Edward J. Shahady, MD

December 31, 2006

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.

December 31, 2006

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.

December 21, 2006

A 36-year-old man complains of right foot pain of several months' duration that limits his ability to run. He has been able to keep running by icing the foot and by stopping his running program for a few days when the pain increases.

November 01, 2006

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.

September 01, 2006

ABSTRACT: Our knowledge of chronic diseases has advanced significantly in recent decades, but patient outcomes have not kept pace. This is largely because the traditional acute care model does not adequately address the needs of patients with chronic disease. Patients play an active role in the management of chronic disease, and successful outcomes are highly dependent on adherence to treatment. Thus, clinicians need to have skills in coaching and encouraging as well as an awareness of factors in patients' backgrounds that are likely to affect their ability or willingness to follow treatment plans. Provider- and system-related factors, such as lack of reimbursement for counseling and high copayments, can also act as barriers to compliance. Among the strategies that can improve adherence are the use of community resources, multidisciplinary approaches, and regular follow-up.

September 01, 2006

Over the past few decades, the management of chronic disease has assumed a greater role in health care. Diseases such as diabetes, chronic obstructive pulmonary disease, and depression have replaced acute disorders as the leading cause of morbidity, mortality, and health care expenditures.

August 01, 2006

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.

June 01, 2006

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.

April 01, 2006

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.

December 01, 2005

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.