232 ‒ Shoulder, elbow, wrist, and hand: diagnosis, treatment, and surgery of the upper extremities

Ғылым және технология

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Alton Barron is an orthopedic surgeon specializing in the shoulder, elbow, and hand. In this episode, Alton breaks down the anatomy of the upper extremities and discusses the most common injuries associated with this area of the body. He explains in detail how he examines the shoulder, elbow, and hand to find the source of the pain and lays out the non-surgical and surgical treatment options as well as the factors that determine whether surgery is appropriate. Additionally, Alton describes the surgical procedures that, when done appropriately, can lead to tremendous reduction of pain and improvement in function.
We discuss:
0:00:00 - Intro
0:00:08 - Alton’s path to orthopedic surgery
0:06:03 - Evolution of orthopedics and recent advances
0:11:21 - Anatomy of the upper extremities
0:20:12 - Rotator cuff injuries, shoulder joint dislocation, and more
0:31:55 - Peter’s shoulder problems
0:36:04 - The structure of the biceps and common injuries
0:39:20 - Labrum tears in the shoulder and natural loss of cartilage with usage and time
0:43:07 - Shoulder evaluation with MRI vs. physical exam, diagnosing pain, and when to have surgery
0:53:20 - How anatomical variation can predispose one to injury and how screening may help
0:59:36 - Pain generators in the shoulder, and the important nuance of the physical exam
1:10:22 - Frozen shoulder
1:16:54 - Shoulder pain that originates in the neck
1:22:22 - Shoulder Exam
1:33:37 - Surgical treatments for a labral tear, and factors that determine whether surgery is appropriate
1:48:11 - Repairing the rotator cuff
1:58:13 - Are platelet-rich plasma (PRP) injections or stem cells beneficial for healing tears?
2:06:16 - Repair of an AC joint separation
2:18:04 - Total shoulder replacement
2:29:21 - The elbow: anatomy, pain points, common injuries, treatments, and more
2:42:42 - How Tommy John surgery revolutionized Major League Baseball
2:48:03 - Elbow Exam
2:55:12 - History of hand surgery and the most significant advancements
3:03:30 - The hand: anatomy, common injuries, and surgeries of the hand and wrist
3:15:47 - Carpal tunnel syndrome
3:23:54 - Other common injuries of the hand and forearm
3:32:54 - Grip strength
3:37:55 - Arthritis in the hands
3:47:20 - Trigger finger
3:53:38 - Hand & Wrist Exam
4:02:20 - Nerve pain, numbness, and weakness in the upper limbs
4:10:54 - Nerve Exam
4:17:24 - The Musician Treatment Foundation
4:31:27 - Gratitude and rucking
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About:
The Peter Attia Drive is a weekly, ultra-deep-dive podcast focusing on maximizing health, longevity, critical thinking…and a few other things. With over 45 million episodes downloaded, it features topics including fasting, ketosis, Alzheimer’s disease, cancer, mental health, and much more.
Peter is a physician focusing on the applied science of longevity. His practice deals extensively with nutritional interventions, exercise physiology, sleep physiology, emotional and mental health, and pharmacology to increase lifespan (delay the onset of chronic disease), while simultaneously improving healthspan (quality of life).
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Пікірлер: 76

  • @PeterAttiaMD
    @PeterAttiaMD Жыл бұрын

    In this episode, we discuss: 0:00:00 - Intro 0:00:08 - Alton’s path to orthopedic surgery 0:06:03 - Evolution of orthopedics and recent advances 0:11:21 - Anatomy of the upper extremities 0:20:12 - Rotator cuff injuries, shoulder joint dislocation, and more 0:31:55 - Peter’s shoulder problems 0:36:04 - The structure of the biceps and common injuries 0:39:20 - Labrum tears in the shoulder and natural loss of cartilage with usage and time 0:43:07 - Shoulder evaluation with MRI vs. physical exam, diagnosing pain, and when to have surgery 0:53:20 - How anatomical variation can predispose one to injury and how screening may help 0:59:36 - Pain generators in the shoulder, and the important nuance of the physical exam 1:10:22 - Frozen shoulder 1:16:54 - Shoulder pain that originates in the neck 1:22:22 - Shoulder Exam 1:33:37 - Surgical treatments for a labral tear, and factors that determine whether surgery is appropriate 1:48:11 - Repairing the rotator cuff 1:58:13 - Are platelet-rich plasma (PRP) injections or stem cells beneficial for healing tears? 2:06:16 - Repair of an AC joint separation 2:18:04 - Total shoulder replacement 2:29:21 - The elbow: anatomy, pain points, common injuries, treatments, and more 2:42:42 - How Tommy John surgery revolutionized Major League Baseball 2:48:03 - Elbow Exam 2:55:12 - History of hand surgery and the most significant advancements 3:03:30 - The hand: anatomy, common injuries, and surgeries of the hand and wrist 3:15:47 - Carpal tunnel syndrome 3:23:54 - Other common injuries of the hand and forearm 3:32:54 - Grip strength 3:37:55 - Arthritis in the hands 3:47:20 - Trigger finger 3:53:38 - Hand & Wrist Exam 4:02:20 - Nerve pain, numbness, and weakness in the upper limbs 4:10:54 - Nerve Exam 4:17:24 - The Musician Treatment Foundation 4:31:27 - Gratitude and rucking

  • @jessethompson6854

    @jessethompson6854

    Жыл бұрын

    This is great! would love a follow-up series-like for the spine, hip, knee/LL.

  • @bayhappy3992

    @bayhappy3992

    8 ай бұрын

    @@jessethompson6854 💯%

  • @TrollsAreFunny
    @TrollsAreFunny Жыл бұрын

    For the clinical side of your audience, more of these types of podcasts covering other medical topics in-depth would be greatly appreciated!

  • @WilliamChan

    @WilliamChan

    Жыл бұрын

    Even great for the average Joe who can then have more informed and enriched conversations with their clinicians about their health, hopefully leading to better outcomes

  • @amyaltshuler8779
    @amyaltshuler8779 Жыл бұрын

    I am a physical therapist of 40 years and I have listened to a lot of professionals convey medical information in continuing education courses I have attended. This was a very impressive presentation by both of you. Thank you very much. I would love to view/listen to a podcast on the lower extremity by an orthopedic surgeon especially pertaining to the foot. This was an excellent overview format which also contained fabulous gems of specificity even for those of us well versed in these subjects. Dr Alton’s enthusiasm for his subject was palpable and wonderfully conveyed. Very informative, I learned a lot.

  • @sarojaniangal5360

    @sarojaniangal5360

    Жыл бұрын

    "you f

  • @sarojaniangal5360

    @sarojaniangal5360

    Жыл бұрын

    Cxf

  • @salvatoresabbatino4825
    @salvatoresabbatino4825 Жыл бұрын

    I am an electronic engineer, nothing to do with medicine, you have entertained me for an entire hour, and I wish I would have studied medicine, there is so much to know there

  • @donheff831
    @donheff831 Жыл бұрын

    This is a fantastic interview. I hope you do the lower body soon (hip and knee).

  • @mr2_mike

    @mr2_mike

    Жыл бұрын

    Let's not forget the Ankle as I feel the Ankle is lacking in medical progression compared to the Knee and Hip.

  • @j.b8728
    @j.b8728 Жыл бұрын

    Awesome for doing this. I'm an Orthopedic PA who works at a major medical center and this is helpful in my approach

  • @CushingsSx
    @CushingsSx Жыл бұрын

    I can’t ❤ this enough 😊 next time, let’s discuss the more neurological side of this discussion; spinal cord, nerve roots, brachial plexus (Real Texans Drink Cold Beers), plexopathy, peripheral nerve; common disorders, PLEASE! 🙏

  • @michelebleh4389
    @michelebleh4389 Жыл бұрын

    This was the BEST podcast yet!! Can you do one like it on the hip/ lost limbs??!!

  • @sharonchriswell8500
    @sharonchriswell8500 Жыл бұрын

    I cannot believe it!!! I’m laying here w a heating pad on arms below shoulders. This man is so easy to listen to n very knowledgeable. This was helpful. You amaze me Peter.

  • @Soldadummy
    @Soldadummy Жыл бұрын

    Since I work in imaging, this is absolutely the best one that I've watched on this channel. Second has been the about MRI

  • @yiwenyoga9617
    @yiwenyoga9617 Жыл бұрын

    Dr. Barron thank you for a clear explanation of such a complex topic! A reminder for the doc, please watch your standing posture in the spine. The sway back is quite pronounced. I have been teaching human biomechanics to the lay community for 25 years and my eye naturally gravitate to posture and movement 😊

  • @emmakleis1364
    @emmakleis136410 ай бұрын

    this is so good, love the physical exams and insights

  • @jimmydeaton9767
    @jimmydeaton9767 Жыл бұрын

    This is fantastic. I'm a occupational medicine PA who sees a lot of upper extremity overuse and accidental injuries. This was super informative and a great resource. Would love to see lower extremity and spine! Keep more of these coming!

  • @ColeWalters
    @ColeWalters Жыл бұрын

    Thank you so much for this. I do chronic pain management as a clinical pharmacist and refer out to ortho very often. This will help me better explain to patients what to expect from ortho surg consults

  • @jdumasss04
    @jdumasss04 Жыл бұрын

    I’m currently 7 weeks post surgery for a Slap tear type III, torn supraspinatus tendon and proximal tear of long head of biceps. This information is excellent in describing exactly what these do. I’m a nursing student so I have a basic conceptual knowledge but to hear an orthopedist explain it clears up so many things. Thank you

  • @tomgunn8356
    @tomgunn8356 Жыл бұрын

    Simply outstanding! Thank you Peter and Alton for this extensive medical education! So thorough and informative. Sorry you didn't mention DuPuytren's contracture, but in fairness, that's not an orthopedic problem. but a disease of the fascia. Keep up the great work!

  • @adapa360
    @adapa360 Жыл бұрын

    What a program! As always worth every second. Amazingly clear and instructive guest, and really liked the long format. Thank you for your efforts!

  • @wordhoney
    @wordhoney Жыл бұрын

    I listened to this episode and then watched the whole thing as well. I don't have any issues with shoulder/elbow/hand (although I'm getting older....and certainly know friends who've had various problems discussed). I just found it really interesting, as a layperson, to have this accessible explanation of the anatomy and how things work and what can go wrong. Definitely came away with a new appreciation of the shoulder joint. I'd love to hear/see an episode or two like this for hips/legs/feet.

  • @bluedevils81
    @bluedevils81 Жыл бұрын

    I'd love this same kind of deep dive into lower back \ hip area of the body

  • @bayhappy3992
    @bayhappy39928 ай бұрын

    Amazingly good discussion. I came because of shoulder pain as well as a hand injury. This is what I was looking for but could not find anywhere. Thanks!

  • @rigaleb
    @rigaleb Жыл бұрын

    How fantastic would be if you could talk about connective tissue disorders and their orthopedic and neurologocal influences, as they are the most underrated and underestimated clinical entities with a huge spectrum from just ”loosy-goosy” to severe lifelong chronic pain, disability and immense suffering.

  • @yiwenyoga9617

    @yiwenyoga9617

    Жыл бұрын

    Wondering what causes tremors in the hands when holding a light object with fingers?

  • @jeankim91
    @jeankim91 Жыл бұрын

    i'm 7 weeks post bankart repair, and although my ortho is very patient and spends time with me i can't ask him all these questions. this has been enormously helpful and illuminating.

  • @DrLizBonet
    @DrLizBonet6 ай бұрын

    Fantastic explanations. Vignettes of cases really helped me understand as well. Thank you.

  • @rebeccagriswold282
    @rebeccagriswold282 Жыл бұрын

    Great interview! Would love to watch this type of show talking about hips.

  • @mediocreape
    @mediocreape11 ай бұрын

    I'm 25 and tore my rotator cuff, I can't express enough how helpful this podcast has been. I'm incredibly grateful to you Peter for starting your own podcast. I found out about you through Joe Rogan and followed your work. God Bless you good Sir or should I say Dr.

  • @lucycooper55
    @lucycooper55 Жыл бұрын

    I have a lot metal in my wrist from an injury and have many of these shoulder / elbow issues as well. Thanks for another important talk

  • @k...5853
    @k...5853 Жыл бұрын

    Me, Monday morning: "There's no way in hell a 4 1/2 hour long video is keeping my attention." Monday afternoon: "OMFG! I got no work done today! That was amazing!"

  • @ogniann2450
    @ogniann2450 Жыл бұрын

    This is fantastic! Very interesting and very useful! I just wish that you had covered knees too, since those are also a very common source of trouble.

  • @raulperezrodriguez
    @raulperezrodriguez Жыл бұрын

    El mejor episodio en este canal en mucho tiempo. Gracias Doctor.

  • @maisongrefe3714
    @maisongrefe371411 ай бұрын

    Love this type of podcast.

  • @ked4864
    @ked4864 Жыл бұрын

    Please, please, please do something like this for the lower extremities too. I KNEED this very much! Thanks!

  • @wriwhisky
    @wriwhisky Жыл бұрын

    This episode is why I joined. Amazing content! As an avid martial artist it helped me understand issues I've had from shoulder to elbow to wrist. I am amazed at how those simple diagrams were able to explain more than complex medical images.

  • @deniseb2571
    @deniseb257111 ай бұрын

    Thank you both for sharing your expertise!

  • @user-vm4cm1mo4q
    @user-vm4cm1mo4q11 ай бұрын

    Fantastic! I’m a PT and have never witnessed any ortho doc in my area conduct this thorough a physical exam! Would have loved to see how Dr. Alton differentiates cervical spine from referred shoulder/upper extremity involvement. Thank you for this. Looking forward to LE

  • @charisnachna4457
    @charisnachna4457 Жыл бұрын

    Thank you for an amazingly educational podcast/youtube video !!!

  • @petrolene_performancecoach
    @petrolene_performancecoach Жыл бұрын

    I dislocated my shoulder a week ago for the very first time. THIS was super AMAZING info!! Thank you!

  • @libbycollins9349
    @libbycollins9349 Жыл бұрын

    This older arthritic fan who loves to exercise and be able to lift heavy boxes when she volunteers at the foodshelf thanks you. Very informative.

  • @SouthOfDodge
    @SouthOfDodge Жыл бұрын

    Regarding the shoulder something I would like to hear talked about--perhaps in an AMA--would be the claims made in the book by John M. Kirsch, MD "Shoulder Pain? The Solution and Prevention". The principal claim in this book is that a daily hanging protocol (hanging from a pull-up bar) could treat and heal specific issues relating to the "acromialhumeral" joint. Please and thanks :)

  • @footleg3310

    @footleg3310

    Жыл бұрын

    Yes, please. I’ve just started hanging, based on Kirsch’s book. Seems like it couldn’t hurt to try (in a cautiously progressive way).

  • @bridginginstitute
    @bridginginstitute11 ай бұрын

    Love the developmental hip dysplasia insights! My team sees people who have this in their background. The brace is a wonderful advancement for the hip formation, but the immobilization for 6-9 months comes at a developmental cost. The core control for balance and the core rotation needed for efficient movement is largely skipped. It naturally would develop from tummy time transitions from the feet pushing to initiate ground based movement. (Many other relationships impacted which I won't outline here.) My Bridging Technique takes development into account in order to reconstruct the hierarchy of movement development and reset the related muscle relationships. Passive, gentle and long-lasting.

  • @waheeb_m
    @waheeb_mАй бұрын

    This is very interesting as ive had a bad left shoulder for a while and just had it operated on. This convo filled in some of my knowledge gaps

  • @asyakush
    @asyakush Жыл бұрын

    Great lecture! Thank you🙏

  • @naydaberlingeri820
    @naydaberlingeri820 Жыл бұрын

    Awsome!!! I wish I had this information before SLAP Tear & Adhesive Capsulitis Surgery. Developed CRPS. Back to 0. After 1yr of physical therapy I am still at 75% recovery. Thanks!!!

  • @susanschwartzenberger9351
    @susanschwartzenberger9351 Жыл бұрын

    I have had rotator cuff surgeries on both sides due to bone spurs in the joints, basically sawing completely through the superspinatous tendons with partial tears elsewhere. I was in my early 60s. With diligent physical therapy, I have full use of both shoulders at 69 yrs old. I had a great surgeon, but recovery is basically up to the patient. It hurts. Do it anyway!

  • @ajack5873
    @ajack587311 ай бұрын

    I love this doc.

  • @bernardojunqueira2392
    @bernardojunqueira2392 Жыл бұрын

    Ohh I was waiting for that one, as I also have a labrum tear and still considering having surgery (or not). Big thanks!

  • @Socalarborist
    @Socalarborist Жыл бұрын

    Looking forward to this. I have a major impingement in my right shoulder, probably need surgery soon!

  • @movevolutionphysicalperfor3132
    @movevolutionphysicalperfor313210 ай бұрын

    I’ve listened to this webinar twice at least. Very solid stuff. I appreciate the great information. I’m getting ready to dive into your knee webinar. By any chance, do you have a podcast? I can find on Apple or Spotify? Your site is a great resource, for my other clinical colleagues, as well!

  • @l.3626
    @l.3626 Жыл бұрын

    I love your podcast

  • @LawnChairGrandMaster
    @LawnChairGrandMaster Жыл бұрын

    NSAIDs and cartilage healing, Dr. just told me NSAIDS a detrimental to healing cartilage. Would love to get more on this!

  • @intellasoftcommunications524
    @intellasoftcommunications524 Жыл бұрын

    I find the revelations and discoveries that are being made with respect to the body, make me wish that I could go back and challenge my doctor on the traditional narratives I have been brainwashed by. From living with the pain of a miss-healed broken clavicle (apparently it is impossible to break and repair it properly) to "you're 60 what do you expect" "Dont't do squats remember your dad had bad knees, you dont want to end up like him" ... rediculous, I do 50 every morning. But allas my upper body strenth is ZERO -- I am highly active but doctors passively and complancently give up on their patients and the patient sadly follows. I find your channel enlightening. It shines a light on modern day health, what is preventable and what can be acheived.

  • @pjhughes9669
    @pjhughes9669 Жыл бұрын

    Fabulous!❤

  • @sunshinesunshine6130
    @sunshinesunshine6130 Жыл бұрын

    What an excellent podcast. If anyone watching this in New Zealand knows of an expert in shoulders, hands, neck in NZ of his calibre please share. 😊

  • @JohnDotBomb
    @JohnDotBomb Жыл бұрын

    So that's what happened to me! I also subluxated my right shoulder doing military press (in middle school). Had it happen a couple more times in middle school and once while lifting a dancer. Luckily I've never done a shoulder intensive sport so it's never gotten worse. I generally avoid military press now; machines and barbells are preferred.

  • @jennyretief4978
    @jennyretief4978 Жыл бұрын

    Had a subscapularis tear with bicep tendon slipping out the groove. Repaired five months ago. Still have that nerve pain in the bicep at times. At least not down into the palm. Just time I suppose?

  • @N412BE
    @N412BE Жыл бұрын

    Wow!

  • @JuanaLove6931
    @JuanaLove6931 Жыл бұрын

    How does Ehlers danlos play into this tendency of these injuries??? Personally struggling to strengthen all these muscles and tendons. Stability is my primary focus on this old athletic body. How does elders danlos play into tendons, cartilage and ect.??? Really trying to figure out how and what exactly is the goal with loosey-goosey joints. I'm just now learning how unusually loose my joints are and getting older is a big concern. I want to out- live and out- perform Dr Attia. No holds bar but pretty ignorant on this important topic!!!

  • @ryanwells2323
    @ryanwells2323 Жыл бұрын

    Peter those arms lookin a little swole 💪🏼

  • @cecebarnes7715
    @cecebarnes771510 ай бұрын

    Where can I find a hand surgeon who will use my own body for tendon graphs for repair of my thumb? I can no longer find one. Everyone now at Kaiser wants to use artificial implants . I have thinning bones at 80 and don’t want artificial parts.

  • @PanAshigaru
    @PanAshigaru Жыл бұрын

    I am confused - short head if the biceps never tears?

  • @mustavogaia2655
    @mustavogaia2655 Жыл бұрын

    2:39:30 - isnt that what they used to do with horses?

  • @alexgracia9576
    @alexgracia95768 ай бұрын

    1:11:40

  • @joshuadeighton8206
    @joshuadeighton8206Ай бұрын

    ya

  • @lucian7432
    @lucian7432 Жыл бұрын

    👊 Prⓞм𝕠𝕤𝐌

  • @iamnatekea
    @iamnatekea Жыл бұрын

    So engineers make the best surgeons?

  • @gondwana6303
    @gondwana6303 Жыл бұрын

    Maybe useful for health professionals but almost completely useless for patients. Also not useful is Peter's vanity checkup.

  • @tonyhardy8097
    @tonyhardy8097 Жыл бұрын

    Follow him little sheep, follow him

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