Back to Waltzing on my Own
Sarah is on vacation in Buenos Aires. Last night she met a handsome young man named Santiago. After a long night of dancing the tango in the plaza and drinking malbec, she woke up with difficulty lifting and pouring hot water in her instant coffee. She tried to do her 67 morning pull ups in the doorway but couldn't even do one. She likely injured this large extrinsic back muscle while dancing with Santiago.
What is the latissimus dorsi?
Caroline is an engineer overseeing a new multibillion dollar bridge construction project that is reaching completion. One day at the construction site, she suffers a deep laceration in the lumbar section of her back, and she is rushed to the ER. A few weeks later, she makes a full recovery. She has missed the ribbon cutting ceremony, and her wife left her for a young nurse. Neurological examination reveals that she still has little sensation in the skin at the site of the injury. The cell bodies of the affected neurons reside in this structure.
What is the dorsal root ganglion?
Boris is a zookeeper at a local zoo, where Rodrigo picked up some extra shifts as an emergency physician to pay off the damages from his car accident. One day, Boris is telling a group of 3rd graders about gorilla behavior, as Boris tries to point toward one of the gorillas, but he struggles to initiate abduction of his left arm. A nearby gorilla passively abducts Boris's arm to 15 degrees, after which Boris is able to continue the movement. The nerve that innervates the affected muscle passes through this anatomical landmark.
What is the suprascapular notch?
Ambulance chaser Joe presents in the ER with loss of sensation in his two most medial digits of his left hand after slamming his hand down excitedly during an illegal poker game. The attending physician performs a neurological exam that reveals that Joe is actually experiencing nerve compression at this most inferior root of the inferior trunk of the brachial plexus.
What is T1?
On the opening night of Chicago, Roxie hits the posterior aspect of her elbow against a chair. She flinches and grabs her elbow, but the show must go on, so she disguises her pain as an intentional body isolation. Bob Fosse himself is watching from the other side. Roxie is likely to experience a tingling sensation in the medial half of this finger.
What is the 4th digit/ring finer?
Hector loves ice cream. To fund his addiction, he sells avocados outside the local market. One evening, an elderly woman knocks him over with a shopping cart in the parking lot. In addition to losing several cases of avocados to the asphalt, he later develops pain in his upper back and has difficulty adducting his right scapula and rotating his head to the left. The affected muscle forms the medial border of this anatomical landmark.
What is the triangle of auscultation?
Gilbert works in a paint factory. After 35 years, and nearing retirement, he experiences severely worsening vision, chronic migraines with photophobia, aura, and nausea. His primary care physician suspects permanent, multi-locus systemic damage after years of exposure to toxic fumes. The primordial germ layer from which the affected tissue arises first appears at this week of embryonic development.
What is week 3?
Denver man attacked by a gorilla at the zoo. An angry gorilla attacked his longtime zooker Boris following an incident in which Boris didn't give the gorilla an extra banana. Boris is currently in stable condition but has lost the ability to extend his forearm. The affected muscle is innervated by the radial nerve and has this distal attachment.
What is the proximal end of the olecranon process of the ulna?
Rodrigo's wife left him after he crashed the McClaren and bought a Toyota Camry. The night the divorce papers were finalized, Rodrigo felt a sharp pain radiate along the lateral edge of his left arm, from shoulder to thumb and index finger. Thinking he was having a heart attack, he called 911 and was rushed to the nearest emergency department. An EKG was performed, and it was determined that his heart rhythm was normal. The attending physician suspected a neurological etiology and orders a spinal X-ray. Posteriolateral disc herniation could be expected at this vertebral level.
What is C5-C6?
Canadians are great dancers, but Gregory is from Missouri. His girlfriend tells him all the time that he can't dance, so he signed up for dance classes at the local community college. Walking out of class one Wednesday, Gregory trips on a rock and catches himself with his hands. Over the next week, he notices pain in his upper back, and his girlfriend notes scapular winging on his left side. He is still able to abduct his left arm above his head. This functional unit innervated by the dorsal scapular nerve is likely responsible for the loss of scapular stability.
What are the rhomboids?
Chris breaks his femur on a ski trip in Breckenridge, Colorado. He is rushed by helicopter to Denver Health Medical Center, where Rodrigo has returned to work following a spinal fusion surgery. Rodrigo places multiple screws into Chris's femur. At the time of surgery, it is discovered that Chris has been living with untreated HIV, and his CD4 count was 284. During recovery, he develops a severe fungal infection that results in high fever, photophobia, severe fatigue, and confusion. A physician places Chris in this body position to get a sample of the cerebrospinal fluid for testing.
What is flexed (lateral decubitis)?
Chris's Hawaiian vacation was cut short when he flew off his surfboard and hit his posterior elbow on an exposed rock. At the ER, neurological examination reveals no remarkable findings, however, Chris is still unable to push open heavy doors, which the demons use to their advantage when they play hide-and-seek with him. Examination reveals that the triceps is unaffected, so the problem must be with this helpful that has a proximal attachment at the lateral epicondyle of the humerus.
What is the anconeus?
Laura works in a secret government facility in which a semi-aquatic alien specimen is being held for investigation. From the other side of the glass of his enclosure, Laura falls in love and lets him out. When he caresses the skin of her arm just medial to the cubital fossa, the nerve that detects his love arises from this cord of the brachial plexus.
What is the medial cord?
Boris finally makes it to Estonia, where he is finally able to relax and recover from his gorilla-fueled trauma. He avoids zoos and courtrooms at all costs and begins training as a nurse at a local university. He attempts to place his first IV in a severely dehydrated patient, but he accidentally pierces this tendinous piece of connective tissue that crosses the cubital fossa anteriorly.
What is the bicipital aponeurosis?
Jerry Springer was walking his springer spaniel on a rainy day. He slipped and fell on a banana peel that the neighbors' kid left out. The next day, he had a hard time laterally flexing and rotating his lumbar vertebrae, indicating that the inferior portion of this intrinsic muscle group was compromised.
What is erector spinae?
Gary is a first year medical student who fell down a flight of stairs and presents to the emergency room with numbness and tingling that radiates from the back of his neck to the top of his head. Upon examination, the attending physician notes that his range of motion is unaffected. This sensory nerve that exits C2 has likely been affected.
What is the greater occipital nerve?
Bernice is on vacation in Denver with her new boyfriend Marc. Marc bets that Bernice cannot win in an arm wrestling match with a gorilla. Bernice never backs down from a challenge, so she sets up an arm wrestling table at the amphitheater. After about 10 minutes, she finally bests the gorilla, who walks away in defeat. Afterward, Bernice has pain in her scapular region. Collateral circulation to the area is aided by these segmental vessels that travel within the intercostal spaces.
What are the posterior intercostal arteries?
Greg works in an office with his love interest Jeremy. They are both insurance underwriters for an auto insurance company and spend many hours sitting at their desks writing emails and sending each other cat memes. One day, Jeremy notes that he has dull numbness radiating from his wrist to the lateral 3 digits of his hand on the palmar side. Greg helps Jeremy out by gently massaging the area and looking deep into his eyes longingly. The likely nerve does not arise from this cord of the brachial plexus.
What is the posterior cord?
Rodrigo is performing a ligament reconstruction surgery in the cubital fossa region of a professional tennis player. During the surgery, Rodrigo receives a call from his ex-wife. He takes the call, and his ex-wife tells him that he owes her $3,000 for back-to-school expenses for the kids. Rodrigo ends the call and accidentally severs the median cubital vein. This nerve is found just anterior to the medial intermuscular septum and runs deep to the medial vein connected to the median cubital vein.
What is the median nerve?
A 29 year old PhD student was drinking vodka cranberries in her room and waltzing to Mozart's Greatest Hits on vinyl when she felt a sharp pain in her upper back. She can no longer laterally abduct her arm beyond 100 degrees due to impaired upward rotation of the scapula. This artery supplies blood to the primary affected muscle.
What is the transverse cervical artery (I'll accept dorsal scapular artery)?
Joselynn has a pet fox named Cynthia that likes to eat tuna sandwiches for lunch. One day while Joselynn is feeding Cynthia, Cynthia bites Joselynn's left ring finger. Joselynn a high fever, hypotension, a high heart rate, confusion, and extreme pain. The infectious disease hospitalist is concerned that the infection may enter her brainstem by this structure that lies within the anatomical landmark whose roof is formed by semispinalis capitis.
What is the vertebral artery?
Hector got a new case of avocados. He has decided to try to overcome his fear of elderly women with shopping carts, so he posts up outside of Whole Foods, where he sells his avocados for $12 each. However, every time he sees an elderly woman with a shopping cart, he chucks an avocado. The vessel that supplies blood to the muscle that acts as the primary lateral rotator of the arm branches from this arterial trunk.
What is the thyrocervical trunk?
At his 6 month follow up following his fall down a flight of stairs at school, Gary tells his primary care physician that he has been having trouble with intimacy with his girlfriend. He notes in particular that he is unable to feel her when he wraps his arm around her. Upon examination, the physician notes a loss of sensation in the medial portion of the brachium as well as the lateral portion of the antebrachium and the medial one and a half digits of the hand. This nerve is likely also affected.
What is the ulnar nerve?
Gregory's girlfriend broke up with him after he spent $5,000 on private dance lessons after he failed his community college dance course. Overcome by grief, he flees to the beach and dances atop a jetty. He is particularly inspired by Bob Fosse's sharp body isolation, particularly of the elbows. As he is performing a classic sultry body roll, he loses his balance and falls down and tumbles across several large boulders. He strikes his cubital fossa area and starts bleeding profusely, but his forearm still receives blood flow from his ulnar artery. The forearm continues to receive collateral blood flow from this smaller vessel that ascends posterior to the medial epicondyle.
What is the posterior ulnar recurrent artery?
Stephanie and Luisa are playing tag in the backyard. Luisa tags Stephanie just as Stephanie is struck on the head by a falling coconut. In the emergency department, sensation over the scalp and neck is intact, and cervical extension is unaffected. However, rotation at the atlanto-axial joint is severely impaired. The most affected muscle inserts on this vertebral feature.
What is the transverse process of C1?
Bernice presents to the ER with a humeral fracture following a skateboard accident at Venice Beach. She informs the physician that she had been smoking cannabis with her boyfriend Tom before the accident occurred. She also noted doing three lines of cocaine while the nurses were away. She has impaired sensation in the dorsum of her right hand and weakened extension of her fingers and elbow. The affected nerve gives rise to this nerve that provides sensory innervation to the skin on the posterior side of the antebrachium.
What is the posterior cutaneous nerve of the forearm?
The gorilla has a vendetta against Boris. One night, while Boris is sleeping peacefully in bed with his cat Steve, the gorilla sneaks into his home and puts a pencil in Boris's shoulder. Neurological examination reveals that sensation is intact in the shoulder region, but Boris experiences difficulty performing daily tasks such as pouring coffee, brushing his teeth, driving, and chopping wood due to impaired flexion and medial rotation of the arm. This portion of the affected muscle originates from the lateral third of the clavicle.
What is the anterior deltoid?
Bernice's ex-boyfriend Tom has struggled on and off with substance use disorder for 6 years, since he was rejected from art school. When Bernice broke up with him 3 months ago, she told him that his art is terrible, and he started drinking heavily again. One night, after drinking 6 16 oz cans of PBR, he passes out on the floor of his apartment. He wakes up with numbness through the posterior aspect of his brachium, antebrachium, and the lateral dosal aspect of his hand. The affected nerve arises from the cord that can be found anterior to the tendon of this extrinsic back muscle that inserts at the intertubercular sulcus.
What is latissimus dorsi?
Liza Minnelli is rehearsing for her performance in Bob Fosse's Cabaret (1972). She is practicing a broken doll walk sequence with her elbows tucked firmly against her abdomen and her forearm extending laterally from her midline at a right angle with her wrists loose and palms facing inferiorly. In the course of the sequence, she slowly extends her wrists and fingers and rotates her palms to face the audience. The muscle responsible for this rotation is innervated by a branch that arises from this cord of the brachial plexus.
What is the lateral cord?
Ambulance chaser Joe is representing a client who slipped and fell at Costco, resulting in persistent headaches and difficulty with balance due to injury of a muscle in the posterior neck. Joe's wife is a chiropractor who treated the client over the course of 3 months. Ignoring conflicts of interest, the affected muscle contributes to the myodural bridge but does not form a border of the anatomical landmark that contains the vertebral artery.
What is the rectus capitis posterior minor?
October 31, 5:27 PM. Griselda is a bad witch, but she is late for work. She works on the corner of Main and Ghoul scaring children and stealing their candy. She hops on her broom stick, but while she is flying she feels a sharp pain in the posterior lateral portion of her thorax. She does a few barrel rolls, but when she reaches up to grab a bat out of the sky, she is unable to fully elevate her arm due to restricted upward rotation of the scapula. The nerve that innervates the affected muscle can be found alongside this artery.
What is the lateral thoracic artery?
Boris sues the gorilla in court for $1.5 million in damages, including out-of-pocket medical costs and emotional distress. The judge rules in favor of the gorilla, denying Boris's claims. As Boris is walking out of the courtroom, the judge throws his gavel and strikes Boris in the back of the neck. Boris goes to the ER, and a neurological exam reveals loss of sensation in his lateral forearm. He is able to complete active abduction of his left arm to 160 degrees and passive abduction to 180 degrees. The affected nerve arises from a group of vertebral spinal roots, with this one being the most inferior.
What is C7?
DAILY DOUBLE
Ambulance chaser Joe's cat is mad at him for buying a new brand of cat food, so Joe is forced to sleep on the floor. The reality is that Joe's law firm has been struggling since he lost the Costco slip-and-fall case in litigation. Joe develops scapular winging arising from a pathological inability to stabilize the scapula against the thoracic wall. This nerve, which arises from the same spinal nerve roots as the affected nerve and innervates a muscle responsible for flexion, adduction, and medial rotation of the arm, is likely intact.
What is the lateral pectoral nerve?
Rodrigo is an orthopedic surgeon in Denver. Ski season is his favorite season. On his way to work one January night, he is speeding in his new McLaren and gets in a car crash that causes a posterolateral T5-T6 intervertebral disc herniation, compressing the dorsal ramus of T6. Contralateral rotation of the spine by intrinsic back muscles located within this vertebral feature is severely impaired.
What is the laminar groove?
Lizzy goes axe throwing with her parents downtown. Her mother notes that she is very good at it, and Lizzy smiles. After a few hours of throwing axes, Lizzy is having some trouble breathing. Upon examination, the attending physician in the ER suspects something neurological, but she is able to flex and extend her elbows easily and abduct her arm laterally with no restriction. The physician also notes impaired head rotation and difficulty performing the shrug motion. Damage to this most superior spinal nerve root is likely causing impaired function of the observed myotome.
What is C3?
Boris decides to change his name and move to Estonia. Despite his loss in court, he decides to buy himself a first-class plane ticket. On the flight to his new home, he falls, resulting in a midshaft humeral fracture. This nerve arising from the affected nerve provides sensation to the posterior aspect of the antebrachium.
What is the posterior cutaneous nerve of the antebrachium?
Gina is a general surgeon who works on-call shifts Thursdays at her local hospital. After a long night of appendectomies, she lies down on her couch to read a few chapters of Mary Shelley's Frankenstein with her pet tarantula Suzy, who earned her PsyD from George Washington University back in 2019. As Suzy crawls over her dorsum of her hand, Gina notes that she doesn't sense Suzy's movements in the lateral two and a half digits. She does a quick self-assessment and finds that sensation in her dorsal and pectoral regions seem unaffected, but she has numbness in the medial one and a half digits of her hand. Gina is not a neurologist, so she consults her friend who suggests imaging of her cervicothoracic region due to suspicion of a compression of one of the nerve roots that gives rise to this trunk of the brachial plexus.
What is the inferior trunk?