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And we're live now. I think you should read the Prospectus. Yep. Hi, everyone. Thank you for coming. We'll just give it a couple more minutes for more people to just come in and join in the lecture. Are you able to see the slides? Yeah, I can see the slides. Great. So, should we start in two minutes if that's okay? Yeah, I'm not able to access the chat. Is there a way that I'm, yeah. Access. Yeah. So if you see in the right hand side of your screen, there should be a chat box. Yes. Do you see that? Yeah. Yep. It's just not allowing me to connect to the chat. So I don't think I'll be able to see if anyone type something that's fine. I should be able to selected it all started two minutes then. Yeah. Uh, so, hi, everyone. I'm Rishi. I'm 1/4 year medical student currently indicating at Leicester. I'm one of the education, um, reps on soup to, for this year. So soup to is basically a national organization that developed that, you know, focuses on delivering, uh, surgically teamed. Um, you know, education and lectures today we've got social with us, uh, here and she'll be delivering the lecture on upper limb trauma and orthopedic clinical conditions. She's currently studying medicine. Um, well, she isn't currently an integrated medical student at King's College London and she's indicating in anatomy development and human biology. Thank you for joining us today is our show. Thank you. Yeah. Hi, everyone. Um, yeah, I'm currently integrating at King's. Um, so I haven't, um, done medicine for, for about a year now, but I'm, I'm doing anatomy at the moment. Um So yeah, so today we'll be going through upper limb orthopedic conditions. Um And sorry, I haven't used this platform before, so I apologize if I make any mistakes. So, um the aims is we're going to revise the applied anatomy of the upper limb. Um And these are conditions, the conditions that we're going to go through before we start. Um, can people type into the chat? What year they are? Um I'm not sure if I can actually see the chat but can just people type um, what year there? So, I have a better idea. Yeah. Yeah. All right. Right. I don't think I can see the chat. So I won't be able to actually, I don't think anyone's put anything on the chart. Uh Okay. Okay. Fine. All right. Okay. Um, sternoclavicular dystopian clavicle, clavicular fractures, um, adhesive capsulitis, rotator cuff tears, a radial head fracture, Allah crown and fracture, a distal radial fracture and skate void fracture today. So, starting off with sternal political a dislocation. Um This is when the Clavel bulges. So, what you'll see is you'll see that the capital bulges forwards. Um, and the stone clavicular joint doesn't really look like a stable joint. Um, but it's supported by many ligaments. Um, and the capsule is weak and the sternoclavicular joint, but, but it's thickened, um by the posterior and anterior um, sternal ligaments. Um and it has a lot of ligamentous tissue um to keep it stable. Um And it's a saddle sign of your joint, but um it behaves more like a ball and socket because of the three planes of movement. Um So it's more like a try Multiaxial joint. Um But we describe it as a saddle joint. Yeah, and that's just the anatomy. Um I think you went through the anatomy with on, on, on Tuesday. So hopefully you all are up to scripture with your lemon asked me. Um But yes, the most common dislocation is an anterior dislocation due to a posterior blow. Um So from behind to the lateral aspect of the clavicle, yes. So this is what it will look like on presentations. So the clavicle bulge forward, um and um so on palpitation, um your palpated bump, you'll see a bump. Um And if it's a posterior dislocation, you'll get this near dysphasia, Tekken appear and stridor. Um Yes. So with, yes, sir, with the physical examination, um you'll get a decrease in range of range of motion and instability. Um And neurovascularly, there'll be paraseizures um because of the and venous congestion, um or a diminished pulse um compared to the other side, um because you'll be getting compression of all the vessels uh near the clavicle. Um So provocative maneuvers and would be turning the head to the side which I actually relieve the pain. Um Investigations would include radiographs and whenever you ever ask for radiographs, you always want to views. So, um if you ever see a, a radiograph and you're asked to interpret it, you always want to ask to have a second one. So does for a lateral one um to better understand what's happening. Um So radiographs um and then ct um management. So non operative would be reassurance and symptom treatment. So usually with a sling operative would be closed reduction under anesthesia, which you can see in the image here, um or open and soft tissue reconstruction which you can see in the image below. So next, we have clavicular fractures. Um So 80% of clavicular fractures are in the middle third. So you can divide the clinical up into three and the majority of them are going to be in the middle of third, midway between the cortical clip, the coracoclavicular um and the Costco clavicular ligaments. And this is because it's the weakest point and um it's the thinnest and arrows point and it's not supported by any ligamentous or muscular structures at that point. Um So the middle third is where you always get clavicular uh fractures. Um Just 10% is in the distal 3rd and 10 to 15% is in the distal 3rd and 5% is in the medial third. Um And it's usually due to a direct blow to the shoulder or fall onto an outstretched arm. Um And as you can see in the image here, fractures in the middle of third, um the medial fragment will have an upwards displacement because it's pulled out by the steno cleidomastoideus. And the lateral fragment fragment is pulled downwards because of the weight of the blame as well as polar, as well as contraction of the deltoid um and pull of the pectoralis major. Um So it was like that um and the fractures are potentially life threatening because you've got a lot of important vessels. Um in this area, you've got the subclavian vein which lies immediately behind um and below the clavicle. Um Yeah. So, symptoms would include um acute onset of anterior shoulder pain directly over the clavicle, bruising, swelling, um difficulty raising the arm, breathlessness. Um And on physical um examination, um it would be tender, swelling, increpitus deformity over the clavicle. Um And your vascular exam, you want to assess the supply of university called Plexus. Um And you might see thoracic outlet syndrome because of the compression of all of the vessels. Um and usually to check for thoracic outlet syndrome I mean, you would do the roost test but with a clever killer fracture, I think that would be a little bit more difficult within erasing there. Um, um, yes, and recall plexuses also in this region, um, which is going to help lots of different manifestations. Um, central diagnosis. Um, generally the dislocation, which we've already talked about investigations again, radiographs. CT, um, CT is usually for pre op planning and it's, there's a suspicion, suspicion of vascular injury or if it's a medial uh middle third clavicular fracture. Um Or if you think that there's a a sc joint dislocation management. Again, non operative operative operative would include intra maturely fixation which you can see in the bottom image here and or if um which you can see in the top image. Um mhm So with or if um there are some disadvantages because there might be an increased risk of need for future prestige is um remember um removal of the implant plant. Um and there's a risk of infection as with all um slattery's um with intra medullary fixation. Um The advantages are there is a smaller incision, there's less soft tissue disruption, it avoids um super clavicular nerves that are commonly injured, injured with plating. Um But with this one, there are higher rates of migration of implants. Um And here are the complications include nonunion, malunion. Um Yeah, so adhesive capsulitis utilized uh sorry, adhesive capsulitis also known as frozen shoulder. Um So it's used to describe a loss of range of motion in the shoulder and this limits comfort and function. So what happens is there's an inflammatory process causing fiber plastic proliferation in the joint capsule. And this leads to thickening um fibrosis and adherence of the capsule um to itself and to the humerus. And hey, um on, on the left that's a healthy um shoulder and on the right, that is a shoulder with fiber plastic proliferation um of the joint capsule. Um And below, there's the classifications. Um So on the bottom, you can see the arthroscopic stages which can be seen in the images above. Um Yes. Um So there are also classifications. Um Yes. So the cusp, so there's usually like a journey of Latisse of capsulitis. So first you get this freezing um the freezing stage, um which is usually 2 to 9 months, it's very painful and you've got restricted movement, then you've got the frozen stage, which can last even longer and you've just got a stiff, stiff shoulder and then there's a thawing phase even longer which um slowly your shoulder gets back to normal and that's not a painful stage. Um And it's a common condition. It, it affects around 3 to 5% of the population and it usually affects people over the age of 40 and it's common and it's associated with diabetes and thyroid disease and Parkinson's disease and other inflammatory disorders. Um And, and it a cousin both shoulders and around 10% of individuals you have a tease of capsulitis. Um Yeah. Yes. So, investigations would be a metabolic panel to rule out thyroid disease under Crenna labs and imaging again, radio grass and arthroscopy to look at the dragon capsule on um, and look for the um any inflammation of the synovium. Um, and whether it started to adhere to itself. Yeah. Um, oh, I should talk about the causes of a piece of capital itis. And so that would be um sorry for not causes four types of adhesive capsulitis. There's frozen um idiopathic. So and, and, and cause diabetic um post traumatic and post surgical. So that those are the four main causes of adhesive capsulitis. Um and in diabetes, um it's thought that in diabetes, um the excessive glucose causes collagen in the capital to become sticky and then the build up that causes the effective shoulder to stiffen and the pain prevents you from moving your arm. Um Yep. So management first line is non operative. So Ansaids, injections, cryotherapy and operative would be manipulation on Dennis, the Asia um and contraindications would be in the freezing inflammatory stage and the freezing stage is the first stage. So the painful stage which lasts up to 2 to 9 months um as well as diabetic and rotator cuff. Um Taz Yeah, and here are some um complications and I've got the videos here of the different management's, but I'm not too sure if there's time to go through them. So, um when you get the sides, you can go through them yourself. Next, we have rotator cuff tears. Um If this is interactive, I would be asking you what are the rotator cuff muscles. But unfortunately, I can't. Um So these are also very common source of shoulder pain, um uh which results in decreased range of motion and it can occur due to both traumatic injuries and young people. Um as and degenerative diseases in elderly patient's um respect is include age, smoking, um hypercholesterolemia, um family history, um and a rotative cuff tear can also lead to subacromial roughness, impingement syndrome, subcoracoid impingement, calcific tendonitis and glenoid labrum tears because of the tear in the rotator cuff will lead to a high riding humorous. So the humerus moves, moves upwards um because of the weakening or tear of the rotator cuff. Um because the tendons progressively weaken and then with advancing age. Um So the capsule is no longer providing support from above. Um So the humerus rides up um when other muscles are contracting and there's nothing stopping it because the rotator cuff this weekend, there's nothing stopping it. So it writes upwards um cause and causes impingement of the super spin artist tendon. Um and of the sub acromial um and of the subacromial bursa um which gives rise to um lead to um class effect in itis um subcoracoid impingement and subacromial impingement syndrome. Yes. And the impingement can cause reactive changes in the bone, causing the tendonitis. Um Yes. So the presentation would be pain with ahead activities and the deltoid a pain at night, um, weakness. Um And here, but you can see some of an overview of the physical uh exam. Um But what, what you would see in the physical exam. Um So yeah, investigations again, imaging, um, radiograph um and an arthrogram, um which is not commonly used but is used when MRI is uh contra indicated. Um management, non operative again, physical therapy and said subacromial injections. Um But with the treatment, you have to consider the activity of the patient, the age of the patient mechanism of the tear characteristics of the test. So the size depth retraction, um whether it's a partial thickness or uh thickness tear. Um Yes. So operative um would be could be tendon transfer. Um Arthur's Book Quick Arthroscopic rotator, cuff repair, mini open rotator cuff repair, um and the mini cuff rotator. Um Many the open rotator cuff repair was once the God's standard, but it's been replaced with arthroscopic um techniques. Again, I've got a video here which you can um later um if you want to um to see how that's done. Um Yeah. So yeah, the arthroscopic and the open our own are considered to be equally as effective. Um And tendon transfer is indicated for massive or a repair of for rotator cuff prepares. Um Hum Yes, complications but include dealt would detachment, um which is is seen with an open approach. Many open approach um and numerous thorax can be a complication of regional anesthesia or the arthroscopy itself that was rotate ical. Next, we have medial epicondylitis also known as golfer's elbow. Um So this is an overuse um syndrome caused by eccentric overload of the flexor pronator mass which can be seen here at the medial epicondyle. Um So it's made up of the flexor carpi radialis, pronator terrors. Um uh flex a copy all Norris in flexor digitorum super superficialis and not always the Palmyra songs because that's not present in everyone and they will converge onto the medial epicondyle. Yes. So this is um pain over the medial epicondyle. Oh and sometimes pain down the forearm. It's worse when making a fist when shaking someone's hand. Um uh But, and it's known as golfers, but it's not restricted to um people who only play golf. Um It's seen in weight lifting a javelin shot, put things like that. Um So the, the symptoms can occur um short um after short time like like it doesn't have to be a long time that you've been over using it. They can appear after just a short while that you've been doing one movement over and over again. Um It's usually seen in repetitive to be so long period of time. It's rare and it affects around 1% of the population. Um the ages. Um I don't have stages, which probably would have been more useful, but there's perry tenderness, inflammation, um Andrew fiber, plastic hyperplasia, brain, then fibrosis and then calcification. On physical exam, there's tenderness 5 to 10 millimeters, distal and Dante area to the medial epicondyle, the swelling area, the MMA pain um with pronation, um and wrist flexion. Um and again, imaging you do radiograph which is usually unremarkable, but you want to rule out other things with the radiograph. Um ultrasound and MRI would show tender no tendinosis. Um Yeah, and these images are just showing you exactly where the pain um is. Yes. So this MRI is showing you the tendinosis which does he uh some of the differential diagnosis, Shiell injury, cubital, uh cubital tunnel syndrome, fracture, um cervical radiculopathy, triceps, tendinitis, and again, management, you've got non operative management first and then operative would be open to Bride Mint. Again, I've got a video for you here, but I'm not too sure if it's time to go through that maybe at the end of this time. Um now, lateral epicondyle itis. So media was golfers, lateral as tennis elbow. Again, it's an overuse injury caused by eccentric overload at the origin of the common extensor attendance. So, before it's the flex, so this was the extensor attendant um leading to tendon at 10 tendon diagnosis and inflammation um which you can see here, uh extensive copy radialis brothers. This one um and this one affects 123% of the population. So a little bit more um and gives symptoms of severe burning pain on the outside of the um outside of the elbow. Um So the pain gets worse on gripping lifting objects or direct pressure over the lateral epicondyle. Um And one of the ways that you can test for lateral epicondyle itis is it's called the Mills test. So you ask the patient to um uh supinate their arm, you palpate the lateral epicondyle and you push there um uh their hand back and, and pain is quite painful over the lateral epicondyle um natural epicondylitis. It's thought to be due to the due diapers over the natural upper conduct involved in wrist extension. Um And so 10, 10 tendinitis bursitis and not an epicondyle itis because of the referred pain. Um sales in a referred pain, then it wouldn't be a tendonitis, but it's called an Epicondyle itis. Um Yeah, and it involves the extensive copy, radiologists, Brevis Tendon, which I already shown you in the image. Um And the other ones are generally not really done. So and one thing, so if you're ever with a tennis player, I don't know, um you would encourage them to release the grip after the ball is struck to avoid um this kind of injury and her just some other provocative tests that I can use um investigations again, radiographs, MRI which is not always necessary management, non operative operative again, I've got videos. Um Yeah. Yeah. And there are some complications. So L U C L injury, um entrapment syndrome. Um and again, infection, infection is going to be everywhere. Next, we have bullet Cron fracture. So these are common fractures of the elbow. And about 10% of all upper extremity fractures are isolated are Holocron like Allegra non fractures. Um This is either due to a direct flow to the elbow by falling on it. Um or very rarely, there's a spasmodic pull of the triceps tendon um which can um fracture ripped um and the direct blow um to the back of the elbow, it's also associated with all the nerve injury. Um Yeah. So presentation um pain is well localized to the, to the holocron into the posterior elbow. Um You can feel a palpable defect. Um Yeah, it's just very painful. We can't extend and these two images. So, if I, I want you to think about it. Now, which one in which one you think there is a fracture, whether it's both, whether it's one, whether it's none. Um I'll give you like five seconds to think about it because I I can't ask you. Um So on the right, um this one is a tie to fracture of the electron on. Um So it's stable under space. Um Even though it's split into two, the electron on, it's still a type two and this one, this is, it appears to be a fracture here. I don't know if you can see my cursor on the left image. Um but this is not a fracture, it's actually a growth plate. Um So you should, whenever looking at radiographs, you should always be mindful of the epi epilepsy or place um not to be caught out by them because they can often be quite confusing in the lower limb as well. Um um The olecranon doesn't fuse until approximately 14 years of age. So be mindful of that, always check the name and date an age of the patient um management. So again, non operative would be immobilization. And here are some of the different ways that you can um operatively um uh manage um no olecranon fracture, um complications. Um So communication can be due to the actual device is used. Um stiffness ossification, arthritis um due to the trauma, uh the direct blow just changes in the uh in the bones. Um and tension band. Um This is usually um with the transverse fracture with no communication and communication usually means how, how like fragmented it is. Um again, intramedullary fixation is transverse fracture with no comminution. So same as the band, um plate screw is for commuted fractures, um oblique fractures, um yeah, an excision. So that's when you take up the Levaquin on. Um and you bring the triceps down to the ana um It's usually an elderly people with osteoporosis. Um Yeah, it's usually a salvage procedure next have a radiohead fracture. So these are the most common type of elbow fracture of all of them. Um These are tip, these typically are to the head of the radius and involve the capitulum. Um It's Foucher. So thor my outstretched hand um with and this often transfers forces along the shaft um of the radius to the, to the head of the radius um and then to the capitulum. Um and there's pain on the outside of the elbow as well as swelling in the upper joint and the patient is unable to fully um flex or extend the joint and there's also pronation. Um there's also pain on pronation um and Super Nation um on exam. Um you can have um a Kim Asus which is a bruising um uh swelling tenderness over the lateral elbow, um deformity. Um and you can have stupid and yeah, motion Super Nation, Super Nation. Um It's usually painful. So stability um testing in the elbow, you can have a posterior lateral draw test, which is the top image or a valgus stress test, which is at the bottom which I'm not sure if you have any of you have done your Huskies um similar to um level um examinations. Um You can also do distal radio on a joint um test where you palpate the risk of a tenderness. Um and you can have one other interosseous membrane where you help it along the interosseous membrane for tenderness investigations. Again, um Radio Ross and CT and you can classify radial head fractures into four types. So the first type is non displaced radial head fractures. Type two is partial articular fracture with displacement. Type three is a commuted fracture. So you can see it's fragmented involving the entire deal head um which is displaced. So comminution and displacement of radiohead and then type four is fracture of the radiohead um with dislocation of the elbow joint as you can see that. Um Yeah. Uh And in this one, um so here you can see the fat, there's a fat pad sign which can be seen in radiohead fractures. Um And I don't know if you can see her, the iris are pointing out a kind of a darkened line here. I can't, I don't know if you can see my cursor but um there's like a clear circular darkened spot around the elbow and the elbow joint, the two red dots are pointing at it and that's called the fat pad sign seen with Radiohead from their fracture, which is swelling of the soft tissue. Um And yes, so CT um yeah, and that's indicated when there's commuted fractures or complex fractures and dislocations. And A CT may also be helpful in pre op planning um to know what technique pressures to use. And usually for Mason type one, sorry, I should have said these are called Mason classification. This is called the Mason classification if you want to look it up later. Um Usually it's non operative treatment for type one Mason. Yeah. Um So I think yes, for operative treatment, you can to get access to the elbow joint, you can have a Kosher versus a Kaplan, a Caplin approach. So you can see the bottom one here. This line is the coach, her approach and the top one is the captain approach. Um So with the Kosher, um there's less risk of posterior Antero CS nerve injury, the P I M um and the P I N posterior interosseous nerve, it crosses the proximal radius from anterior posterior within the supinator muscle, four centimeters, distal to radial head. Um However, with the Kosher, uh there's a risk of destabilizing the elbow. Um if the capsule incision is too posterior with the Kaplan approach. So the top one um there's less, less risk um of destabilizing the elbow thin the Kosher approach. Um there's improved exposure of the anterior fractured ligaments and when screw fixation is used, but there is a greater risk of posterior intraosseous nerve injury and radio nerve injury. And that was sorry, that was a good the differences between the two approaches. So now the store radius fracture, again, this is a fall on an outstretched hand. Um and it makes up, it makes up, it's the most common orthopedic injury. Basically, it makes up 17.5% of the fractures and adults. Um and 50% of the fractures are intra articular risk factors are osteoporosis. Um And if you do get a distal radius fracture and an elderly um women, she should always have a Dexa scan because it means that there's a great higher chance of her having fractures in the future. So you should always have a Texas camera um the radius. So the radius is responsible. So when you fall, the radius is responsible for 80% of the load um that transmits through the arm. And so that's quite a high percentage. Um and it articulates with the scaphoid lunate and it still honor, which means that all those structures at risk of fracturing and there's different types of classifications, you don't have to learn. And this is just so that you have an idea of what they are. There's a Fernandez based on mechanism of injury, Fragmin, which is based on the joint involvement Malone which divides the intra articular fractures into four types. Um And there's a O which is, is a lot more comprehensive, which I didn't include her. And then here are some um uh types of distal radius fractures. So you have Smith's and Collies which are actually articular and Barton's which is intra-articular. Smith's is low energy volar lee displaced and Bolelli is the palmer side. Um And then you have Collies which is low energy dorsally displaced and those are both extra articular and then you've got buttons which is intra-articular. Um and it's a fracture location of the radio radio couple um presentation again, it's going to be pain, swelling, deformity, um bruising sweat, spelling tenderness look for is volar tilt. Um It's an important moment um used to assess um distal radius fractures. Um And what it is um basically you make a line perpendicular to the radius. Um and then you draw a line that passes through the tips of the radius. Um So the door, the dorsal and the viola um rims and then you measure the angle between those two lines. Um and normal is usually 7 to 15 and less than 10. Um is related to us outcomes. Uh sorry, greater than 10 dorsal tilt is related to us outcomes in more than 20 volar tilt is related to unstable fractures. You can also do CT for pre op an MRI for soft tissue injury management. Um Again, non operative, um it's closed reduction, it's been mobilization. Um And that's usually for extra articular. So for your colleagues or your Smith's operative. So you've got um close reductions, closed reduction, percutaneous pinning, um open ocean internal fixation or external fixation um indications for or if would usually be um if, if the radiograph, the X rays is showing instability. Um So you look at the va long Ebola angle for that. Um Yeah. So if the viola sorry, the volatile, so if the volar tilt um is progressively being lost, then that would indicate that you would have to do an orf or if it's communicated or displaced. Um just, yeah. Um an external fixation um would be for open fractures, highly commuted fractures. So fragmented fractures, medically unstable patient's who can't undergo long, lengthy procedures. That's when you would do external fixation and complications would be media owner of neuropathy. In other words, carpal tunnel syndrome and other neuropathies, other, as well as um ruptures of different tendons. Next, we have skate void fracture. Um Again, this is I'm sure you will know fuchsia. Um And I would then ask you what the um borders of the anatomical snuffbox are. Um So you can kind of see in the image here approximately. You've got your radio, radio, radial styloid process distantly base of the first metacarpal. The floor is by the scale, avoid an trapezium. Um Medially, you've got extensive policies, longest, this one. Uh And naturally you've got abductor policies, longest and extensive policies press. Um And on this radiograph here, you can see the um skate void is here. It's this one. Um Yes. So again, swelling, pain on sir conduction, pain on resisted pronation. Um The scaphoid, it's a complex 33 D structure. Um It looks like a boat or a twisted peanut as you can see her. Um It is, yeah, it's the largest bone in the proximal um row, um couple proximal carpal row. Um and it articulates with the radius of the loom, the radius, the lunate. Um The trappers trappers were trapezium and also the capitate. So it's articulating with quite a quite a bit in the hand. Um uh usually radio grass um bone scans if the fracture is hidden. Um So bone scan will give you a better image, a better idea what's going on. And this is the bone scan, the image on. Mmr I can also be used if it's a hidden fracture. Um So with a skateboard fracture, avascular necrosis usually happens in around 30% of people. Um And yes, sorry. I thought first, I'll talk about the manage. So, not particularly um again, immobilization if it's not displaced, not critically, a percutaneous screw feitian which you can see here um or an open orth. So this is a percutaneous screw fixation. Um And there's a dorsal approach and the Xolair approach, the dorsal approach is usually for a proximal fractures which you can see here, an Ebola approach. Um but the volar approach is better in the way that avoids um the blood vessels we apply um supply the skate void. Um And the major um and the blood supply to the skate avoid. Um it's the dorsal carpal branch of the radio artery um as well as um the superficial palmer branch, radio artery. But this is a much like it gives a much less supply to the skate voyage than this one does. So, Ebola, our approach is better because you avoid those structures. Um Yes. And with a skate food fracture, avascular necrosis is um it's quite common um with around 30% of people getting avascular necrosis and it's more associated if you have a proximal fracture. Um So the more proximal the fracture, the more the higher risk of avascular necrosis. Um and then some complications of skateboard fractures um would be non union osteonecrosis, um problems with the hardware with, with the screws um and a snack wrist, which is progressive arthritis of the wrist um after um after skate food fracture and that is it. Um I was hoping I'd be able to do a little quiz. Um but I don't think I can. Um Syria, thank you all if you're still here for joining. Um Yeah, and just let um Rashi know if you want any of the slides um or anything but feel free to contact me if you have any questions. Um I think I put my email at the beginning. Uh Maybe not, but my email is Sophie Jack Bow, Sophie dot Jack both at KCL dot Basically. Okay. Thank you. Yeah. Any questions from the audience? Mhm. I think so. Sure. There's no, I don't think any questions. I think you should be all right to be honest. Okay, great. Thank you so much for your presentation. Thank you. If you've got any feedback, you know, to give, please, please please message me uh you know about your experience and all that. Okay, I will do. Thank you so much, very much. I know, I know you were saying you mentioned that you wish it would, it would, it would, it would have been more interactive lecture and that's something I've voiced out as well because I delivered the plastic lecture a couple of weeks ago. Yeah. Yeah. Maybe that's something. If you could, you know, if you put down and send that to me as well, then maybe we can, you know, feedback for next year. Yeah. Absolutely. For me, I think it's like, I literally just can't use the chat. I don't know why. Yeah, that's something I'm surprised but we'll try and fix that as well for next, for the next for next week's ration you. Yeah, I will I'll give you that feedback. Thank you if anything else as well, anything good or bad, we appreciate that. Alright, thank you so much. Thank you. Thanks for your time. Bye bye.