Uninjured athlete with edematous arm · Dx?

A 16-year-old boy presented to the emergency room (ER) with pain, redness, and swelling of his right upper arm that had been bothering him for 2 days.

Chronic Pelvic Pain in Women.

Chronic pelvic pain in women is defined as persistent, noncyclic pain perceived to be in structures related to the pelvis and lasting more than six months. Often no specific etiology can be identified, and it can be conceptualized as a chronic regional pain syndrome or functional somatic pain syndrome. It is typically associated with other functional somatic pain syndromes (e.g., irritable bowel syndrome, nonspecific chronic fatigue syndrome) and mental health disorders (e.g., posttraumatic stress disorder, depression). Diagnosis is based on findings from the history and physical examination. Pelvic ultrasonography is indicated to rule out anatomic abnormalities. Referral for diagnostic evaluation of endometriosis by laparoscopy is usually indicated in severe cases. Curative treatment is elusive, and evidence-based therapies are limited. Patient engagement in a biopsychosocial approach is recommended, with treatment of any identifiable disease process such as endometriosis, interstitial cystitis/painful bladder syndrome, and comorbid depression. Potentially beneficial medications include depot medroxyprogesterone, gabapentin, nonsteroidal anti-inflammatory drugs, and gonadotropin-releasing hormone agonists with add-back hormone therapy. Pelvic floor physical therapy may be helpful. Behavioral therapy is an integral part of treatment. In select cases, neuromodulation of sacral nerves may be appropriate. Hysterectomy may be considered as a last resort if pain seems to be of uterine origin, although significant improvement occurs in only about one-half of cases. Chronic pelvic pain should be managed with a collaborative, patient-centered approach.

"Doctor, I'm so tired!" Refining your work-up for chronic fatigue.

Recent advances in our understanding of the pathophysiology of chronic fatigue and related disorders can help guide your response to this common complaint.

Urinary problems in women.

Women who have symptoms related to the genitourinary system present daily in a typical family medicine practice. The most common complaints are dysuria, increased urinary frequency, and incontinence. In the vast majority of cases the underlying problem is either urinary tract infection, urinary incontinence without infection, or bladder pain without infection that may be termed painful bladder syndrome/interstitial cystitis. This article discusses epidemiology, pathophysiology, risk factors, diagnosis, and treatment of these conditions.