Bone Pain: Or something else? Differential Diagnosis

Blood, blood-forming organs – immune system (D50-D90).

  • Eosinophilic granulomatosis – appearance of granulocytes as a space-occupying mass in bone; occurs in childhood; radiographic characteristic is rapidly progressive osteolysis (bone loss; bone dissolution). The foci are usually without reactive margins in the skull roof, oval in the extremities, where they are located in the diaphyses (bone shaft; the long bones consist of two bone ends (epiphyses) and a bone shaft (diaphysis) – the section between epiphysis and diaphysis is called metaphysis).
  • Coagulation disorders*

Endocrine, nutritional and metabolic disorders (E00-E90).

  • Hyperparathyroidism (parathyroid hyperfunction).
  • Hyperuricemia (elevation of uric acid levels in the blood)/gout.
  • Gaucher’s disease – genetic disease with autosomal recessive inheritance; lipid storage disease due to the defect of the enzyme beta-glucocerebrosidase, which leads to the storage of cerebrosides mainly in the spleen and marrow-containing bones
  • Rickets (synonyms: English disease; juvenile osteomalacia) – disorder of bone metabolism in children in the growth phase, leading to marked demineralization of bone (“bone softening”) and skeletal changes due to retardation of bone growth.

Infectious and parasitic diseases (A00-B99).

  • Brucellosis – bacterial infectious disease usually transmitted to humans from infected animals.

Musculoskeletal system and connective tissue (M00-M99).

  • Arthritis (inflammation of the joints)
  • Coxitis fugax* – non-infectious inflammation of the hip joint with spontaneous healing.
  • Degenerative changes
  • Dermatomyositis – disease belonging to the collagenoses, affecting the skin and muscles and associated mainly with diffuse pain on movement.
  • Disc hernia (herniated disc).
  • Discitis (inflammation of the intervertebral disc)
  • Epiphysiolysis (epiphyseal loosening) – form of bone fracture in children and adolescents.
  • Fibromyalgia – syndrome that can lead to chronic pain (at least 3 months) in several areas of the body.
  • Hereditary hypophosphatemic rickets – skeletal changes caused by a disorder in vitamin D metabolism.
  • Infectious arthropathy* (joint disease).
  • Bone dysplasia (bone malformation) such as Jaffé-Lichtenstein syndrome (form of fibrous dysplasia), McCune-Albright disease, or fibrodysplasia ossificans progressiva
  • Bone metastases (osseous metastases) (likelihood of skeletal metastases).
    • Bronchial carcinoma (lung cancer) (30-50%).
    • Cervical carcinoma (cervical cancer) (rare).
    • Endometrial carcinoma (cancer of the uterus) (rare).
    • Urinary bladder carcinoma (bladder cancer) (30-50%).
    • Testicular carcinoma (testicular cancer)
    • Colon carcinoma (colon cancer) (10-30%)
    • Hepatocellular carcinoma (8%)
    • Mammary carcinoma (breast cancer) (> 50%)
    • Renal cell carcinoma (kidney cancer) (30-50%)
    • Esophageal carcinoma (esophageal cancer).
    • Ovarian cancer (ovarian cancer) (2-8%).
    • Pancreatic carcinoma (cancer of the pancreas) (5-10%)
    • Prostate carcinoma (cancer of the prostate gland) (> 50 %)
    • Thyroid carcinoma ((thyroid cancer) (40%)
  • Bone cyst – cavity in the bone
  • Perthes disease* – aseptic bone necrosis of the caput femoris (femoral head; head of femur).
  • Osteochondrosis – degenerative changes in bone / cartilage.
  • Osteomyelitis* (inflammation of the bone marrow)
  • Osteopetrosis (marble bone disease)
  • Osteoporosis
  • Rheumatoid arthritis*
  • Spondylolisthesis (spondylolisthesis)
  • Growing pains – about one-third of all children between 2 and 12 years of age occasionally suffer from growing pains; they usually occur in the evening or at night (80% of cases); the next morning, the child can move without pain without restrictions
    • Symptoms/complaints:
      • Brief burning, pulling, or throbbing pain in both legs or arms.
      • Can be so painful that children are jolted from sleep
    • Localizations:
      • Front sides of the thighs
      • Backs of knees
      • Shins or calves
      • Pain always occurs on both sides, alternating between both extremities if necessary, and can vary in intensity
      • Joints are not affected
    • Growing pains are rest pains, not exertion pains [Diagnosis of exclusion! Diseases to be clarified include those marked with * ].
    • Complaints are self-limiting
    • Warning signs (red flags) of malignancy (malignant tumor): B symptoms (severe night sweats, unexplained persistent or recurrent (recurrent) fever (> 38 °C); unwanted weight loss (> 10% percent of body weight within 6 months)), back pain as the main localization, palpable mass, bleeding tendency, nonarticular bone pain (bone pain that does not involve a joint); abnormalities in the blood count and smear, LDH ↑
    • Physical examination: no abnormal examination results.
    • Laboratory diagnostics:
      • Small blood count
      • Differential blood count
      • ESR (erythrocyte sedimentation rate)
      • If necessary, also determination of transaminases, alkaline phosphatase (AP), LDH, creatinine.
    • Medical Device Diagnostics:
      • X-ray in two planes
      • Magnetic resonance imaging (MRI) of the affected region.

Neoplasms – tumor diseases (C00-D48)

  • Cervical carcinoma (cervical cancer).
  • Bone marrow carcinosis
  • Bone metastases (see above).
  • Langerhans cell histiocytosis – group of differently progressing systemic diseases that lead to proliferation of Langhans cells.
  • Leukemias (blood cancers) – e.g. acute lymphoblastic leukemia (ALL), acute myeloid leukemia (AML), chronic myeloid leukemia (CML).
  • Mastocytosis – two main forms: cutaneous mastocytosis (skin mastocytosis) and systemic mastocytosis (whole body mastocytosis); clinical picture of cutaneous mastocytosis: Yellowish-brown spots of varying size (urticaria pigmentosa); in systemic mastocytosis, there are also episodic gastrointestinal complaints (gastrointestinal complaints), (nausea (nausea), burning abdominal pain and diarrhea (diarrhea)), ulcer disease, and gastrointestinal bleeding (gastrointestinal bleeding) and malabsorption (disorder of food absorption); In systemic mastocytosis, there is an accumulation of mast cells (cell type that is involved in, among other things, allergic reactions). Among other things, involved in allergic reactions) in the bone marrow, where they are formed, as well as accumulation in the skin, bones, liver, spleen and gastrointestinal tract (GIT; gastrointestinal tract); mastocytosis is not curable; course usually benign (benign) and life expectancy normal; extremely rare degeneration mast cells (= mast cell leukemia (blood cancer)).
  • Non-Hodgkin’s lymphoma (NHL) – under this collective term, all malignant (malignant) diseases of the lymphatic system (malignant lymphomas) are summarized, which are not Hodgkin’s disease.
  • Plasmocytoma (multiple myeloma) – malignant tumor disease from the group of non-Hodgkin’s lymphomas; the origin is, as with all lymphomas, in the lymphoid tissue.
  • Tumors of the bone* , such as:
    • Ewing’s sarcoma – predominantly children and adolescents between the ages of 10 and 18; locations: predominantly humerus (upper arm bone), ribs, femur (thigh bone), and fibula (fibula bone).
    • Osteosarcoma – predominantly adolescents and young adults (60% under 25 years of age); localizations: predominantly metaphyseal in the long tubular bones; metaphyseal means located in the section of bone between the diaphysis (shaft of the bone) and epiphysis (ends of the tubular bone)
    • Osteid osteoma
    • Ossifying osteofibroma

Injuries, poisoning, and certain other sequelae of external causes (S00-T98).

  • Distortion (sprain)
  • Fracture (bone fractures)
  • Bruise
  • Overuse syndromes
  • Trauma (injury)*

Medication