2/First, a rule of thumb—or rather a rule of elbow! You have 10 fingers. If you divide that in half, you get 5. Similarly, if you divide your arm in half at the elbow, you get 5--C5 that is! C5 radiates towards the elbow. So if it radiates below this, it is > C5 & above is < C5
3/So let’s start with C2. C2 predominantly radiates along the dorsal aspect of the scalp, as it supplies the greater occipital nerve. I remember this bc the number 2 has a swan like neck that mimics the contour of the back of the head and its distribution
4/Next is C3. C3 starts radiating right around the ear and circles around to the front of the neck, as it is a contributor to the great auricular nerve and anterior cutaneous nerve of the neck. I remember how it starts bc the number 3 looks like those big grandpa ears.
5/C4 radiates along the suprclavicular fossa, as it helps innervate the supraclavicular nerve, and goes towards the deltoid. I remember this because the triangular part of the number 4 looks the bulging deltoids that you always see on TV, but never in real life 😂
6/I remember C5 using that general rule that half of the number of fingers (5) equals halfway down the arm (elbow). C5 radiates towards the elbow.
7/C6 radiates to the thumb. I remember this because when you count to 6, you use up all the fingers on one hand and then end on the thumb of the next hand. So you end on a thumb when you count to 6 and C6 radiates to the thumb
8/We only have two cervical nerves left (C7, C8) for the 4 fingers left. So we will just use every other finger. So starting with C6 at the thumb—skip a finger gets you to the middle finger, that’s C7, skip the next finger gets you to the pinky, and that’s C8!
9/Now you know where in the c-spine to look when a patient has pain radiating from the neck—but remember there are subtleties to this & these are general guidelines to help you. Hopefully, remembering cervical radicular pain distributions will no longer be a pain in the neck!
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1/Asking “How old are you?” can be dicey—both in real life & on MRI!
Do you know how to tell the age of blood on MRI?
Here’s a thread on how to date blood on MRI!
After reading this, when you see a hemorrhage, your guess on its age will always be in the right vein!
2/If you ask someone how to date blood on MRI, they’ll spit out a crazy mnemonic about babies that tells you what signal blood should be on T1 & T2 imaging by age.
But mnemonics are crutch—they help you memorize, but not understand
If you understand, you don’t need to memorize
3/If you look at the mnemonic, you will notice one thing—the T1 signal is all you need to tell if blood is acute, subacute or chronic.
T2 signal will tell if it is early or late in each of those time periods—but that type of detail isn’t needed in real life
@TheAJNR 2/Since the prehistoric days of medicine (1979!), we knew that some brain tumor patients treated w/radiation (XRT) initially declined, but then get better.
Today, we see this on imaging, where it looks worse early, but then gets better.
Now we call this pseudoprogression.
@TheAJNR 3/Why does this happen?
XRT induces a lot of inflammatory changes—from initiating the complement cascade to opening the blood brain barrier (BBB)
It’s these inflammatory changes that make the imaging look worse.