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Hello and welcome to sick notes where we explain medical things in simple terms last week I saw the movie Joker the fantastic movie I loved the vision of it thought Joaquin Phoenix's portrayal was absolutely sublime and there was some fascinating medical things as well, and I know how much you guys like to know a little more your favorite movie, so I thought I'd share some of my thoughts, so this is going to contain lots of spoilers you have been warned okay first up there Pete to be some kind of physical deformity around Arthur flex back and shoulder blades this was mainly due to being underweight so possibly showing cathexis that's the word we use for extreme muscle loss due to illness and possibly related to some sort of poor posture as well but there did also look to be some underlying deformity to the area — this is the joy of what these films as a medical professional you're always trying to figure out exactly what's going on deformity could be two things, so acutely we'd worry about a fracture so a broken bone or even a dislocation clearly there is nothing wrong acutely as artifact isn't in pain, and he appears to have full range of motion of the shoulder sore throughout the film, but we did see those harrowing scenes of him being physically abused as a child in his backstory so possibly could be a result of a poorly healed injury so a poorly healed fracture as a child and now the possibility is damage to the nerves in the area particularly a nerve called the long thoracic nerve that innervates a muscle called serrated anterior so this muscle here and Job this muscle is to pull the scapula so the shoulder blade around the back so looking out skeleton here the serrated anterior muscle connects to your first eight ribs and moves underneath the scapula here underneath the shoulder blades and actually connects to this fur this aspect what we call the medial aspect of the scapula and so when it contracts it pulls the scapula around the rib cage damage to the long thoracic nerve that innervates this muscle or damage to the muscle itself causes a deformity called winging of the scan Kills actually can imagine this muscle way pull around this scapula moves out like this creating the deformity the damage to this area is most often cause again by trauma, but we also know that Arthur has a neurological condition so and the illness affecting the nerves of the body so depending on what that illness exactly is it might affect the peripheral nerves so the nerves that supply the muscles in this area so whilst I was watching the movie I actually thought the wacky Felix's body was part CGI because it looks so mad but turns out he actually lost 52 pounds over 23 kilograms just for the role and according to this Vanity Fair interview the shoulder deformity is actually something that Phoenix has had from birth, so a congenital abnormality are saying you're born with or maybe even as a result of some trauma from birth I think in terms of the Arthur Fleck...
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