Willis Paull, PhD

A 24-year-old man seeks medical attention 3 weeks after he injured his little finger playingfootball. He reports that the finger “came out of place” at the middle knuckle (proximal interphalangeal[PIP] joint); he quickly put the finger back into place himself, quit playing, andiced it. About 2 hours later, he was unable tomove the finger without significant pain, andthe following day, inability to move it interferedwith his performance of tasks that requiredfine manual dexterity. Since then, thepain has decreased, but the finger remainsswollen and he has not been able to fully extendit at the middle knuckle. In addition, thetip of the injured finger is hyperextended.

A 23-year-old man complains of looseness, clicking, and intermittent soreness in his right knee.In addition, the knee locks for short periods, and he has an occasional shooting pain up his rightthigh that causes the knee to buckle when he is walking. These symptoms have occurred intermittentlyover the past year, along with periods when the knee functions normally.

A 17-year-old girl who is a competitive cross-country runner presentswith exercise-induced pain in the lower left leg that hasbeen present for 2 months. She describes the pain as a feelingof tightness that begins after 20 to 30 minutes of running; thistightness usually resolves within 15 to 30 minutes after shestops. During the past 3 weeks, the tightness has been accompaniedby a cramp-like pain. The patient runs before and afterschool about 12 miles each day. In addition to running, she hasalso begun playing flag football during the past 2 weeks. She isotherwise in good health.

A 48-year-old woman complains of finger and knuckle pain in her right hand of 1 year's duration. She is right-handed. The pain is located over the metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints of the index and middle fingers.

A 16-year-old boy complains of right lower leg pain that began after his first week at a summer basketball conditioning camp. Before he left for the camp, he was jogging off and on, averaging a few miles a week.

A 17-year-old boy landed with most of his weight on his plantar-flexed right foot during a skateboarding accident. He felt pain on the top of his right foot and could not bear weight on it.

A 16-year-old football player complains of increasing pain in the ring finger of his right hand. It began 2 days earlier, when he tried to tackle a running back by grabbing the player's jersey; he felt immediate pain and was unable to continue holding on to the jersey.

A 12-year-old girl complains of left knee pain and swelling that resulted from a collision with another player while she was playing kickball the day before. Her left foot was planted as she tried to catch a ball, and she was hit on the outside of the left knee.

A 17-year-old student complains of worsening pain on the lateral side of his right foot that began 2 weeks earlier and now causes him to limp.

A 55-year-old right-handed house painter has had a constant dull ache in his right shoulder for 3 weeks. The pain worsens when he steers his car or elevates his arm, and the inability to raise his arm above his head interferes with his work.

For 4 weeks, a 23-year-old runner has had a painful burning sensation about 1 inch above andlateral to the left knee cap. Occasionally, the pain radiates to her hip and 1 inch down the lateralside of her leg.

A healthy 23-year-old woman, who is a longtime runner, calls your office the day after shetripped on a tree root while running in the woods and twisted her right ankle. She noted immediatepain on the lateral side of the ankle but did not hear or feel a pop. She was able tobear weight and walked out of the woods. However, as she walked, the ankle became morepainful and began to swell. When she reachedhome, she applied a heating pad and restedthe ankle. The next morning she noted increasedswelling and moderate discomfortwhile walking.