Prompt Cast
Importance of Physical Exams in Upper Extremity Orthopedic Surgery
TLDR The episode delves into the diagnosis, treatment, and surgery of the upper extremities, emphasizing the significance of physical exams in identifying shoulder, elbow, wrist, and hand issues, with a focus on minimally invasive procedures and the work of the Musician Treatment Foundation.
Timestamped Summary
00:00
The episode focuses on a deep dive into the diagnosis, treatment, and surgery of the upper extremities, specifically the shoulder, elbow, wrist, hand, and nerves, with a special emphasis on the importance of physical exams and the work of the Musician Treatment Foundation.
09:15
Minimally invasive orthopedic surgery, specifically shoulder arthroscopy, evolved from primitive techniques to more advanced, less invasive procedures over time.
18:59
The shoulder muscles, including the supraspinatus, play a crucial role in shoulder movement and stability, with tears in the rotator cuff being a common issue that can vary in severity and presentation.
29:19
The labrum in the shoulder can tear due to repetitive use or significant dislocation, leading to instability and potential complications, especially in active individuals.
39:07
Most MRIs show positive findings in asymptomatic individuals, and a good history and physical examination are crucial in determining the need for surgery in shoulder injuries.
48:32
The clinician can often determine shoulder issues based on physical examination before resorting to an MRI, assessing factors like muscle strength and pain location.
57:37
Shoulder pain can be caused by various issues like AC joint problems, bursitis, rotator cuff injuries, labral injuries, bicep tendon inflammation, and arthritis, which can be diagnosed through a combination of physical examination and MRI findings.
01:06:31
Loose joints can lead to adhesive capsulitis, commonly known as frozen shoulder, which can be multifactorial and often requires control of inflammation, physical therapy, and sometimes a simple 30-minute surgical release of the capsule.
01:15:44
A physical exam of the shoulder can often reveal the root cause of pain or issues without the need for extensive imaging, and surgical treatments such as labral repairs can now be done percutaneously with smaller incisions.
01:24:45
The surgeon uses lower pressure during surgery to reduce postoperative pain and distention, and percutaneous techniques are used for labral repairs with small incisions.
01:33:29
Shoulder pathology can lead to elbow issues such as medial collateral ligament tears due to torque overload, highlighting the interconnectedness of upper extremity injuries.
01:43:06
Stem cell injections may not lead to spontaneous healing of asymptomatic rotator cuff tears, as shown by a natural history study, raising questions about the efficacy of such treatments.
01:52:20
A patient with a sternoclavicular joint injury was advised immediate surgery, highlighting the potential severity of such orthopedic emergencies.
02:01:40
Surgical procedure for shoulder arthritis involves removing the arthritic head, bone spurs, and replacing it with high-density polyethylene, maintaining rotator cuff integrity and allowing patients to resume various activities post-surgery.
02:11:02
Golfers are now experiencing more lateral epicondylitis on the leading arm due to increased club size and hitting power, with first-line treatment typically involving rest, NSAIDs, cortisone injections, and sometimes physical therapy for pain relief and recovery.
02:19:53
Parents sometimes inquire about Tommy John surgery for their children to increase pitching velocity, but it's important to clarify that not all elbow issues require surgery, and some injuries, like tricep tendon tears, are often related to eccentric loading activities like skiing.
02:29:11
The anatomy of the hand is complex, with varying numbers of bones in each finger, metacarpals, and carpal bones, including the scaphoid bone which is difficult to heal due to its limited blood supply, often fractured in young athletes from hard falls with a specific wrist position, requiring careful diagnosis and treatment to avoid non-union.
02:38:08
The hand is highly innervated, with over 60% of higher cortical neurons devoted to it, emphasizing the importance of maintaining hand function for cognitive development and well-being.
02:47:51
Fractures of the distal radius are common and can dramatically affect hand function, with various mechanisms leading to these injuries, including falls and direct blows, often requiring surgical intervention.
02:57:18
The owner nerve is more important for grip strength than the median nerve, with pinky and ring fingers playing a significant role in grip function.
03:07:01
Surgical repair of trigger finger is a common non-traumatic procedure for hand issues, often requiring cortisone injections or surgery for relief.
03:16:34
Steroids are often used to treat patients with shoulder pain that is actually originating from their neck, and subtle cues in patient symptoms can indicate conditions like double crush syndrome or lower cervical nerve compression.
03:25:55
A non-profit organization was established to provide free care to under and uninsured professional musicians, with over $2 million in free care provided over five years, including surgeries and non-operative treatments, and plans to expand with the help of over 60 surgeons across different cities.
Categories:
Health & Fitness
