Multiple myeloma physical examination

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Hannan Javed, M.D.[2]; Haytham Allaham, M.D. [3]; Shyam Patel [4]

Overview[edit | edit source]

Patients with multiple myeloma usually appear fatigued and lethargic. Physical examination of patients with multiple myeloma is usually remarkable for pallor, purpura, hepatosplenomegaly, bony tenderness, carpal tunnel syndrome, and signs of cord compression. Any of these physical findings may warrant further evaluation, and thus lead to an incidental diagnosis of multiple myeloma.^[1][2]

Physical Examination[edit | edit source]

General appearance[edit | edit source]

• Multiple myeloma patients often appear lethargic and fatigued

Vital Signs[edit | edit source]

• Low-grade fever may be present

Skin[edit | edit source]

• Pallor
• Ecchymoses
• Purpura

HEENT[edit | edit source]

• Lymphadenopathy
• Conjuctival pallor
• Visual defects
• Exudative retinal detachment
• Retinal haemorrhage
• Increased adipose deposition around the neck (if dexamethasone is used for therapy)
• Cotton-wool spots may be present

Abdomen[edit | edit source]

• Hepatomegaly
• Splenomegaly
• Abdominal tenderness (if hypercalcemia is present)

Skeletal[edit | edit source]

• Bony tenderness along cervical, thoracic, and lumbar spine
• Bony tenderness in long bones
• Tinel's sign may be present
• Phalen sign may be present

Neurologic[edit | edit source]

• Dermatomal sensory loss
• Altered sensation
• Neuropathy

Psychiatric[edit | edit source]

• Mood alterations (if hypercalcemia is present)

References[edit | edit source]