrist, you know, being in a neutral position. I think you said it in terms of at the keyboard.

That's something that I learned from a really good teacher when I was young. And I've always preached that and taught that and talked about. We talk about that a lot. And I've done videos on that. Certainly not from a medical or even injury standpoint, but just from the standpoint of being able to effectively pull the sound out and create the music that you want to at the keyboard. But I've always also said that I haven't suffered any serious injuries.

I mean, yeah, I've gotten sore and sometimes I take a break or whatever. But I've always felt that. you know, the more natural we are, you know, just like, you know, athletically in terms of like the more natural your technique is, the less chance there is for you being able to repeat over and over again and do something that is going to bring you to injury. I just never known that was medically approved or not. Yeah, it's interesting because for some people, this comes easy, right?

Just like any other sport, you know, for some people, their shots natural, for other people they have to work on it. I would assume, and I'm not a musician myself, that I don't have a musical bone in my body, but I would think for some people, they have to work on being comfortable and being relaxed. And you can get there, but it just takes some more concentrated effort. That's great. It's great.

So you want to get to some questions, Adam? Do we have any? Well, no, I had a question. So sometimes we get asked, too, like, you know, I injured my wrist playing basketball, Peter, or some other activity. Is there something, is there anything like I have a good friend who is an ER nurse at Children's Hospital here in St. Louis. And she's like, I would never, ever let my children, you know, ride in ATV because I see too many of those all the time.

Is there equivalent of that for a hand surgeon? Is there something that's like, don't do that? Or for professionals not here who don't want to risk, you know, a possible career stalling injury? Oh, Peter's got a good story about that because I think it directly applies to him. Peter, you can start and then I'll jump in. Okay. Yeah.

So we'll get the patient and the doctors. recollection of that of that acute illness no so i was actually uh chuck in addition to being a wonderful surgeon and wonderful father and um just nice all-around guy is also a serious amateur basketball player and i mean on on the like we joke about being semi-professional in our athletic endeavors but we've played together quite a few times and he's a great player like a great and sometimes it sounds like an insult when you say he's a great thinker it means they're not he's very athletic as well but he has great court vision.

Yeah, well, when people talk about my, like, wow, you're such an intellectual player. They mean, I'm playing like an intellectual, you know. But, no, Chuck's a great basketball players. We've had a lot of fun playing together. And there was a period where the regular game that we played, I would only go to the game if I saw Chuck on the email that he was going to be attending, thinking my hand surgeon will be there, thus mitigating any problems. You are an intellectual player.

But I did have an injury. once and see the shows I shouldn't have showed up when Dr. Chuck wasn't there was not in attendance at the game and I dislocated my left thumb and you know I'd never dislocated I jammed my you know my fingers a lot over the years so I kind of felt like I was fine and I'd never broken you know in any anything in my fingers or my hands or anything but it was clearly dislocated and one of the Yahoo's at the game was like I'll pop it back in and there actually was another doctor I don't remember if you remember Pete Crawford was actually at the game. He's not a surgeon. You know, he's a, I think a, I'm not sure what kind of diet. Cardiologist, right. And so he was the one. He's like, no, you're not going to be popping anything back in.

It's like, we're calling Chuck. And you were out of town and we called you. And I think I took a picture of it. And you gave me some. You were like, okay, go down to my hospital, to Barnes and or whatever, BJ's, whatever was called at the time. And you called some folks there. And I was quickly admitted in.

It was actually, you had so much pull there. I think I was pushed back in front of some gunshot wounds and like some arms. You know, they were like concert. And I think you described me as a concert pianist. So they were like, there was a lot of jumping around. I'm exaggerating a little bit. But anyway, I got back there. And I think I was with some of your residents or fellows that were there.

They came over. And they, you know, popped it back in, but in a different kind of way. I think there was x-ray done first. And then my wife showed up very hysterical. but already getting very angry when she saw that I was going to live through it. Why are you? Because there was a lot of why are you playing basketball? You're a pianist. That's how you make your living. But anyway, it was the extra, I guess, showed that it wasn't broken and then you were able to see that.

And it was put back in and it was banned, you know, it was wrapped up and that kind of a thing. And so that was really the only really bad injury. And actually a week later, I was able to play. I had a gig. It was like a local kind of a small charitable thing, but I really wanted to do it. And I was able to play. I think I still had it wrapped some and you had looked at it maybe by that point. but maybe that was a real lucky lucky uh well yeah a couple of things from this you know my philosophy is

i want to keep players playing whether that be basketball or get you back to your job uh if that happens to be as a professional pianist i think it's incredibly important and i know that you i think you stop playing ball for a while because i think kelly said yeah not do this and i didn't like it then and i think eventually you must have worn her down because i know you hit the court again you know i think almost every injury you can deal with. Almost every injury you can deal with. And sure, there's risk. I think our risk are actually pretty similar.

If I play ball and I, you know, hurt a finger that this can affect my ability to get back in the operating room. But you know what? Life's short. I think you should do what you have fun with. But I will say for those like people who are on ATVs or right now, you know,

everyone's sheltering, but kids are out in the backyard playing. And what I see when I walk around my neighborhoods, everyone's going crazy on their scooters and their, and no one's wearing helmets or wrist guards. And you know, you know what that means. There's going to be falls and there's going to be injuries. So I hope people are smart with how they go about with these activities. Right, right.

Let me ask a question, Chuck. So I have been watching a lot of MMA lately, which I'm like new to the game here, but I'm loving it. And so like I was watching some the other day on YouTube and I was like, I'm going to learn jiu-jitsu. And then I texted a friend of mine who's like a lifelong jiu-jitsu. guy and I was like how often do you injure your fingers, hands, wrists, or arms, jujitsu? He's like, not a lot. He said probably five times this year.

Is that, like, as a professional piano, should I stay away from combat sports? You know, again, I don't know. I'd stay away from that, dude. I think that, yeah, you've got to exercise some, you know, common sense. My nephew is a martial artist and is really good. And like literally three days before he's heading off for his freshman year in college, he was trying to pass his black belt test and broke his metacarpal, broke his hand. Ended up needing surgery and the whole thing was a debacle.

But, you know, he's back out fighting again. Again, there's probably technique there as well, you know, to minimize your risk unless you're actually grasping or sprawling, you know, sparring with somebody. That's great. I see, I think he just yelled to his wife that he's starting MMA. See? It's like you wrote him a prescription. start. Well, I love that. That was like supposed to be a softball question for you. Like, as a piano, should I do MMA? And Chuck is like, well, you know, maybe. Why not?

Well, if it's short. No, but I do think this, and we've talked about this before, like, the concept of the benefits of being and, you know, staying active and participating in, especially sports that you're a passionate about, that you can really, you know, bring so much to your fitness in general. And then as you come, you know, back as a musician, as an athlete musician, what it can bring, maybe is worth a little bit of the risks of some of these things happen. Is that what it sounds like? I think, you know, we talk about in sports, you know, we talk so much about the adolescent athlete and we talk about the kid who starts playing just soccer at age 10 versus the kid who plays multiple sports for as long as possible, and there's no doubt it's beneficial to stay active in multiple different ways. It's good for the muscles. It's good for everything. That applies here. The more active you are in general. the better your body is going to hold up.

And if you just do one thing, if you sit at the piano and just play piano for multiple hours a day, it's hard. It's harder on your body and you're less likely to be resilient against injury. This is a really good question. Peter, I don't know if you've ever experienced this, but there's this, like, there's a lot of armchair doctoring going on with piano technique. On this podcast. I mean, with doctor, between you and I, usually, we're trying to minimize it today.

But, yeah. So there's, like, someone said, ask. So the thing they told you outside a club about some tendons of your hands connected to your torso and others connected to your back is true. So this is something that when we talk about learning piano technique, we talk about, I've heard that these three fingers are connected through tendons up to your chest. And then these two are on a different path that ended up in your back. And I was always like, is that true or is that total horse poop? So that's total, no. So, yeah, there's two kinds of muscles or tenets in the hand.

There are ones we call intrinsic, which start and finish in the hand. So the entire muscle and tenet is within the hand itself. And those are the muscles of the fleshy part of the thumb and some of the muscles between the fingers. And then there's muscles that start in the forearm and finish in the hand. And those includes ones that bring your wrist back or contribute to straightening your fingers. None of the muscles in the hand go above the elbow. Truly, I mean, they kind of come close, but really don't go above the elbow. They definitely don't go above the shoulder and they definitely don't connect your back.

But I think what it gets to is this whole kinetic chain idea that anything you do with your wrist, the elbow, you know, position of the elbow matters, position of the shoulder matters. Even your torso matters. So it's all connected, but not directly. right yeah i mean i had a piano teacher once that was like having me pull my fourth and fifth fingers like imagining from my back and i was like i don't i don't know if this is real it's real to me and i think that's that's like a lot of times where we maybe hopefully not on this podcast but take it a little bit too far as far in terms of like using your whole body from a conceptual standpoint when you play the piano is very important but what we shouldn't do is

then to actually say because it is connected in a way that it isn't. But in terms of positioning stuff, I think that it is important, right? Absolutely. Yeah, I mean, it goes back to what we started talking about. Not directly connected, but everything's connected. And position of one joint affects the muscle power and function of each other joint. So sort of, you know, I guess the message is the correct one, but the specifics probably weren't accurate. Now, what about something that we we do advise often just from personal experience and also sort of teachers saying this in a little bit of common sense is this idea of when you're really doing intense practice, especially like by intense, I mean like you're in that flow state, you're a little bit unaware of everything except either the composition you're working on,

the music or whatever, is to like put a timer on so that you don't, so like two hours don't go by when you're in the same position. You thought it was like 10 minutes. And I'll do this because I've had this problem before. So I'll do like 50 minutes, 45. For me, kind of works. And then I just force myself to get up as much as I want to keep going and walking around, maybe do a little bit of stretching or something. And it seems to work.

Would there be any medical foundation to that? Or is that just something good to do? I don't know if I could say medically, but it absolutely makes sense. Totally agree with that. Because when you stop thinking and you're so focused on the task at hand, you don't think about positioning. and you can get muscle fatigue. And then what happens, you get muscle fatigue.

You get muscle substitution. So you're asking muscles that shouldn't be helping with the task to do the task. And then it just leads to this chain of events, which is not good. So I think that makes all the sense in the world. Okay. And then what about something that, oh, sorry, go ahead, Adam. No, I was just going to say, you know, too, I like this idea of sort of musician cross-training. I'm not really thought about that, that we spend hours and hours in this one position

working these very specific muscles in our hand and somewhat up up to our elbow and then ways like doing some exercises to sort of cross-trained those like even for me I notice when I'm consistently doing push-ups I have less strain on the piano somehow and I always attributed to I'm just stronger but it's probably that like I'm I'm like working out some of those muscles in my hands and wrist as I'm doing as I'm just supporting myself on the regular as some cross-strain I think it's it's an interesting thing to think about as pianist that you know It's cool to like try to like work those muscles as we practice scales and connect, you know, music to our brain.

But like doing a little bit of like different kinds of exercises off the piano could probably help reduce the injury. And then I suppose just like any other cross training, like you're building up the supportive muscles that aren't being, you know, aren't the primary muscles when you're playing. That could have been all just made up just there. But it seems no, I like it. I'm wondering if I'm wondering if I'm.

cross-changing regimen we could come out with something specific. I don't think we could, but it sounds good. I like the idea. Yeah. So someone's asking, and I know this is, we don't want to push you into any kind of telemedicine, but someone's asking about numbness in my left hand as a guitar player, but maybe just the general idea of like when do we, as musicians know, like what is the signal where we need to just, as you said earlier, you know, take some motron or whatever, but when

does it cross over to you really need to go see a specialist? And I mean, I know that we're at a special time pandemic in terms of it's hard to have access to doctors if it's not an emergency. But when do you kind of know when it crosses over into something serious? Yeah, I think that's a great question. And first of all, I will say that many practices, ours included, are transitioning to offering telehealth or telemedicine. So three weeks ago, we didn't have a single telemedicine visit. And now, I think our group alone, orthopedics at Washington University, I think does about 150 a day, 150 visits a day. And while you can't do everything over a video chat like this, we can usually figure things out

and then help with treatment. You're right. I don't want to get into specific, but I will say the question about numbness and tingling, and what we worry about with numbness and tingling is carpal tunnel or another pinched nerve. And one of the things that we want you to avoid, no matter what instrument you're playing, it's a position of constant wrist flexion or elbow, you know, hyperflection trying to show it. Those two positions together or separate are not healthy on the nerves crossing those joints. And so again, getting back to the posture comment.

But if numbness truly is there, whether it's brief or whether it's constant, if it continues to come back, if it's intermittent, I think that's a reason to see the doctor, especially if it becomes constant, any condition that becomes constant is concerning. And then would you typically, would somebody in that situation go to their general doctor? Would you want to go straight to a specialist, an orthopedic, or you kind of want to go straight there? I guess I'm a little biased. It depends on the primary care physician. It depends.

You know, some of them are really good and they can start the treatment process. There's nothing wrong in certain, you know, cities and practice types and going straight to the specialist. I think that's a hard one to answer for everybody, though. Got it. Cool. definitely key if you're experiencing any kind of those sharp pains though like don't don't wait on it go see someone soon you know don't try to play your way through it especially if it just keeps up consistently totally agree with that yep what about um what about like hand exercises away from

the piano and stuff and just general things is there anything that's ever been i mean i'm i know there's stuff that people do in piano i used to have those steel balls that i mean it felt good, but then I think it was more of like a meditate, very 90s, very 90s. But that was great. And then there was that hemp necklace too. Yeah, hemp necklace, exactly. CBD lotion and the balls and the hemp necklace. I'm ready to practice, you know.

But is there anything, any kind of like exercises or that could actually be helpful? You know, if I'm reading you're right, those balls were like two balls that made a little noise and you rotate them around in your palm. Yeah. That probably does make some sense. And then just anything, those stress balls actually or something that I recommend relatively frequently. Ah, stress balls.

And you know what? I used to do that around the same time. Stress balls, sorry. You're writing this down. I am, man. This is my personal. I'm getting advice, man. Come on.

Yeah. That's why we do it. We're around here. We're not messing around. No, the stress balls, I remember really liking that. The ones I didn't like, and I always felt like were a little bit, you remember the ones that had springs for every finger? That didn't seem because it was like strength.

Because, you know, a big thing for pianist is, course, our fourth and fifth, like you want to be able to play with all 10 of your fingers equally. And there's all these exercises and books that, you know, independence of the fingers, independence of the hands. That's another issue. But the fourth and fifth thing, yeah, look at that. Exercises for independence of the fingers. Oh, wow. So it's about strengthening, you know, your fourth and fifth finger and then dealing with the thumb, which, unless you're an orangutang, which many have said I am, is shorter than, you know, and so it's like you're playing at the piano, which is just flat. I always said, like,

if we could develop a piano that was curved, it'd be easier because we're dealing with different lengths to our fingers and thumbs, but you have to use all of them in theory equally. So a lot of the stuff is about strengthening the fourth and fifth fingers. And I've always felt that there's definitely like a, you know, your brain is controlling all these things. So you have to, you've just used these more and stuff. So it's about using them more.

But those things with the springs and stuff came about for a lot of it. And I remember when I was at Juilliard, they used to be like, oh, yeah, I mean, you've been doing the springs. I was like, man, it kind of hurts when I use it. That couldn't be that good. But could that actually even strengthen your fingers anyway? I don't know if I buy it because most of that flexion strength you get from the forearm muscles. You know, again, if it hurts when you're doing it, don't do it is the bottom line.

Right. I got a trivia question for you, putting medicine and piano together. So there's a certain – we use a lot of eponyms in surgery like the Collies fracture or the Jones fracture or things like that. And then certain things have kind of a layman's terminology. So we have a fracture in the hand, which we often see in adolescence called the extra octave fracture. So this is for you guys. What do you think the extra octave fracture is? And maybe you'll tell me I'm totally wrong in the use of that.

But the extra octave fracture is when you break the base of your fifth finger. Yeah. It typically goes out more. Yeah. Ideas that expands your range. Is that the right way? Wait, I want that. Can I purchase that injury?

I have a weird, I don't know if you see that, but my pinky just naturally like hangs out there. And I think it's from years, especially like that, like gets way down from being able to hit those, like you see that. Yeah, we, our hands will change when we try to do all that stuff. So. Yeah, and I mean, it's really seen as like a positive for pianist, the bigger reach you have.

And there's a, like a tenth, which is kind of my maximum. that's a little bit aspirational for, I don't know, maybe half the people or something. Like, that's, you know, a good, I don't have particularly large hands, but I can reach that. And so, like, that's, and you can even go beyond that. But, yeah, 11th stuff. Well, if you get a 10th, what does Adam get? That was 11th, I think. I can get an 11th.

Okay. Wow. I can kind of get an 11. Yeah. But the 11 doesn't have, it's not like the 10th. 10th really has some very good musical applications. So if you can almost get it, it's sort of like, oh, I want to get there. But I've always wondered, and I've never told anyone this, but I felt like, you know,

I mean, my range definitely got bigger. I felt beyond when I just had, was growing. But is it possible the more you are stretching that you could actually extend that, I mean, without the actual extra active injury that you talked about? Nobody, you know, actually their pinky, please. Yeah, yeah, right. Not recommended. Yeah.

I think you can. I buy it. I do buy it. There are rigid structures. We call it like when I was an intramatic carpal ligament, which looks like that's what Adam may be have stretched over time. I don't think I've seen it on a day-to-day basis, but I would guess you can. Yeah. And get some joint. The joint itself probably just becomes a little more mobile with time. Right. Cool. Yeah. Well, this is great, man. Yeah, Dr. Goldfarb. Thank you so much. This was really, really awesome. We should do this again soon because. this was super fun. The three of us will stick around after this podcast is over just for a minute to wrap it up. We're probably not going to keep this on YouTube because of some video issues that we're having. But check out this over on the You'll Hear It Podcasts on our audio podcast. The audio is still good for this. So thanks everybody for the questions.

And thank you, Chuck, for joining us. Yeah, it was fun. You got from our podcast heroes. Check out the upper hand podcast. I got a link in the U.S. YouTube I dropped there and it'll be on the show notes as well. So check that out when you get a chance.

Awesome. Until tomorrow. You'll hear it.