Case history
Case history #1
A 24-year-old woman presents with 'whole-body' pain for the past year that is not controlled by analgesics. She also has palpitations and dizziness when she gets out of bed in the morning and feels very tired, to the extent that she has to rest after work. She works as a teacher and was formerly an enthusiastic athlete and dancer. In infancy, her legs would tire easily and she would insist on being carried. On several occasions she twisted her ankles badly, limping for several weeks. By 16 years of age, her ankles were so 'weak' she was forced to give up dancing and athletics. She has a history of recurrent dislocation of the left shoulder. The initial episode occurred when she missed her step and fell down a flight of stairs, but now the shoulder dislocates on minimal provocation, and quite often she has to go to the emergency department to have it reduced.
Case history #2
An 8-year-old girl is brought by her mother to see her primary care physician because the girl has pain in her legs at night, especially after physical activities. Her mother reports that as an infant the girl never crawled but 'bottom-shuffled' instead. She did not walk until 20 months of age and then tended to fall over easily. Her mother noticed that the girl was more 'bendy' than her older siblings and also clumsier, always bumping into furniture. Constantly fidgeting, she was always changing position. She hated walking around shopping centres, preferring to be carried or pushed in the buggy. Her ankles are unstable, and she is often going over on them. She walks with very flat feet and has difficulty keeping up with her friends. She holds a pen in an awkward manner, and her hand gets very tired after writing half a page.
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