Bone Tumors: Examination

A comprehensive clinical examination is the basis for selecting further diagnostic steps:

  • General physical examination – including blood pressure, pulse, body temperature, body weight, body height; furthermore:
    • Inspection (viewing).
      • Skin and mucous membranes [broad ulcerated (“ulcerated”) nodule in cutis (skin) and subcutis (subcutaneous) (palpable) (usually painless/poor)?]
      • Mouth, teeth [due todifferential diagnosis: reparative giant cell granuloma (slow-growing lesion leading to painless distention of bone with tooth displacement and loosening)]
      • Neck
      • Extremities:
        • [Swelling? may be reddish or bluish in color; size; consistency; displaceability of skin from underlying surface.
        • Deformities of joints and bones?
        • Numbness and paresis (paralysis)? can be expressed in the form of sensory deficits, bladder or rectal dysfunction to paraplegia]
      • Spine, thorax (chest).
      • Gait pattern (fluid, limping)
      • Body or joint posture (upright, bent, gentle posture).
      • Malpositions (deformities, contractures, shortenings).
      • Joint (swelling (tumor), redness (rubor), hyperthermia (calor); injury indications such as hematoma formation, leg axis assessment)]
    • Measurement of joint mobility and range of motion of the joint (according to the neutral zero method: the range of motion is expressed as the maximum displacement of the joint from the neutral position in angular degrees, where the neutral position is designated as 0°. The starting position is the “neutral position”: the person stands upright with the arms hanging down and relaxed, the thumbs pointing forward and the feet parallel. The adjacent angles are defined as the zero position. Standard is that the value away from the body is given first). Comparative measurements with the contralateral joint (side comparison) can reveal even small lateral differences.
    • If necessary, special functional tests (differential diagnostic e.g. meniscus test).
    • Assessment of blood flow, motor function and sensitivity:
      • Circulation (palpation of pulses).
      • Motor function: testing of gross strength in a lateral comparison.
      • Sensibility (neurological examination)
    • Auscultation (listening) of the heart.
    • Auscultation of the lungs
    • Palpation (palpation) of the painful area [pressure pain, pain on movement, pain at rest?]
    • Palpation of the abdomen (belly), etc.
  • ENT examination[due todifferential diagnoses:
    • Maxillary sinus empyema – accumulation of pus in the maxillary sinuses.
    • Maxillary sinus mycosis
    • Jaw cysts
    • Ostitis fibrosa – painless distension of the forehead and maxilla (upper jaw bone).
    • Pneumosinus dilatans (rare) – dilatation (dilation) of the paranasal sinuses due to impaired valve mechanism.
    • Sinusitis (sinusitis)]
  • If necessary, neurological examination[due topossible secondary disease:
    • Paresis (paralysis) of varying degrees of non-traumatic genesis]
  • If necessary, orthopedic examination [due todifferential diagnoses:
    • Aneurysmal bone cyst – aggressive, expansive growing cyst.
    • Brodie abscess – form of hematogenous osteomyelitis (acute or chronic inflammation of bone and bone marrow) in childhood; pressure-painful swelling, often in the tibia (shinbone) area
    • Fibrodysplasia ossificans progressiva (FOP; synonyms: Fibrodysplasia ossificans multiplex progressiva, Myositis ossificans progressiva, Münchmeyer syndrome) – genetic disease with autosomal dominant inheritance; describes the pathological, progressive ossification (ossification) of the connective and supporting tissues of the human body, which leads to an ossification of the muscles; already at birth are present as a non-specific symptom shortened and twisted big toes.
    • Fibrous dysplasia – malformation of bone tissue, that is, the bones form tumor-like protrusions.
    • Ischemic bone necrosis (“bone infarction”) – demise of bone tissue.
    • Bone abscess
    • Paget’s disease (osteodystrophia deformans) – bone disease that results in bone remodeling and gradual thickening of several bones, usually the spine, pelvis, extremities or skull.
    • Ossification (ossification) after fractures (bone fractures).
    • Osteochondrosis dissecans – circumscribed aseptic bone necrosis below the articular cartilage, which may end with the rejection of the affected bone area with the overlying cartilage as a free joint body (joint mouse)
    • Osteomyelitis – acute or chronic inflammation of the bone and bone marrow, usually due to bacterial infection; combination of osteitis and myelitis (bone marrow/spinal cord).
    • Osteopoikilosis (synonyms: osteopathia condensans disseminata, osteopoikilia; “stippled bone”) – multiple, small, round or oval foci of bony sclerosis; localized in metaphyseal-epiphyseal region of long bones, among others; may simulate osteoblastic bone metastases in breast carcinoma
    • Ostitis (synonym: osteitis) – inflammation of bone tissue.
    • Stress fracture
    • Injuries/Sports Injuries]

    [due topossible secondary diseases:

    • Bursitis (bursitis) in the affected area.
    • Chronic pain
    • Limited mobility
    • Incorrect load and joint misalignment, postural deformities (caused by the pain → avoidance behavior).
    • Joint malpositions
    • Short stature (too small body size for the age)
    • Pathological fracture (bone fracture) (spontaneous fracture due to pathological (pathological) processes in the bone).
    • Oblique growth
    • Asymmetrical growth in length of arms or legs – due to displacement or destruction of growth plates, caused by the spread of osteochondroma.
    • When osteoblastoma is localized near joints or growth plates:
  • Health check

Square brackets [ ] indicate possible pathological (pathological) physical findings.