University of Connecticut School of
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Medicine my name is Chris Morosky and
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thank you for taking the time to watch
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this video on how to tie one and
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two-handed knots over the next 15
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minutes or so I’d like to introduce you
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to a somewhat silly but memorable way of
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learning how to tie surgical knots after
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watching this video and with a little
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bit of practice this will become basic
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muscle memory so get out your sneakers
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and let’s get practicing because this
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right here is how I learned how to tie
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surgical nuts okay so for starters we’re
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going to talk about two-handed nuts now
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the simple concept here is that you need
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to learn how to tie around both your
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index finger and tie around your thumb
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the other thing that’s important to keep
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in mind is that you’re eventually going
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to want to make a finger circle and then
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you’re going to also want to make
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something called I like to call the
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suture circle you can see there’s kind
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of a circle right here so to get started
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I’m going to teach you how to tie around
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your index finger then I’m going to
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teach you how to tie on your thumb these
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will not be flat knots and what we’ll do
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is after that we’re going to alternate
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back and forth from index finger to
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thumb and then you put down flat knots
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with two flat knots going after each
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other being a square now so for starters
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you want to start with the little
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position I like to call shooting guns
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now if you ever in the operating room
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you have to do this and you’re getting
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nervous just now come back to shooting
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guns because this is the starting point
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so with your fingers making two little
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guns you’re going to hold the suture and
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with your other three fingers now you do
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want to learn how to tie with both your
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left hand and your right hand but I’m
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just going to show you how to do this
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with your right hand for starters so
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let’s start with the index finger so
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with the index finger you’re going to do
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what I call internal rotation you’re
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going to create half the suture circle
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with with that you’re now going to do
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the other half of the suture circle to
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make you can see there’s a loop of
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suture around my index finger with that
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you make a very nice finger circle and
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then you push your opposite finger so in
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this case the thumb through the suture
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circle you then pick up your tail
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pinched it in between your finger and
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thumb and push the tail back through the
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suture circle and tie it down
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you’ve now tighten that it’s not a flat
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knot which is okay
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so I just want you to practice doing the
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index finger over and over and over
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again until that becomes Messel muscle
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memory so something like this down
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internal rotation suit your circle close
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your finger and thumb push your thumb
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through the suture circle really push it
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through like over do this at first pinch
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the tail push the tail back through your
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suture circle and down internal rotation
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suit your circle finger circle put your
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thumb through grab the tail push it back
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and down and one more time internal
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rotation suit your circle close the
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finger circle push your thumb through
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grab the tail push it back and down okay
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so now we’re going to work on the thumb
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side of things so again start with
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shooting guns and where as the index
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finger was an internal rotation you’re
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going to kind of externally rotate with
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your thumb but same concept you’re going
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to create half the suture circle here
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you’re going to bring the other loop
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around to create that whole suture
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circle like you can see then you close
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your index finger and thumb put your
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index finger through grab the tail pinch
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it between your fingers push that tail
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through your suture circle and put it
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down again in slow motion shooting guns
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external rotation suit your circle
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around your thumb close your index
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finger and thumb push your index finger
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through pinch the tail push it through
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the search suture circle down external
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rotation suture circle index finger and
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thumb to make your finger circle push
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that index finger through pinch the tail
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push it back through the loop and down
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and one more time
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external rotation suit your circle
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finger circle push that index finger
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through pinch the tail push it through
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and down okay so now we’re going to
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practice going back and forth from our
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index finger to our thumb so back from
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index finger to thumb there’s one more
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thing you need to do to be able to tie
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square notch which is crossing but we’re
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going to get to that in a second so tie
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flat knots or granny knots here that’s
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okay but just go back and forth so here
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we go
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index finger through down thumb through
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down index finger a little slower this
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time through pinch it down thumb push
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your finger through pull the tail
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through down index finger down thumb
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down the more you practice this the
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faster you’re going to get but make sure
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you maintain good technique because
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you’re going to teach yourself how to
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type bad knots if you don’t do this
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fluidly and smoothly and make sure
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you’re going back and forth from index
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finger to thumb each time okay and now
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to finally tie our square knots
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now with this you’re going to have to
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know about the concept of crossing your
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tails to make this work so for starters
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when you tie it up the first thing you
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want to do is cross your tails now
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depending on which tail you cross you’re
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going to start with either your index
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finger or your thumb also depending on
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which hand you’re using but let’s stick
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with the right hand so with my right
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hand if I take my right tail and cross
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it over the left I have to start here
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with my thumb to make this not go down
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flat now if I were to cross my left tail
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over my right I would have to start with
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my index finger on my right hand to make
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this not go down flat the last concept
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here is that as you’re tying not only do
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you have to alternate back between index
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finger and thumb you also need to
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alternate on which direction you pull
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down your knife so for example if I
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cross with my right over my left tail
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and I start with my right hand I’m
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actually going to start with my thumb
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and I’m going to pull my right tail down
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so that’s thumb down as I come back up
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and do my index finger I now want to tie
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with my right hand up
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we’ll go thumb down index finger up
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thumb down index finger up and you can
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see I’m not going to full 90 degrees or
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180 degrees in each direction
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it’s just 90 it’s a little off skew but
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you do have to pull you’re not down in
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that direction if you do this
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alternating back and forth and you
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alternate between your index finger and
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your thumb you’ll find that you tie what
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looks like a chain-link or square knots
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okay so the final step here is to show
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you how to do this on one of these
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practice boards a lot of you guys are
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going to get this at your schools
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there’s one dark string and one light
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string these are kind of nice because
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once you tie square knots you can kind
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of see a weave back and forth to tie a
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square knot what I really want everybody
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into practice though is this whole
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concept of crossing and doing this one
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with your right hand and then if you get
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good at right hand do it with your left
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hand so I’m going to show you what this
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looks like with the left hand so if I
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cross again with my right over my left
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and I have to use my index finger to
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make this first not go down flat I’m
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gonna take my right hand and go up here
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now I come back and I do my thumb and
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with my thumb my right hand is going to
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go down index finger right hand up thumb
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right hand down index finger right hand
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up thumb right hand down
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it doesn’t matter really what hand you
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pick as long as you consistently go back
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and forth between your index finger and
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thumb and then cross your hands and
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again like I said what’s nice about
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these practice boards is that when
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you’re done if you’ve tied score nuts
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you can see this darker half of the
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suture going back and forth and you can
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know that it looks like a chain link and
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those are square knots okay so now into
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an introduction to one-handed knots so
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one-handed knots are kind of nice
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because if you’ve got something on one
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of your suture ends or if you’re just in
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a tight space and need to tighten knots
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you can do one hit and that’s pretty
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nicely a lot of people tell you that you
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can’t tie one-handed knots as square
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knots but you certainly can as long as
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you alternate back and forth between
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what I like to call the karate chop and
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the figure-four and pay attention to
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crossing up and down as you tie it on
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your nuts
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so I’ll break this down and first we’re
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going to learn about the karate chop
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okay so for starters an introduction to
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the karate chop so just like with two
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handed knots you start off with shooting
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guns with the karate chop your starting
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position is a figure four now again
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we’re only using one hand so your other
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hand can pretty much be doing nothing so
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for the karate chop you make the letter
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D I usually pull in my finger and just
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hold my middle finger and my ring figure
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out with this you want to do an internal
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rotation or karate chop down on your
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suture that you’re holding your tying in
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you can see this is going to create half
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of your suture circle you want to bring
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the other suture around to create the
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full suture sort suture circle around
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both your fingers and then you need to
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bend your middle finger back over the
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Lupus suture grab this little part
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that’s being held between your middle
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finger and pinched in between your index
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finger and thumb pinch it and then flick
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that little part through which is how
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you bring it through the loop of suture
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circle so again a slightly sped up
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karate chop down this is
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an internal chop bring the looper suture
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over grasp a little part of suture on
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tension pinch it in between your middle
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finger and your in your ring finger
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flick the tail through pull it down
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karate chop suit your circle grab that
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tail flick it through one more time
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karate chop suture circle
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grab that tail flick it through and one
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more time karate chop suture circle grab
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the tail flick it through you’re halfway
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there
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that’s the karate ten okay so now on to
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the figure form so whereas the karate
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chop was an internal rotation the figure
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four you have to think of an external
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rotation you want to create a little
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bridge with your index finger and your
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thumb and you want to come out and
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around educate a little trapeze across
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these two fingers and you want to make
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that pretty big okay you can see that
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this also creates half of your suture
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circle so now bring the little trapeze
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part over your your other side of your
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suture the part that you’re holding on
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tension and you’re going to create what
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looks like a figure four again starting
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position for the karate chop is here for
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the figure four you’re going to hold the
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suture back down in these three fingers
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almost like shooting guns form this
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little pincher external rotation to
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create your little bridge across the two
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fingers bring this over your suture on
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tension to create your suture circle now
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you’re going to bend your finger and you
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got to flick that little part that’s
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sort of like the trapeze there which is
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why you need it to be nice and big and
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on tension and they’re going to flick
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that through the suture circle pull it
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through then all right so now a little
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more fluently pincher trapeze here’s the
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figure four you’re going to grab it
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little trippy’s and flick it through the
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loop of suture circle down starting
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position pincher little trapeze right
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here make that figure four that’s
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actually how you make your suture circle
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grab that little trapeze part on tension
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this takes some practice and then you’re
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going to want to flick it through pull
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the tail through one more time pincher
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trapeze figure four flick that tail
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right through and down okay so now
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putting this all back together again
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you’re going to have to alternate back
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and forth between your karate chop and
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your figure four and just like with the
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two-handed nuts you’re also going to
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have to alternate between one your right
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hand goes up and your right hand goes to
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down so to put this together here we go
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karate chop grab it and for this I’m
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going to have my right hand go up come
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back to figure four pull the tail
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through my right hand goes down
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karate chop right hand goes up to your
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four right hand goes down karate chop
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right hand goes up figure four right
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hand goes down karate chop right hand
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goes up figure four
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right hand goes bending it’s a little
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harder to see this on the shoe then on
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your practice board but if you look at
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it it does look like a little bit of a
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chain rope here and that’s how you know
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these are square knots even with
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one-handed knots okay and this is how it
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would look like if you use it on the
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practice board so again
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karate chop down actually we’re going to
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go up figure four down
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karate chop up figure-four then karate
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chop up figure-four down variety chop up
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figure-four down and you can see these
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are nice square nuts with the purple
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kind of winding back and forth okay and
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so that’s about it
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so once you get this down it’s going to
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go about this fast this basically
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becomes muscle memory and then when
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people are distracting you or if you’re
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a little nervous you don’t even have to
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think about it it’s just something that
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you kind of do automatically and the key
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here really is you want to do this with
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something big like your shoelace or your
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practice board because you want to make
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sure you get the muscle memory down of
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tying good square knots before you move
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on to small suture because if you
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practice with small suture at first you
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won’t be able to see your nuts may end
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up teaching yourself some bad habits
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that you don’t really want to propagate
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all the way through so grab your shoe
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give us a practice have some fun and I
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hope you find this video to be helpful