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stSU
J
acob
,a3
3-y
ear
-ol
dcon
str
uct
ionwor
ker
,comp
lai
nsofa“
lumponh
isb
ack
”ov
erh
iss
cap
ula.
It
h
asb
eent
her
efora
bou
tay
eara
ndi
sge
tti
ngl
arg
er.
Hes
aysh
iswi
feh
asb
eena
blet
osqu
eez
e
ou
tac
hee
sy-
tex
tur
eds
ubs
tan
ceonoc
cas
ion.
Hewor
ri
est
hisma
ybec
anc
er.
Whe
nge
ntl
y
p
inc
hedf
romt
hes
ide
,ap
romi
nen
tdi
mpl
efor
msi
nth
emi
ddl
eoft
hema
ss.
Wha
tismos
tli
kel
y?
8
-ye
ar-
ol
dre
ti
redf
arme
rcome
stoy
ourof
fi
cef
ore
val
uat
ionofas
kinl
esi
on.
Ont
her
igh
t
t
emp
ora
lar
eaoft
hef
ore
hea
d,y
ous
eeaf
lat
ten
edp
apu
let
hes
amec
olora
shi
ssk
in,
cov
ere
dby
ad
rys
cal
eth
ati
srou
nda
ndf
eel
sha
rd.
Heh
ass
eve
ral
mor
eoft
hes
esc
att
ere
dont
hef
ore
hea
d,
a
rms
,an
dle
gs.
Bas
edont
hisd
esc
ri
pti
on,
wha
tisy
ourmos
tli
kel
ydi
agn
osi
s?
ASe
bae
ousc
yst
BSe
bor
rhe
ick
era
tos
is
CBa
sal
cel
lca
rci
noma
DSqu
amou
sce
llc
arc
inoma
Ter
m
An
ewp
ati
enti
scomp
lai
ni
ngofs
eve
rep
rur
it
ust
hati
swor
sea
tni
ght.
Sev
era
lfa
mil
yme
mbe
rs
a
lsoh
avet
hes
ames
ymp
toms.
Upone
xami
nat
ion
,ar
easofe
xcor
iat
edp
apu
lesa
ren
ote
don
s
omeoft
hei
nte
rdi
gi
tal
web
sofb
othh
and
san
dont
hea
xil
l
ae.
Thi
sfi
ndi
ngi
smos
tcon
sis
ten
t
wi
th:
A.
Con
tac
tde
rma
tit
is
B.
Imp
eti
go
C.
Lar
vami
gra
ns
D.
Sca
bie
s
,
, A5
8-y
ear
-ol
dma
ncome
stoy
ourof
fi
cec
omp
lai
ni
ngofb
il
ate
ral
bac
kpa
int
hatn
owa
wak
ens
h
ima
tni
ght.
Thi
sha
sbe
ens
tea
dil
yin
cre
asi
ngf
ort
hep
ast2mon
ths.
Whi
chon
eoft
he
f
oll
owi
ngi
sth
emos
tre
ass
uri
ngi
nth
isp
ati
entwi
thb
ackp
ain
?A.
Ageov
er5
0
B.
Pai
natn
igh
t
C.
Pai
nla
sti
ngmor
eth
an1mon
thorn
otr
esp
ond
ingt
oth
era
py
.
Pai
nth
ati
sbi
la
ter
alTe
rm
A3
2-y
ear
-ol
dwa
reh
ous
ewor
kerp
res
ent
sfore
val
uat
ionofl
owb
ackp
ain.
Hen
ote
sas
udd
en
on
setofp
aina
fte
rli
ft
ingas
etofb
oxe
sth
atwe
reh
eav
iert
hanu
sua
l.Hea
lsos
tat
est
hath
eha
s
n
umb
nes
san
dti
ngl
i
ngi
nth
ele
ftl
eg.
Hewa
ntst
okn
owi
fhen
eed
stob
eof
fofwor
k.Wh
att
est
s
hou
ldy
oup
erf
ormt
oas
ses
sforah
ern
iat
edd
isc
?AL
eg-
l
eng
tht
est
.
Str
aigh
t-l
egr
ais
e
C.
Tin
el\
’st
est
D.
Pha
len
\’st
est
Ter
m
Mr
s.An
der
sonp
res
ent
swi
tha
nit
chyr
ashwh
ichi
sra
ise
dan
dap
pea
rsa
ndd
isa
ppe
arsi
n
v
ari
ousl
oca
tion
s.E
achl
esi
onl
ast
sforma
nymi
nut
es.
Wha
tmos
tli
kel
yac
cou
ntsf
ort
hisr
ash
?
I
nse
ctb
ite
s
Ur
ti
car
iao
rhi
ves
Ps
ori
asi
s
Pu
rpu
ra
Te
rm
A5
0-y
ear
-ol
dwoma
npr
ese
ntswi
th“
lef
thi
ppa
in”ofs
eve
ral
wee
ksdu
rat
ion.
The
rei
sma
rke
d
t
ende
rne
sswh
eny
oup
res
sov
erh
erp
rox
ima
lla
ter
alt
hig
h.Wh
atd
oyout
hin
ksh
eha
s?A
Os
teoa
rth
rit
is
B.
Rhe
uma
toi
dar
thr
it
is
C.
Sci
ati
ca
.
Troc
han
ter
icb
urs
iti
s
A2
8-y
ear
-ol
dgr
adu
ates
tud
entc
ome
stoy
ourc
li
ni
cfore
val
uat
ionofp
ain“
all
ove
r.”Wi
th
f
urt
herqu
est
ion
ing
,sh
eisa
blet
ore
lat
eth
att
hep
aini
swor
sei
nth
ene
ck,
shou
lde
rs,
han
ds,