Author: Basil Ike, DO
Co Author #1: Alexander Sin MD
Co Author #2: Lauren Simon MD, MPH, FAMSSM, FACSM, FAAFP
Senior Editor: Rahul Kapur, MD
Editor: Rachel Sachs, DO

Patient Presentation:
67 year old female presented to her Primary Care Sports Medicine physician via synchronous real-time audio and visual communication with bilateral thigh pain and confusion.

History:
67-year-old female recreational jogger with history of hypothyroidism, presented with a fever of 102.4F, sore throat, and acute onset bilateral thigh pain that worsened over the course of 10 days. Pain was localized in her anterior thighs with referred pain in her lower back, without neck pain or stiffness. According to her spouse, she was not sleeping at night due to worsening thigh pain and appeared very tired with intermittent episodes of confusion. Her spouse initially thought that the thigh pain was from running and treated her conservatively with rest and analgesics at home. However, since thigh pain and episodes of confusion did not improve, she sought medical attention via synchronous real-time audio and visual communication with her Primary Care Sports Medicine physician.

Physical Exam:
Due to COVID-19 pandemic: Virtual visit findings, no vitals were
taken.
HEENT: atraumatic, eyes moist, no proptosis, no visible neck mass
or goiter, no myxedema, no oral lesions, no throat exudate, Neck full flexion
Skin: facial rosacea to nose, pink papules noted on bilateral scapulas and on upper back (photo1)
Back: scapular dysfunction on right, no discoloration or malalignment, tender to self-palpation, muscles spasms on right mid back. Forward flexion within normal limits
Extremities: tender to self-palpation of trochanters; thighs tender to palpation, with no palpable masses or muscle defect,
Neurological: normal gait with heel/toe walking, and tandem walking.
Mental Status: initially confused, then became more lucid as interview progressed.

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