Metastatic Bone Disease Clinical Presentation

Updated: Jan 11, 2018
  • Author: Howard A Chansky, MD; Chief Editor: Harris Gellman, MD  more...
  • Print
Presentation

History and Physical Examination

Although pain is an important symptom of musculoskeletal metastases, it is nonspecific. The pain pattern can be helpful if, in addition to being activity-related, it is present at rest and at night, especially in patients older than 50 years. However, this pain pattern can be present in patients with osteomyelitis and Paget disease, and in these instances, it is also nonspecific.

There are two main scenarios in which an orthopedic surgeon will be consulted to help evaluate a patient with a suspicious bony defect, as follows:

  • In the first instance, the surgeon is asked to help evaluate a patient who has experienced a pathologic fracture or who has a known primary carcinoma as well as a bony defect
  • In the second, more worrisome instance, the surgeon is consulted in the evaluation of a patient whose bony defect was serendipitously found during the radiologic evaluation of another condition

In the above instances, the orthopedist must perform the following three functions:

  • Determine the cause of the bony defect
  • Predict the probability of fracture [17]
  • Prophylactically fix a pathologic or impending fracture

These functions are discussed further in Workup.