On “Match Day” this month, senior medical students in the United States will find out where they are going for residency training; they will prepare to move on. Meanwhile, as demonstrated by this month’s Index of Suspicion case reports, several different conditions can alter the muscles of our patients. Learning together, we can help our patients move forward successfully.

Philip R. Fischer, MD

Associate Editor, Index of Suspicion

An 11-year-old girl presents to our clinic with main concerns for abnormalities in fine motor skills. She reports difficulty buttoning and unbuttoning her shirt, using door knobs, and operating the numeric combination lock. In addition, her mother reports that she is always clumsy and unable to maintain balance. The symptoms are present for a few years and seem to be slowly progressive. She also reports occasional early morning headaches for the past 2 months described as throbbing bifrontal pain, with photophobia and...

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