Analysis of misdiagnosed cases of neck, shoulder, waist and leg pain caused by bone metastases and early warning measures
10.3760/cma.j.cn341190-20210616-00688
- VernacularTitle:骨转移瘤致颈肩腰腿痛误诊病例分析与预警对策
- Author:
Weixing ZHONG
1
;
Zujiang CHEN
;
Yikai LI
Author Information
1. 南方医科大学中医药学院中医骨伤科教研室,广州 510515
- Keywords:
Bone neoplasms;
Neoplasm metastasis;
Neck pain;
Shoulder pain;
Lumbago-leg pain;
X-Rays;
Diagnostic errors;
C-reactive protein;
Blood sedimentation
- From:
Chinese Journal of Primary Medicine and Pharmacy
2023;30(3):371-374
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the cause of misdiagnosis of neck, shoulder, waist, and leg pain caused by bone metastases and to improve the outpatient diagnosis rate.Methods:Five misdiagnosed cases of bone metastases who were admitted to the Traditional Chinese Medicine Department of Orthopedics and Traumatology, School of Traditional Chinese Medicine, Southern Medical University from January 2019 to July 2020 were included in this study. Their clinical manifestations, diagnosis results (outside hospital diagnosis and outpatient diagnosis), and imaging manifestations were retrospectively analyzed.Results:Five cases of bone metastases were misdiagnosed to have cervical spondylosis, lumbar disc herniation, femoral head necrosis, femoral shaft fracture, and ankle sprain. Accelerated red blood cell sedimentation rate and increased C-reactive protein level were found in all five cases. Bone metastases were confirmed by X-ray, CT, and MRI examination results. All of them had warning signs for bone metastasis: age > 50 years, history of a tumor, unexplained weight loss, general malaise, neck, shoulder, waist, and leg pain without an obvious cause, sudden worsening of pain, night pain, resting pain, pain on direct palpation, no obvious improvements in these symptoms after symptomatic treatment for 1 month, disease development not conforming to the general law of cervical spondylosis, lumbar disc herniation, femoral head necrosis, femoral shaft fracture, and ankle sprain, increases in red blood cell sedimentation rate, C-reactive protein, and alkaline phosphatase levels, which are not consistent with the symptoms of cervical spondylosis, lumbar disc herniation, femoral head necrosis, femoral shaft fracture, and ankle sprain, and slight external force leading to fractures.Conclusion:Further tests and imaging examinations should be performed according to warning signs. Clinical schemes of malignant bone tumors suitable for general practitioners can easily, economically, and effectively identify malignant bone tumors.
