Brief Answer: See Below Detailed Answer: Hi and thank you so much for this query. I am so sorry to hear about all these symptoms that your child has experienced. We shall take a close look to them below and make recommendations based on our best understanding. 1. Given the nature of the various activities he has carried out over all this time, it is understandable why the parts he uses most to execute these tasks like hands/shoulders/etc are being reported. They clearly fit the perfect description of this condition which get worse towards the end of the day and generally less in the early hours of the morning. This is caused by repeated use of these muscles and nothing else. Rest and some pain medications should be able to get this controlled. 2. A single elevated blood pressure should not cause panic. However repeated and sustained elevated blood pressure values warrant medical attention. Also, the conditions under which blood pressure should be measured must be respected. A person who has difficulties sleeping, is in pain, etc clearly does not satisfy the required conditions. I will recommend that he gets it controlled when he is in a more relaxed state. If it should be persistently high, then he should seek further medical attention to make sure there is nothing wrong going on. Hypertension at his age of 21 is very unlikely unless there is a clear cause to this. For now, there is no reason to rush to the emergency unit. Even values of 178 do not require a visit to the ER. Do you have any family history of heart disease and cholesterol problems? I will like these cholesterol values to be measured and the lipid profile break down done before mentioning drugs. Also, lifestyle measures should be tried and showed not to be of any great help that can justify drugs for cholesterol. In all, get his blood pressure controlled again and the lipid profile re-assessed. Also pain medications and rest would help him with the overuse musculo-skeletal pains. I hope you find the above information helpful. I wish him well. Thank you so much for using our services and please feel free to request for clarifications and more information if need be. Dr. Ditah, MD.

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Brief Answer: Thanks for the follow up precision. Detailed Answer: Hi and thanks for following up with these precisions. They are very much appreciated. For the blood pressure information, it remains valid about your child. There is no emergency right now but follow up visits to control it should be considered. If anything abnormal should come up, it would be addressed accordingly. The cholesterol numbers need to be checked before I will consider getting him treated for this or not. A single value with no follow ups is not convincing enough for me to go aggressive. The information about the sore hands shoulder and skin also remains valid. There is no big change. Get some good pain medications and some rest to help recover from this. I wish you well.I hope you find this information useful. thank you so much for using our services and feel free to request for more information if needed. Thanks. Dr. Ditah, MD.

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