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A28-year-old man presented to the emergency department with right shoulder pain that radiated to the right arm as well as pain of the right hip and lower back. His medical history is significant for sickle cell disease (SCD) with the HbSS genotype (homozygous for the S globin). He had a hemorrhagic stroke in the setting of venous sinus thrombosis 2 years earlier with no persisting neurologic deficits as well as osteonecrosis of bilateral hips and right knee requiring right total hip arthroplasty and right total knee arthroplasty. His pain started 3 days earlier after he exerted himself performing yard work and had progressively worsened. He described the pain as sharp, throbbing, and 10/10 in severity. The pain did not improve with acetaminophen or oxycodone. He also reported shortness of breath, which had resolved. He did not have fever, chills, chest pain, cough, abdominal pain, diarrhea, or recent trauma. Home …