Examination of the patient with a musculoskeletal tumour

Examination of the patient with a musculoskeletal tumour differs a little from a routine examination of a limb. The aim is to look for findings which support your diagnosis.

When examining a mass, you should consider the following:

  • site
  • size
  • depth (superficial to deep fascia or involving/deep to it)
  • shape and surfaces
  • fluctuance
  • pulsatility
  • tethering of overlying skin
  • draining lymph nodes
Associated features might include:
  • lymphoedema
  • involvement of neurovascular structures
  • signs of malignancy elsewhere (eg abdominal masses)
  • involvement of an adjacent joint
  • other masses elsewhere (eg hereditary multiple exostoses)

Taking a history

Taking a history from a patient with a suspected bone or soft tissue tumour requires a different emphasis from the rest of orthopaedics. Particular features to note include:

  • Length of history (is this a preexisting mass that has changed?)
  • Rate of growth
  • Pain history (site, character, severity, radiation, modifying factors, periodicity – is there mechanical or night pain?)
  • Previous surgery at the site of interest (ie is this a local recurrence?)
  • History of ¬†malignancy (could this be a metastasis?)
  • History of a predisposing condition (eg Hereditary Multiple Exostoses)
  • Previous radiotherapy
  • Family history (think ¬†inherited disorders like Li Fraumeni syndrome)
  • Symptoms suggestive of malignancy (eg weight loss, lethargy)