I am seeing a 24 year old woman who is highly active, does multiple sports and has a labor intensive job 6 days a week. She has left shoulder pain centered around the rhomboids/middle trap, that causes restriction on left cervical rotation (about 60 degrees) and shoulder flexion (only when scapula is retracted/engaged, when not it can go all the way up but when it is it only goes to 90). She says it feels elevated compared to right side but I can’t really see it (could just be me though).

The weird thing is that when it hurts, it refers down into a sciatic pain distribution, going all the way down the left leg to around mid thigh. Also her R big toe gets numb ???!

EXSTORE: upper body no inhibitions, though should I use more force on someone athletic? Lower body I could only find left TFL and anterior gluteus medius. Some pain on external rotation of left hip.

She’s had multiple falls (skiing, equestrian).

She gets chronic cold hands and feet and sweats constantly, actually sweats more profusely when she’s cold. Factor X blood deficiency. I feel like these might point at chronic systemic, but the acute nature of these spikes from shoulder to thigh puzzles me, and she is otherwise very functional at a high level.

Any thoughts?