Dr. Neal ElAttrache 6/9/26

Petros and Money talk with the world-renowned orthopedic surgeon and sports medicine specialist know for treating elite athletes and celebrities, and serves as the head team physician for the Los Angeles Dodgers. He has pioneered the Nano Scope procedure that Tarik Skubal and Blake Snell had recently. 

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Episode Transcript

Speaker 1 (00:00):
Doctor Neil Elatrosh, world renowned orthopedic surgeon, sports medicine specialist,
one of the world's most famous doctors. How do you
know he's a doctor? Right now? He is wearing his
white coat and his stethoscope and he has his reflex
hammer in the big pocket.

Speaker 2 (00:16):
Oh that flashlight there?

Speaker 1 (00:18):
You know you put right, guys, maybe behind his ear
Cedar Sinai Curlin Job Institute. He is a fove a
friend of Vassay, and he's highly sought after for elite
athletes all over the world and a great guy too.
To do a radio interview. Here he is doctor Neil

(00:38):
Elatrosh on the Petrosen Money Show. What's cragging? Doctor? Thanks
for doing it?

Speaker 3 (00:42):
Hi, jentlemen, how you doing?

Speaker 1 (00:44):
Ah? Great, fabulous and we're happy to have you. We
know you're in between patients and you're a very busy man,
so thank you for accommodating us. We got to ask
you about the nanoscope nano needle surgery because it's all
in the news these days. It's the first time we've
ever heard about this. What is this procedure we keep
hearing about?

Speaker 3 (01:06):
Well, it's it basically going to accomplish the same things
as with the usual arthroscopy, just miniaturizing the miniaturizing the equipment.
So the nanoscope is about one a little less than
two millimeters in diameter, so it's it's like the size

(01:29):
of a of a needle, and it has a chip
on the end of it and gives you about one
hundred and twenty degree view. So that compares to a
normal arthroscope that's a little over four millimeters in diameter,
so it's less than half the size, and it helps

(01:50):
you get into a joint and into tight spaces without
having to have a more significant exposure and tiss less
uh tissue invasion.

Speaker 2 (02:03):
Maybe it's because it just happened with the Dodgers, So
we hear about loose bodies, the fact that happened to
two guys on the team here in short order. But
have have we always called loose bodies loose bodies? Is
this something new? Did it have a different name?

Speaker 1 (02:16):
Uh?

Speaker 2 (02:17):
And And am I right in saying that, like, I
just don't feel like this was something we heard a
lot about or have we and we just missed it?

Speaker 3 (02:24):
Well? I mean maybe you've heard of somebody saying they
had bone chips in there in their joint or in
their elbow you loose loose chips or you know, all
all is about the same thing. You know, when when
you have when you've been throwing for a while, uh
for years, the back part of the elbow, there's a

(02:48):
lot of sheer on the on the bones in the
back part of the elbow, and uh with the you know,
the massive forces that these guys put on uh. You know,
time after time or months at a time, you get
you get some of these little little chips that will
either break off because they formed spurs on the back

(03:11):
of those can break, or you can get small small
debris that flakes off the bones, and those can grow
inside the joint like a pearl. You know, they get
they get nourished with the joint fluid. It's like they
can start off tiny, but they can end up growing big.
And if they're positioned just right or are big enough,
then it gives the pitcher a real problem with feeling

(03:35):
feeling like he can finish his pitch. You know that
he and after ball release, he doesn't feel like he
can really get his elbow extended. And and the way
that these guys throw it and spin it. Now, you know,
if they can't finish their pitch and get a little
bit of the back spin on on the ball. Then
they can't get the get they can't get it to move,

(03:58):
they can't get it to really finish, and uh, they
lose a little bit of velocity and they lose a
little bit of a command. So then if you see
somebody like like scooball what was happening to him?

Speaker 2 (04:12):
You know, the.

Speaker 3 (04:15):
Last straw was when when his people saw him sort
of shaking his arm to try to shake it loose,
you know, uh, you know during a game. You know,
that was a loose, loose body, a bone chip getting
wedged where it shouldn't be. And and he had been
able to to wiggle his arm around, you know, to

(04:36):
get the thing to wiggle free. But that's pretty unpredictable,
and you can imagine how how distracting and disconcerting it
is when at random you you know, your elbow is
going to lock and you're you're on the mound and
you're you're throwing it one hundred miles an hour, So
you know, it really is it's a it's a very

(04:58):
distracting thing. These guys, most these guys when they're getting
those kind of mechanical symptoms. They can't, they can't make
a go of it, they can't compete with it.

Speaker 1 (05:05):
The great doctor Latrosha is our guest, and he's very
gracious talking to us in between patients walking around saving
everybody's arms and legs. Doctor, how many surgeries do you
do a week? Just to give us perspective because you
are globally sought after.

Speaker 3 (05:22):
It depends on how big the cases are. You know,
I can't, I can't do. I can't do you know,
more than a few big cases in a day. So I,
on average I do about six big cases a week,
and then the smattering of smaller ones that will take
me maybe an hour. But the bigger ones Tommy John's

(05:44):
or revision Tommy john or complex multiple ligament knee injuries
like we see in the NFL. Now, there's no simple
or very few simple ACL tears anymore in the NFL.
There's so much trauma that there's going to be some
other things is that generally you have to fix, so
so none none of those things are real quick, quick

(06:06):
operations anymore. So it just depends on how big the
cases are.

Speaker 2 (06:11):
The you mentioned trauma. Notwithstanding we know football, you know,
just inherently is going to be a spot where you
see a lot of that. But is there like, have
we figured out preventative wise, you know, to try to
protect the arm and the elbow or is it just
I mean you said it, you're throwing the ball one
hundred miles an hour and that that singular movement is

(06:32):
repeated over and over and over again. Is it just
inevitable that that thing is going to break down when
you have that much force and violence on that ligament
or do you think there we will find something that
could help with that moving forward?

Speaker 3 (06:44):
Well, you know you're asking it. You're asking a very
very important question because if you look at the statistics
of how much it costs when these guys get hurt
and the number of injuries, I mean, it's an hundreds
of millions of dollars a year in replacement costs and

(07:05):
you know, lost salary because if somebody's sitting on the
bench of rehabbing. So and I do have very specific
thoughts about this, and it's really a pretty big focus
of mine in baseball now. So this is a long topic,
but I will tell you that a lot of the

(07:29):
big shoulder problems and some of that are actually related.
The shoulder and elbow injuries are somewhat remotely related because
of the mechanics involved begin when these kids are when
these guys are are are throwing when they're young kids,
and so that the the changes in the skeleton that occurs,

(07:50):
especially in the shoulder, when these guys are throwing year round,
they're playing year round baseball, and when their team is
not in season, then instead of playing a different sport
and getting an off season like a lot of us
used too when we were playing when we were younger,
they're going to a high performance camp or high velocity

(08:13):
camp where they're throwing a heavy ball and they're doing
all the things that they see the big league heroes
are doing. And they come in when they're fourteen or
fifteen years old, and there are you able to throw
it over ninety miles an hour. And when I see
a kid like that, especially a kid that's not really

(08:33):
outsized for his age, I know that he's sort of
artificially manufacturing the ability to throw it like that, and
I already can envision what I'm going to see when
I look at his MRI scans or X rays. So
a lot of these problems begin in youth when the

(08:54):
growth plates are still open and they cause some anatomic
changes in the shoulder and in the elbow. That then
set the stage for problems, you know, when they get
to that next, next, next level of competition and whether
it's college or in the pros, and then then the
big problems really start. So you know, just in general

(09:18):
that that is a focus of mind. So by preventing
some of that the abnormal anatomy to form would would
definitely decrease some of the bigger shoulder injuries that we see.
And it is, like I said, related to the to
elbow injuries too. And aside from that, you know, there's

(09:38):
some things in the game right now that if you
look about two years ago, there was an explosion of
injuries where you thought that every game you were going
to see somebody tear their ligament in their elbow. And
it was true, there was a spike in injuries there.
It was post COVID, about a year or two post COVID.

(10:00):
But what else was happening at the time was that
they changed the rules. They put in a pitch clock,
they took away the TACKI substances that these guys were
able to grip a baseball and doing that when the
philosophy of baseball had now gone through every team in
the major leagues that you throw with max effort, whether

(10:21):
it's velocity or spin, every pitch, and so you rarely
see a pitcher now go past seven innings. You know,
you rarely see them finish a game nine innings because
just the amount of effort that they're making. They're throwing
flat out, redline max velocity, max spin every pitch and

(10:41):
with a pitch clock and no grip, no Tacki substance
to make a grip. So these guys had to learn
learn that that's not how they trained, that's not how
they grew up. And so but leave it to these pitchers.
If you take their Tacki substance away for them to
not be able to grip the ball, they're going to
still spin it ungodly spin rates. They're just going to

(11:06):
find a different way to grip it. And what they
did was they figured out a way to position their
fingers on the ball and then really massively twisted their
forearm at the end called pronation and the death grip
that they would put on it with massive spin like
that that if you wanted to tear a on a

(11:29):
colatteral ligament in the laboratory, you do exactly that, and
so it is just so we we saw those things
really starting to rip.

Speaker 1 (11:41):
Well.

Speaker 2 (11:43):
Incredibly kind with his time, and we know you learn
so much. We learn a lot. We would love to
do it again. I mean a million things we can
get into with the good doctor, but with the loose bodies,
with the nano needle and everything that we've been hearing about.
We know people love getting educated all this and trying
to figure out when their favorite players will come back.
We certainly appreciate you taking time out of your busy day, doctor.

(12:04):
Thank you.

Speaker 3 (12:05):
Good to talk to you guys. I really enjoy your program.

Speaker 1 (12:08):
Oh, thank you, oh doctor Dale Alatrosh