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

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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


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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