Multiple myeloma physical examination
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
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 hemorrhage, 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 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 - Fat deposition around shoulders.
- Macroglossia
- Purpura
- Carpal tunnel syndrome
References