Multiple myeloma physical examination

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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

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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

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### General appearance

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* Multiple myeloma patients often appear lethargic and fatigued

### Vital Signs

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* Low-grade fever may be present

### Skin

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* Pallor
* Ecchymoses
* Purpura

### HEENT

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* 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

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

### Skeletal

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* 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

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* Dermatomal sensory loss
* Altered sensation
* Neuropathy

### Psychiatric

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* Mood alterations (if hypercalcemia is present)

## References

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1. ↑ Multiple myeloma. Wikipedia (2015) https://en.wikipedia.org/wiki/Multiple_myeloma#Signs_and_symptoms Accessed on September, 20th 2015
2. ↑ Multiple myeloma. Canadian Cancer Society (2015) http://www.cancer.ca/en/cancer-information/cancer-type/multiple-myeloma/signs-and-symptoms/?region=mb Accessed on September 20th 2015