The most common presenting complaint is pain and swelling around a joint in an adolescent. A history of trauma is common and may lead to misdiagnosis.
A careful musculoskeletal history and examination should be performed in all children and young adults presenting with pain and/or joint swelling. If a satisfactory cause cannot be identified an xray should be performed.
Any patient, child or adult, who has unexplained pain or swelling around a joint that has persisted for more than six weeks should have an X-ray of the limb performed, including the joints above and below the site of the symptoms.
Plain radiographs are the investigation of choice and are cheap, of negligible risk and discomfort and widely available. More advanced imaging such as CT, MRI and bone scans are important for treatment planning, not diagnosis and can be performed once the patient has reached a specialist centre.
Failure to recognize the possibility of osteosarcoma and refer a patient quickly and appropriately can lead to unnecessary amputation and death.
If an osteosarcoma is suspected the patient should be immediately referred to an orthopaedic surgeon specializing in the treatment of bone tumours at a multidisciplinary treatment centre.
Under no circumstances should a biopsy be attempted as this can compromise future limb salvage surgery and lead to amputation. All biopsies should be performed under the supervision of the surgeon who will perform the definitive surgery.
Under no circumstances should referral be delayed while further investigations beyond a plain radiograph are awaited. Multidisciplinary centres have rapid access to high-quality imaging and further investigations will only cause delay in treatment.
Presentation of Osteosarcoma:
| Symptom/Sign | Frequency |
| Pain | 90% or more
|
| Swelling | 60%
|
| Decreased range of motion | 40%
|
| Pathological fracture | 5 - 10%
|
| Multifocal | Can very occasionally present with aches and pains in multiple bones
|
