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69: TUMOR, BONE

Eric Shamus, PhD, DPT, PT, CSCS; Stephanie N. Wright, MOT, OTR/L

CONDITION/DISORDER SYNONYMS

  • Chondrosarcoma

  • Ewing (or Ewing’s) sarcoma

  • Osteosarcoma

ICD-9-CM CODES

  • 170 Malignant neoplasm of bone and articular cartilage

  • 170.0 Malignant neoplasm of bones of skull and face except mandible

  • 170.1 Malignant neoplasm of mandible

  • 170.2 Malignant neoplasm of vertebral column excluding sacrum and coccyx

  • 170.3 Malignant neoplasm of ribs sternum and clavicle

  • 170.4 Malignant neoplasm of scapula and long bones of upper limb

  • 170.5 Malignant neoplasm of short bones of upper limb

  • 170.6 Malignant neoplasm of pelvic bones sacrum and coccyx

  • 170.7 Malignant neoplasm of long bones of lower limb

  • 170.8 Malignant neoplasm of short bones of lower limb

  • 170.9 Malignant neoplasm of bone and articular cartilage site unspecified

ICD-10-CM CODES

  • C40.00 Malignant neoplasm of scapula and long bones of unspecified upper limb

  • C40.10 Malignant neoplasm of short bones of unspecified upper limb

  • C40.20 Malignant neoplasm of long bones of unspecified lower limb

  • C40.30 Malignant neoplasm of short bones of unspecified lower limb

  • C41.0 Malignant neoplasm of bones of skull and face

  • C41.1 Malignant neoplasm of mandible

  • C41.2 Malignant neoplasm of vertebral column

  • C41.3 Malignant neoplasm of ribs, sternum and clavicle

  • C41.4 Malignant neoplasm of pelvic bones, sacrum and coccyx

  • C41.9 Malignant neoplasm of bone and articular cartilage, unspecified

PREFERRED PRACTICE PATTERNS

  • 4E: Impaired Joint Mobility, Motor Function, Muscle Performance, and Range of Motion Associated With Localized Inflammation1

  • 6B: Impaired Aerobic Capacity/Endurance Associated With Deconditioning2

FIGURE 69-1

AP view of the distal femur. Many of the radiographic features of this osteosarcoma mark it as a malignant tumor. The abnormal area of mottled lucent and sclerotic tumor in the metaphysis fades gradually into the shadows of surrounding normal bone. It is difficult to see where the tumor begins and ends; there is a large soft tissue mass adjacent to the bone (M). The periosteum has been unable to maintain a shell of mineralized new bone around this mass. The sclerotic areas within the bone and the mineralized portions of the soft tissue mass both have a relatively amorphous, smudged appearance that is seen with calcified osteoid matrix. (From Chen MYM, Pope TL, Ott DJ. Basic Radiology. 2nd ed. www.accessmedicine.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)

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PATIENT PRESENTATION

A 21-year-old female began noticing severe low back pain after working out at her local gym. After a week of back rest, the pain continued and she made an appointment with her primary care physician who provided anti-inflammatory medications and continued back rest. The patient reports the symptoms continued and she began to notice additional pain and a lump on her right scapula.

After a PET scan, CT and MRI she was diagnosed with Ewing sarcoma and has received five rounds of chemotherapy, radiation to right scapula, left distal ...

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