Review Question - QID 212677

A 14-year-old girl is brought to the clinic by her mom for an annual well-exam. The patient is concerned about her repeated ankle sprains and reports that “it has been harder to keep up in gym class.” Her mom reports that she has sprained her right ankle 4 times over the past year. The patient has otherwise been healthy with a normal birth history. Her father suffers from a “nerve disorder where his muscles shrink.” The patient denies any other concerns, pain, weight changes, fever, palpitations, or shortness of breath. Her menses are regular and without pain. A physical examination is unremarkable except for findings shown in Figure A. What is the most likely explanation for this patient’s symptoms?