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Ortho Dx: Chronic Shoulder Pain

The patient’s shoulder pain can be attributed to end-stage shoulder arthritis consistent with rotator cuff arthropathy. Stability of the glenohumeral joint largely depends on the ability of the rotator cuff to keep the humeral head centered in the glenoid cavity.1,2 The rotator cuff exerts an inferior pull on the humeral head that is balanced by…

Derm Dx: Blistering of the Lower Lip

This patient was diagnosed with bullous lichen planus affecting his oral mucosa based on the presence of classic lesions of lichen planus on his extremities, as well as subsequent biopsy findings. Bullous lichen planus is an uncommon variant of lichen planus, a cell-mediated inflammatory disorder that may affect the skin, nails, and mucous membranes. The…

Ortho Dx: Foot Pain in a Child

The patient is presenting with Kohler disease or osteochondrosis of the tarsal navicular. Kohler disease is a rare idiopathic disorder that usually occurs in children between the ages of 4 and 8 years.1,2 The navicular is the last bone in the midfoot to ossify; the theory is that running activities in children cause compression forces…

Derm Dx: Swelling of the Lips and Tongue

This patient is experiencing angioedema induced by his angiotensin-converting enzyme (ACE) inhibitor therapy. Angioedema occurs in 0.1% to 0.7% of patients treated with ACE inhibitors. Angioedema manifests as deep dermal and subcutaneous swelling that typically affects the face and upper airway.1 Black populations, women, individuals aged >40 years, those on immunosuppressive therapy, and those with…

Derm Dx: Disfiguration of Finger and Toe Nails

Psoriasis is a common skin condition that may negatively affect a patient’s quality of life.1 The disorder is associated with multiple comorbidities such as cardiovascular disease and diabetes mellitus.2 A significant percentage of patients with psoriatic nail changes will develop psoriatic arthritis,3 and nail psoriasis frequently accompanies cutaneous disease in up to 50% of patients.4…

Crusted Pruritic Rash Under Breast

Darier disease, also known as keratosis follicularis, dyskeratosis follicularis, or Darier-White disease, is an autosomal-dominant inherited disorder characterized by keratotic plaques and papules.1-3 This genodermatosis results in hyperkeratotic plaques developing in seborrheic areas, as well as associated palmoplantar papules, oral mucosa changes, and nail abnormalities.3,4 The disease was first noted in 1889 by French dermatologist…

Derm Dx: Large Hyperpigmented Patch With Hypertrichosis

Becker nevus, also known as Becker melanosis, is a benign congenital epidermal nevus that has a notable distribution and onset of presentation. The characteristic hyperpigmentation and hypertrichosis of Becker nevus are usually distributed over 1 shoulder and/or upper trunk with presentation occurring after puberty.1,2 Although congenital melanocytic nevus and Becker nevus are characterized by hypertrichosis…

Ortho Dx: Sudden Onset Knee Pain

SONK often starts with a sudden onset of knee pain that may worsen at night. SONK must be differentiated from secondary osteonecrosis, which most commonly results from corticosteroid use. Other conditions that cause secondary osteonecrosis include alcoholism, smoking, and coagulopathy. SONK is thought to result from an insufficiency fracture of the femoral condyle that fails…

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