Jun 11, 2012|
Dr. Jennifer Green, a hand and upper extremity surgeon, completed her undergraduate education at the University of California at Berkeley. She completed medical school at Georgetown University School of Medicine where she was elected to the Alpha Omega Alpha Honor Society. She did her internship and Orthopaedic Surgery residency at Tufts-New England Medical Center and completed a hand and upper extremity fellowship at the Philadelphia Hand Center at Thomas Jefferson University.
Transcript - Not for consumer use. Robot overlords only. Will not be accurate.
There is news hey am searching. WR JU. -- -- -- New York zoomed into the health and wellness are with the dog -- -- -- AM six AB WR Kerio fan but. Good afternoon. This is doctor Gary Glaser and welcome back -- the -- the moment show on Boston's talk station. BM succeeding WR KOI hope that you all had an enjoyable week in a multi week. And I wanted to welcome doctor Jennifer green of Newton was he was a big associates. Who -- kind enough to join us on Sunday afternoon. The into the weekend. Younger and we can hope I didn't have a good week thank you grabbing me today could Jen thanks for joining us so -- is one of thirteen orthopedic surgeons. At Newton was US computer associates. They have a wonderful group. Each one in the group has a little specialty. And -- specializes mainly in the wrist elbow when he ends. And we thought we would start out by speaking about Carpal Tunnel Syndrome. A very common condition using patience we'll start -- facing their primary care provider over Woolsey primary tremendous and many -- won't command. With discomfort -- -- in rest we'll see myself one of the nurse practitioners. And will take some steps. For preliminary diagnosis and treatment and sometimes the patients and I'm still seeing and we crying a visit from the specialists so -- For all of our listeners if you could define Carpal Tunnel Syndrome. -- Carpal Tunnel Syndrome is where the median nerve gets compressed etheridge at the rest just comes into the -- The median nervous and nerves that supply some of the muscles of -- some Indiana hand. As well as the sensation of that sum the index finger and the middle finger so if you have a median nerve they can squish as it crosses the rest to start getting numbness and tingling in the found the index finger and the middle finger. Sometimes you can get some weakness of your son's twelfth. And -- is a lot of other structures that go through that little thin covering at the risk correct. Correct there's the median nerve -- and it also travels with nine tendons that come into the hand in healthy people to move your fingers up and down. So there's a very confined spaces. Game with a little information committee cause a lot of symptoms seek. Actually as the tendons as we get a little bit older sometimes our attendance well little and they can compress and squish the nerve. And since the nervous the only thing that has any give the nerve -- gets questioning you end up with symptoms. What are some common causes of what will cause Carpal Tunnel Syndrome. That's a good question there's a lot of discussion about what actually causes Carpal Tunnel Syndrome. We know that there are certain problems actually lead to Carpal Tunnel Syndrome one of those things is diabetes. I mean the people who are overweight have a tendency to develop Carpal Tunnel Syndrome. Women that are pregnant can sometimes develop Carpal Tunnel Syndrome people with thyroid problems also have Carpal Tunnel Syndrome. On there's -- other things with in the workplace if you do a job that has a lot of vibration like working with the Jack camera sometimes actually to Carpal Tunnel Syndrome. -- -- it's it's difficult to know whether or not a lot of keyboard work or a lot of filing a lot of repetitive activity actually caused Carpal Tunnel Syndrome. We don't have a lot of evidence to support staff that there's it's it's a little bit dispute and. So one of the patients and our practices going to commend. Tomorrow. -- when the nurse practitioners. Which he recommends the first steps that be taken by the medical team in evaluating patient. I think the patient has numbness and tingling in the index finger the middle finger in the thumb I think the first step is usually to get a wrist brace. A lot of times patients how about this numbness and tingling that wakes them up that night the wake up in the middle of the night it'll find that they have to shake their hand out 'cause it feels like it's asleep. Comments have a patient wears a wrist -- night while they're sleeping it keeps the race too nice and straight doesn't let them -- in any direction. And I usually keep some more comfortable if there -- neck brace while they're sleeping I think that's a good first step. And counsel patience to Wear that just bothers sleeping because. To where that 24 hours isn't the best for the muscles they don't have any atrophy great and we can obviously be more control. When were awake but it -- ten reserve you know. Mentioned to us that can't we control what are interested to Armenia in the evening exactly other then that's. The support. Is there any role for -- or any anti inflammatory medication. I think if it makes patients feel better it's okay to go ahead and do that. There hasn't been not much evidence that shows that's on anti inflammatory medication is gonna cure the problem but because it is good pain medication might help patients feel a little bit -- And same thing with ice that makes people feel better I say go for it. And how long would you say that as the primary care provider. And for the patient who should we give the patient until. Time to see if they're getting good relief. -- Resolution of the symptoms before we -- them to your group. I think it depends I think if patients feel better with that wrist brace. They can go ahead and where that wrist brace tonight if it bothers him a little bit during the day I think once the problem becomes more persistent. And happens during the -- -- it's more frequently in -- every night and they're not getting good rest even with a brace on. Think that's a good chances to send them to a specialist we haven't evaluated. So now we're at that's up Jen and they're going to be sent over to see you wouldn't the most orthopedic associates. Against the patients are even wearing nets supported the evening they've tried ice to -- done any information. They -- in the inflammatory medication just to help relieve some of their symptoms as well. And nothing is working. What's your next step. Now except I do is just make sure that I do agree with the diagnosis of carpal tunnel -- I do a couple of tests in the office. This is on us I think that it's carpal tunnels and a mind usually send patients have a nerve conduction study during EMG. Just to test the health of the nervous half point. So I can see whether the nervous really irritated or just a little bit irritated. For the EMC work in the patient expect during that test. That is a test where I usually send them to a neurologist -- the psychiatrist who specializes in doing the study. And that test not the most comfortable tests in the world that they do use tiny little needles that helped to conduct electricity through the nerve so we can see whether the nervous healthy or not. It's actually very helpful in determining. On the stage of the couple tunnel syndrome firm for me that he answered them. Any role for physical therapy in this condition. Usually in the very beginning stages they can sometimes help patients feel a little bit fatter than nervous caught -- -- any scar tissue if there's ever been any kind of injury. Sometimes I think occupational therapy or physical therapy can help. But a lot of times it doesn't I -- make things change in the long and. You're listening to the health and wellness show on Boston's talks stationed -- succeed WRKO. My guest today is doctor turned green of new the most who have defeated associates. Doctor green is one of thirteen orthopedic surgeons. They -- wonderful website that website is www. NW away dot com -- WWW. -- and for Newton W for Wellesley. All orthopedic he associates. Dot com their phone numbers 6179640024. Again 6179640024. They always have same -- appointments available so tomorrow morning after the weekend. For anyone who needs what the -- services. I strongly recommend you give their group call. For today's show for any questions. And you can leave a message at 617. 2666868. Again at 6172666868. And doctor green will be sharing your back to you as well. We spoke to a physical therapy for a Carpal Tunnel Syndrome. -- -- is doing notification doing any exercise on their own any role for that -- early on. I think it's important to just make you keep your hands strong and flexible lot of people and they have any tiny hand injury your hand discomfort they'll stop using their hands I think that's. Not so good in the long run but as far as specific action sizes I don't think anything's gonna change in the long run. In this computer reads many patients -- wonder if the way that they're keyboardist positions. Is causing unity symptoms. Any truth that. I think that it's important that the workstation beset accident -- tire body posture and your arms in your wrists are all in good position. That usually means keeping your Alba is at a ninety degree angle and keeping your -- nice and neutral set they're not too flexed her to extended one way or the other. But as far as. Key boarding itself I don't think that is has much troll and in contributing to Carpal Tunnel Syndrome. How often do you see when Carpal Tunnel Syndrome is diagnosed. That patients who returns you saying that he came back again. I think that it is kind of common that that happens I think a lot of people get temporary relief from using the wrist braces. But unfortunately Carpal Tunnel Syndrome once it starts to progressive doesn't usually get -- on its own. And after the EMC's. What are the other conditions that can mask is Carpal Tunnel Syndrome that you seem. You can have problems with your neck where you get some nerve compression pitcher necklace from a little bit of arthritis and that can cause some problems. I'm if you had any arm injuries sometimes that can cause some problems with the nerve itself. Sometimes. There's other nerves that can be involved in people mistakenly think that's carpal tunnels and -- they have to make sure that the EMG helps to determine what exactly what nervous exactly involved. Putting the MG aside. If we're suspecting that the neck may be responsible for affecting the nerve. What are other aspects of the patient can look out for when their percent of the office. Think it's important to per doctor to check to make sure the patient does or does not have neck pain. A lot of times -- patients moved their neck from side to side or from ear to shoulder. Sometimes they'll feel a little bit of a twinge go right down their arms in and that's something we have to be aware of because that does not Carpal Tunnel Syndrome that usually means -- little bit of arthritis -- pensioner about the and that. So very important for all our listeners that when you're seeking medical attention. And you think you may have Carpal Tunnel Syndrome. Very important to let the provider know what feeling any next symptoms as well. -- certainly help us in making the diagnosis. And will also witness in the direction for proper treatment. Switching gears Jan two tennis elbow also known as -- have become the latest. Commute to find that conditions for a listeners. We have tennis although as we have a lot of pain over the side the outside part of your elbow. -- we usually find it happens in the wintertime after people do a lot of shoveling. Or in the summertime after people do a lot of gardening or in the fall and people do a lot of freaking here in New England. And it's just a lot of penis feels like that's teen starts at your elbow and comes right down the top of your form and sometimes patients describe it is a burning eighteen -- It's a really difficult to use -- arm. Does an injury from trauma ever. Present in this drizzle and sometimes they can't sometimes patients can lift something really heavy and they feel almost like it tearing sensation over the side of her elbow. You're basically what happens in that situation or even and the chronic situation is that the attendance -- insert up on the top of the although. I'm -- Tierra little that you get these really tiny tears about ten minutes that those stairs try to heal themselves they just generate a lot of pain. Into a recording at the same condition as well yes that's the same it's just a cute in an injury setting or chronic if it's something that happens over time. So the patient will be doing a lot of gardening a lot of region. This out of your announcement shrinking but -- for sure. Hands. They've had symptoms for a certain amount of time. How long should they let it go before they come into their permanent cure office. I think if it's something that's starting to impact all youth activities it's happened during the day and you can no longer -- your activities you should probably take. I take the problems your primary care doctor just make sure that nothing else is going on and that's that's really what the problem his. Those are some things we can do to actually help that make it a little about her. So in the primary care setting. -- often use ice men were using anti inflammatory medication I wanna remind all of our listeners that for anti inflammatory medication. You must be sure that you're allowed to take it with your primary care provider with a nurse practitioner. Physician assistant. Not everyone is allowed to take these medications they don't come. Completely risk free when you do take them you wanna take them with food. Ended this week a prescription strength of Ibuprofen. Of 600 milligrams. Is different than 600 milligrams over the counter and and once you keep that in mind I know it's been a theme of earlier shows as well. Usually it'll suffice just taking the over the counter I think in the proper milligrams. But keep -- you don't separate out is suicide and if you're going to need long term therapy and you need a prescription. It is a little different. So agenda patience been their primary care provider. And they've already tried ice. They've already tried. Anti inflammatory medication. And the condition is still persist and now we're sending them over to new -- -- -- associates what steps he's taken. They usually once again examine the patient make sure that I agree with that diagnosis and that there's nothing funny going on with the other joint itself. And if I'm sure that it's -- up McConnell I'd answer at this tennis although usually the next step by two is on top with a patient outlook causes it. And then different options that we have treatment options unfortunately we cannot cure this problem. And this problem usually goes away on its home but -- can take a really long time to some of the things I recommend in the meantime if you do a little bit of physical therapy. Some stretching exercises of the muscles than those -- that's by the elbow can actually make patients feel a little bit battered. -- -- can also do stuff like ultrasound mini do heat treatment and ice treatments and all of that action makes things. -- on the matter. You are tuned into the -- and will lose our will dog -- -- blizzard on the radio surgery. -- -- -- -- I. This is doctor own laser and you're listening to the health and wellness show on Boston's talk station came succeeding WRKO. For any questions. 6172666868. Is the number to call into. But the station again it's 6172666868. You can email questions or messages from doctor John Green a new miles you have competed associates and so be sure to get back to. The phone numbers for new ones who have been associates he and his 6179640024. 6179640024. We're now speaking about tennis elbow. Also known in medical terms as lateral and -- on the latest. In January mentioning that but this condition that a lot of times it just needs to go away on its own that we concerning treatise reportedly with ice. Anti inflammatory medication. You do us physical therapy but it if can be a long time when you say a long time what Camille -- expect for the duration. Usually I'll tell my patients it can go anywhere from about three man stepped up to a year. Usually goes away by about nine months to twelve months but we usually try to tell patients if they might be in for the long haul but eventually kind of burns itself out. So I destroy them 12 be prepared for with this condition. You really can be enforced for the for the long haul and doesn't mean that there's anything intrinsically wrong with the elbow. But they use have to be patient with that but restore encouraged to call obviously in and its second. Are actually is ever hopeful. They are especially if a if a patient has had an other trauma in the past. Because sometimes a little bit of arthritis can constant irritation of those tendons in -- it's it's no with the underlying cause of that problem -- this. So extras are helpful -- for me if the problems thing going on for a really long time in and nothing seems to be making it better on usually get X -- just attack. And when a patient comes to your group needing X rays. They can get the X is right out of the office at extras are done and the -- -- have to go anywhere else we can get them right there in the peso though the results before they leave exactly what's really really convenient that. When they're going to see the specialist. Add your groups that everything is really done all of that does it exactly because you know how busy everyone isn't. It's on ways to get the diagnosis when you went on the spot. With the -- we also have waiters or golfer's elbow condition. Could you define that for us. Yep that's similar to the lateral McConnell and -- of the tennis elbow -- its feet inside part of the -- that's usually involves with this problem. And for some reason you get some little tendon tears off at say at stony point of the elbow on the inside and that can be very painful. Little bit different on the inside partisan cheap that your nerve that live is right behind your elbow groove. That's the funny -- -- people being pretty often get a shot down year on your arm. And sometimes and nerve to get your cheated at the same time. Are we looking at the same. Course of -- of times for a resolution yet in the same treatment modalities. Yeah I use -- for that problem I also recommend some therapy. And again they can take a long time to improve that usually gets better on its own. -- -- vs golfer's elbow do you find physical therapy more beneficial for one. -- the other. Think it's helpful for both I think when the therapists use the heat treatment and ice treatments and ultrasound and the other things they have with I -- a free since. I think a lot of that -- the symptoms batter on both the -- outside and the inside part of the health of the -- -- -- -- patient expect to have with the physical therapist but it depends on insurance usually Saddam a lot of times 68 weeks of therapy. Sometimes in the beginning a little bit more frequently depending on how intense the problem in this. And then usually if you can get the stretch is on your own mini I have to go to therapists quite as frequently. So although patients served you know traveling you know very far distances to see yourself for your associates. For physical therapy. Probably their best interests to get to a place close to work or close to home because need to expect you know many many more visits -- to really benefit. Trigger finger another condition. Then you deal with could you define trigger finger for us. -- trigger finger is. I'm when -- tendons in the hands as they come into the fingers get swollen and tendons travel from our forms into our fingers. And they help us be able to defend our fingers into our palms. We know as we get a little bit older and also we have any kind of trauma sometimes those tendons -- up. An assist tendons travel through a pulley system into the fingers they can get swollen and click and locked -- so a lot of times patients wolf. Try to wake up in the morning in their fingers are stuck in their palm and they can't open them up. And that's stricker and. So when the patient has a condition. And they're trying to snap the tendon out of that lock position. Are they doing any damage to lieutenant. No they're not doing any damage and it's important to try to get the hand opened. But it usually is somewhat painful. Ends once the patient. Has that occur even once. That's -- should seek attention correct yes I think the faster they get it treated the better we are taking care of it and curing the problem early. If it's been long standing it's a little bit harder to cheer on and sometimes we can't make it go away with just one injection. To have statistic somewhat that magic time is where past a certain point whether it be three weeks or three months where the outcomes are much different than if they seek earlier attention. Yeah we usually say within about four months if we can get to a patient with informants takes a cortisone injection in order to cure this. I'm we have better chances at sealing it with one or two injections with and that -- period of time. In after the patients receive their treatments. How often does this -- It's hard to say again it's that what causes triggering it's -- not always known that we know that some patients with diabetes. Iman again patients that are overweight can have more attention to develop it. So faith if they've had it once it's a possibility they can have a began in the same finger even in another finger. -- and dressing with with diabetes and being overweight. We know all the risk involved. And we think about protecting the heart. And we know when your diabetes when we're looking at cholesterol levels which trying to get patients to a goal level. The same we that we would've they've had known heart disease and they've had a known. Stroke. Hands. With diabetes and being overweight a lot of times we don't associate orthopedic conditions. With the you know especially with diabetes. -- with or you know being overweight and obese certainly people tell us -- my -- really -- all that extra weight and I'm carrying. They can do it at their hips and they certainly you know with with the back pain we find out but it's interesting but diabetes for all of our listeners that. Carpal Tunnel Syndrome and in trigger finger that that's really a risk as well also. For anyone who needs more motivation to get their diabetes and the good controller. Yet there we'd under good control. There's already a lot of motivation but this you know these are other conditions that we don't always have these you know jump out and us. With with trigger finger. And becoming smaller of the tendon. Who's gonna win that patients really be able to prevent that. No unfortunately not and we can't always predict who is gonna happen to file once it happens we've recommended to get some treatments that she can still use your hands and that it doesn't impact. Other activities you try to do during the day. You're listening to the health and wellness show on Boston's talks recent. -- succeeding WRKO. To call into the show 6172666868. And you can leave a message productive during green or myself. And that's 617. She was 666868. There was -- with speed & Associates. Has a wonderful website www. And through Newton W four Wellesley orthopedics. He associates dot com the end www. NW OA dot com. -- for the web site and for these conditions I was thinking about is there information on the website that a patient can be directed to. There is things if you go to our website there is on patient resource says and that's going to be a lot of information about all different sorts of topics that are pretty common that we see. From the fingers and hand to wrist elbows and shoulders knees and hip problems. In patients can get on that site even if they're not a patient exactly exactly so that's really great so we encourage everyone to announce that their website -- hopeful. You when you're having certain symptoms although we so we don't want some -- -- diagnosed themselves but if you have a certain symptoms and wondering what is that something that's. Could be consistent with what it is orthopedic conditions and you go on. For the web -- to me when unison direction but obviously we want you to seek medical attention so please keep that in mind as well. Some arthritis and other teams and you deal with you define that for us. -- some arthritis or diesel -- arthritis is arthritis that occurs down at the bottom of the son for the son meets the rest. And it's develops over time we usually find it more commonly in women than in men and more commonly in women who around the age of fifty herself. I'm and then a little bit older than that is well. And it's just arthritis that develops and makes a really difficult to do activities because you have trouble using your thumb tip pinch or -- things a lot of people have difficulty opening jars. Inserting tees and trying to turn -- even holding magazines or books. -- arthritis. What what treatment remedies are out there for the patient in the year 2012. And fortunately we can't cure this problem neither but we try to make patients feel better as they have to go through it there are a lot of patients who have arthritis who never have symptoms and who gets better. So we do recommend it to come CS if you have any peanut base of your son. But usually -- or recommend is anti inflammatory medication assuming that patients can -- get that it doesn't go against any of the other medicines or any medical problems that they have. -- we do have some topical medications that sometimes make patients feel better. We can use in -- is so -- -- which keeps us some joint and a nice good position which makes it easier to do a lot of activities. Sometimes we can give some injections that make patients feel -- as well in the there's always surgery weighed down the line if nothing else. So when would injections. Come into play after have to how long of a symptoms and I and our -- pretty severe symptoms but -- the general timeframe we're looking. It's sort of depends some eight ends up being if that if we can't get the patients to feel better within about three to six months sometimes a cortisone injection becomes a good option -- half points. Usually tries to therapy usually try to brace and sometimes that helps and if that doesn't help or if it helps temporarily. But the pain comes back and -- I would try -- injection. Continue mention surgery as well. So -- what -- are we looking at surgery and what what are you doing during this during the surgery to improve the condition. Like I tried to do surgery in less everything else has not worked and it's actually pretty rare that we have to do surgery in this condition only happens in about 10%. According to some of the studies. I -- but for the surgery basically let arthritis it's a bone on bone problems so usually for the surgery we actually take out one of the bones it's causing some of the problems. And patients do well without backbone we can fill that beast with attendant for something for some scar tissue. How many usually actually works pretty well but we try not to do it unless everything else has something else. After the surgery how long if me. Rehabilitate -- Period this -- looking at it's quite a recovery which is why we try not to -- the surgery in less everything must we have nothing else to offer but it's about 46 months. In physical therapy will obviously play a major role in that they're exactly we have exactly usually you're in a cast for about four to six weeks after the surgery and then a lot of therapy after that. Try to get your motion and strength back. This is doctor -- Glazer and you listen to the hope the moment so on Boston's talks vision. AM succeed WRKO. Doctor Jennifer green as my guest today at -- -- -- -- -- -- associates the end she's one of thirteen orthopedic specialist of the group. They -- wonderful group they always have -- appointments available I know that from -- it carmaker medicine this and many many patients over. And it's the same -- appointment served really appreciated. Our patience and for medical providers so we think you when you group for that. The website I encourage everyone to take a look at WWW. Dot NW always dot com the end www. NWA dot com. Wonderful patient education resources. Or would just be able to communicate with the office. The phone number for unemployment is 6179640024. Again 617. 9640024. Doctor green and I spoke about Carpal Tunnel Syndrome. Tennis elbow golfer's elbow. Trigger finger in finally some arthritis. Backing up to Carpal Tunnel Syndrome. Draw our listeners what would you say -- the most three important. Take -- points weren't and one who's listened today. And seeing that one of the things is it's not something you have to live -- we see a lot of patients who have had numbness and tingling in their index finger in their middle finger. And feel like their hand as clumsy for a long time because they never realize that there was something really wrong. But if we can get if -- patient he'd come CS sooner we can actually cure for them and that way you keep your hand function. So I think it's important to note that that might be going on in just seek. Health so we can we can get it -- for you. Hands. We also want to stress to patients that you're not too old to get checked for this condition. Cracked in data to really affect your life and change change your lifestyle as well brain and I'm going to put my phone back on silent that's my my oldest. Sabrina who's sending me text message so Sabrina that he will be home soon. Tennis elbow. Would -- -- most important points. Things being done to know that that's the diagnosis and know that that that pain to have on the side of your outlook is tennis elbow and not something else going on. And I think it's really important that it will go away it's usually goes away on its own in about 85 to 90% of people it does go away on its own. It's just something you kind of have to get through while it's going away. Ninety the other important thing is also get it checked doubts that we can see if there's anything we can do to make you more comfortable as have to go through it. And we mentioned about the recovery period to expect months right -- certainly not days. And not even weeks but really do expect several months is exactly and it doesn't mean it does anything intrinsically wrong with the elbow. But a long recovery time is what to expect -- golfer's elbow. Coffers although similar I would also -- she gets that if I waited to make sure that that's the problem there is a nerve that's close by the only are nervous the funny bone nerve. Live is sprayed around that region so a lot of times we have to make sure that that -- is okay and not involved at all since that's the other thing that's important about coffers of and trigger finger -- the three most important take -- mrs. tripping or similar carpal tunnel cinema I think if as you noticed that your fingers locking in your pomp. Come get it checked out can we can help that we can take care of that problem and it's easier to do it sooner rather than later. It is something that can infect your life and we can we can make you fatter. In finally some arthritis. -- arthritis is another thing it's something that we can help to improve the symptoms that you don't have to live with that there's a lot of different. -- alternative ways of doing activities that cause pain that we can let you know about we get too involved in therapy and make that pain I'm better. We we spoke about all these conditions and a lot of -- well it will occur in a certain age population. You know summon a wide range population me just pretty young athlete for teenagers. Early twenties. What are some of the most common missed a morning conditions you've seen any change. You think a lot of for young people a lot of trauma comes into play a lot of times people can have small bones that break in their wrist. I'm especially young people have very strong race of the wrist itself the did the radius bone doesn't break that they can have a small ski -- -- fracture. -- a lot of times you don't realize it's broken and that's being stupid they think it's a -- pedantic being broken bone. I'm a lot of some injuries not arthritis that ligament tears in the summer pretty common in the young athletes. I am playing lacrosse are playing basketball they take it GM to -- some and get a ligament care. I'm thinking that's another really common problem. So we have that athlete who has had a GM found in the right in the middle of a sports and competition. A big sports game. Ends they're not exactly sure. What happened although they know there and a lot of pain. Do that -- athlete plea through the pain was so they really to stop the activity grade than in the air India checked. I think if it's really painful I think it's secretive just get a tax I think if you're trying to play with a painful some or any kind of injury. It's possible to play through it but you might injure him more or injure something else worse if you try to play through it so I think if you're in pain it's important to stop and get -- checked out just make sure you're not doing any additional damage. So for the young athlete who's listening. Or for the parent or grandparent of a young athlete. Ends you witnessed this and you can see. That the young athlete just isn't. Maneuvering the same way with their hands but with their wrist. You really need to have -- stop the game. In -- told their coach are told the trainer. And not be a hero because and young athlete for any athlete for that matter and any age but especially someone younger you -- -- going to do Damon's. Unnecessarily to the hand and wrist. That you don't need to so we really encourage everyone to stop the activity -- known to be responsible for yourself. For that -- you mentioned the web site with patient. Educational materials. What are other highlights of the website. You can find out all about the doctors and our practice where all the doctors trained with their specialties are. I can find out about the different people that work in our office including the physician assistants we do have physician assistants as well that are available for he patients. And there's different forms to download on the web sites that pure new patient coming in sometimes you can take care summit your paperwork before you actually get the office MIT -- little bit of time. I'm and then again the patient resources are very valuable as well. But some of the first deployments of the usually undersecretary start answering phones that -- 15830. In our first appointment is at 8:30 in the morning. All right that's very helpful to know. And one other point that -- emphasizes well that many of these orthopedic conditions that -- and I was speaking about today that diabetes. Aliens obesity are risk factors for so we spoke about patience but these conditions that there's already a lot of motivation to get healthy. TU diabetes under good control. To lose the weight which we obviously know people are much -- era and a Laura -- when you're -- extra week. This gives everyone even more motivation. And again it's very interesting. To. Realize that some of these orthopedic conditions. That diabetes is a risk factor. And we hope that you -- think that's part. Again this is dontrelle and -- you've been listening to hold them on -- show on Boston's talk station. BM succeeding WRKO. A one thing doctor Jennifer green for joining us on a sunny afternoon time away from her family. Hands new -- -- the big associates. Tomorrow morning at 815830. They will be ready to answer the phone man when he agreements necessary. They always have seen their -- available. I wish -- well I'm hoping we I have been reading my mind and we look forward to tuning in next -- here to show. And things listening to.