A 12-year-old African-American boy is brought to the office by his mother for a well-child checkup. The patient and his mother both state that the patient has been otherwise well except for occasional mild pain and stiffness in the upper back. Symptoms began gradually about a year ago and are present intermittently. The pain and stiffness do not bother him significantly or limit his activities, and they have never awakened him from sleep. He denies any trauma or overuse. He is not currently playing any organized sports although he is able to be normally active with friends and siblings.