Multiple myeloma physical examination

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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 hemorrhage, or cotton-wool spots. 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 sign, or a Phalen sign due to carpel 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
• Macroglossia
• Purpura
• Carpal tunnel syndrome