Multiple myeloma physical examination

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Multiple myeloma affects not only the bone marrow, but also spreads to other organ systems. This therefore, requires a detailed assessment of various organ systems. A number of times, any of these physical findings may warrant a further evaluation, and thus leads to an incidental diagnosis of multiple myeloma. Pallor, purpura, signs of cord compression, hepatosplenomegaly, bony pain without tenderness and carpal tunnel syndrome are some of the most common physical findings, in a patient presenting with multiple myeloma.

Physical Examination

Head, ears, eyes, nose, and throat (HEENT) examination: Pallor is one of the most evident physical findings associated with multiple myeloma. Additionally eyes may show exudative macular detachment, retinal haemorrhage, or cotton-wool spots.

Skin: Ecchymoses or purpura from thrombocytopenia may be evident.

Central nervous system: It includes altered sensations, dermatomal sensory loss resulting from cord compression and neuropathy, myopathy, a Tinel's sign, or a Phalen sign due to carpal tunnel compression secondary to amyloid deposition.

Gastrointestinal system: Hepatosplenomegaly

Cardiovascular system: Cardiomyopathy from plasma protein deposition.

Bony and muscular system: Pain without tenderness is a feature highly specific for multiple myeloma, though not diagnostic. Pathological fractures are also pretty common.

Extramedullary plasmacytomas, which consist of soft-tissue masses of plasma cells, are not uncommon.

Amyloidosis may develop in some patients with MM. The characteristic physical examination findings that suggest amyloidosis include the following:

• Shoulder pad sign - Fat deposition around shoulders.
• Macroglossia
• Purpura
• Carpal tunnel syndrome

References

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