290. System Interactions

A 68-year-old patient with a history of hyperlipidemia reports new bilateral thigh soreness and weakness that began gradually over the past month. She denies any recent increase in activity, and the pain is present at rest and unchanged by stretching or light movement. On examination, the clinician notes mild proximal muscle weakness without swelling or warmth. Which of the following sources of pain is MOST consistent with this presentation?

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