Aches & Joints

Wednesday, September 17, 2008

Lumps & Bumps

Things to consider when you notice a lump on your body

Over the course of a day, we all poke, rub, and scratch.  Usually it’s an itch or a sore.  Occasionally we notice a lump!  What should we do?  Rightly, some of us will worry about it and cannot rest until we find out what the lump is.  Others will completely ignore it.

Fortunately, the vast majority of lumps and bumps are benign (see box at end) and do not threaten our lives.  But some can be dangerous and require immediate medical attention.  So which lumps should we worry about?  Which lumps and bumps require a doctor’s care, and which ones can be ignored?

We usually discover lumps and bumps about our hands and feet earlier than if they were in our thighs or buttocks, for example.  Our hands and feet don’t have as much soft tissue around them, making it easier to notice even small lumps.  Our buttocks, thighs and even the upper arms can hide quite a large mass before we notice.

Feel the size of the lump carefully. Small tumors less than 2 cms are more likely to be benign.  Is the lump painful?  Benign soft tissue tumors tend to be painless.  Does the lump move about as you press on it?  A tumor that is not fixed in one place is not growing into adjacent bone or organs.  Such mobile tumors are less likely to be dangerous.  An important characteristic of a tumor is whether or not it is growing.  Measure the size of the mass with a measuring tape and record its size.

A 2 cm lump would be considered a small tumor.  However, if the tumor expanded from 1 cm to 2 cms in 2 weeks, then the tumor is growing relatively quickly and should not be ignored.

Magnetic Resonance Image (MRI) of a thigh, identifying a lipoma - a benign fat tumor, adjacent to the thigh bone.

Patients should contact their primary care physician regarding any newly discovered lumps.  In the meantime, perform a thorough self-exam of the rest of your body (including the hands and feet).  Look for other lumps or bumps, or areas of skin pigmentation that are new.  Make sure to look at the soles of your feet and the palms of your hands.

The doctor may order an MRI (magnetic resonance imaging) exam, possibly with the use of a contrast agent.  A surgeon can use the MRI information to decide whether the tumor can simply be removed, or if it requires additional tests.

If the lump is greater than 5 cms, painful, or is growing, the doctor may recommend a biopsy. During a biopsy, a small portion of the lump is removed with a needle and analyzed by an experienced pathologist to determine if the lump is benign or malignant.  Malignant lumps can be life threatening (see box) and often require sophisticated care and complex surgical excisions.

“It’s never a waste of a doctor’s time to have a lump or bump evaluated,” states Dr Kevin Raskin, Assistant Professor at Harvard Medical School and Tumor Surgeon at the Massachusetts General Hospital, Boston, MA.  A physician should evaluate new lumps and bumps, those that have changed over time, or are causing symptoms. “The over-arching theme is ‘don’t be shy.’ Bring up even the smallest worry with your doctor.  An ounce of prevention is worth a pound of cure, and peace of mind is priceless,” advises Dr Raskin.

Benign: (beh-NINE); mild, gentle and non-threatening;
Tumors that generally do not threaten the life of the patient.  They very rarely spread to other areas of the body, and often do not need to be treated unless they are bothersome to the patient.

Malignant: (muh-LIG-nunt); tending to spread and infiltrate;
Tumors that may threaten a patient’s life.  They often spread to distant organs including lymph nodes and lungs.  These need to be treated by experienced physicians.

Monday, August 04, 2008

Yoga For Arthritis

Yoga can provide immense physical benefits for women with arthritis.

For arthritis patients, aerobic exercises, muscle conditioning and increased physical activity can keep you strong and agile, improve heart fitness and reduce your weight.  Yoga provides an effective alternative to the traditional strengthening and aerobic exercises, and offers other benefits as well.
While yoga may bring visions of complex body contortions, most yoga classes provide simple, gentle movements that gradually build muscular strength, promote balance and improve flexibility.  Its meditative nature soothes and relaxes the mind, and is associated with increased mental alertness and enthusiasm.  Scientific studies have shown that practicing yoga is a safe and effective way to increase physical activity, which is strongly recommended for arthritis patients.  Yoga does not increase pain or worsen arthritis.

Patients should take some simple precautions while performing yoga or other exercise regimens.  Share your limitations with the instructor.  A good yoga teacher will provide alternatives and modifications to all activities, so that you can work within your level of comfort.
Patients with poor flexibility may benefit the most from a yoga practice.  Instructors may provide an array of mats and blocks to make poses easier.  Additionally, some yoga can be performed while sitting in an office chair.

Start with simple poses and see if your muscles are sore after a day or two.  Then gradually increase the intensity of the poses.  Always listen to your body and recognize your limitations.  Yoga is not competitive; do not be swayed by others who have better form.  Some yoga poses do require extreme flexibility, strength, and balance, but these are not for beginners or arthritis patients and best left to experienced yogis.

Done patiently and carefully, a regular yoga practice can provide immense physical and psychological benefits, which may be especially helpful for arthritis patients.

Tuesday, May 13, 2008

Men are from Mars and Women get Arthritis

Biochemistry, Anatomy and Lifestyle Explain Why more Women Suffer from Arthritis.

Titles in bookstores remind us that women think, behave and feel differently than men.  Even in health, diseases in women manifest and progress uniquely, and the effectiveness of medications varies.  Scientific research informs us that women are also more vulnerable to arthritis.  Such differences may be due to hormonal, genetic, biomechanical, and lifestyle differences between genders, contributing to disparities in men and women’s treatments.  Understanding these gender-specific differences will help us treat women’s arthritis more effectively.

Wednesday, April 23, 2008

Sprains and Strains

Sprains and Strains
Sprains and strains are a result of minor trauma to muscles, ligaments, and/or tendons.  These are recognized by pain, immediate swelling in the area, and may be accompanied by discoloration of the site.

Difference between Sprains and Strains
A sprain is a stretching or tearing injury to one or more ligaments.  The severity depends upon the extent of injury or tear in the ligament.  Is it partially or completely torn?  How many ligaments are involved?  Are other soft tissues around the site injured?  The most frequently sprained ligaments are in the ankles, knees and wrists.

A strain is an injury to either a muscle or a tendon caused by overuse, force, or stretching.  Depending on the severity of the injury, a strain may be a simple over-stretch of the muscle or tendon, or it can result in a partial or complete tear.

Two common sites for strains are the back and the hamstring (muscle located in the back of the thigh).  Contact sports such as soccer, football, hockey, boxing, and wrestling, put people at a higher risk for strains.  Long distance runners experience strains in multiple muscles in their legs.  Tennis, rowing, golf, and other sports that require extensive gripping can increase the risk of hand and forearm strains.  Elbow strains can occur in people who participate in racquet sports, throwing, and contact sports. 

Wednesday, April 16, 2008

Repetitive Strain Injury

Repetitive Strain Injury or RSI describes a group of conditions associated with overuse of soft tissues such as muscles, tendons and nerves.  RSI causing pain can affect the upper back, arms, hands, wrists, or fingers.  Continuous and prolonged use of a computer keyboard, strumming a guitar, or wielding tools on an assembly line, have all been associated with RSI.

Wednesday, November 21, 2007

Stretching Calf Muscles - A Heel Drop

The Heel Drop is another great exercise to stretch the calf muscles, the Achilles tendon, as well as the fascia under the heel.  You can do this where ever you see a set of stairs.  And it only takes a couple of minutes.

Tuesday, October 02, 2007

Toe Extension

For most of the day, our feet are bound within stiff shoes and many of the soft tissues within the feet are infrequently used.  This is a simple yet very effective exercise to stretch the heel, the plantar fascia and the toes.

If you have heel pain, perform this stretch as you wakeup and place your feet on the floor.  This can also be performed while sitting in the office or on the couch.

Tuesday, September 25, 2007

Heel and Achilles Tendon Stretch

A warm-up exercise to perform before running or participating in sports.  This stretches the Achilles tendon as well as calf muscles.  If you have heel pain (plantar fasciitis), this stretch may help alleviate the pain.  You don’t need to go to a health club or gym to do this exercise, it can be performed while sitting in your office or waiting in the coffee line, or even during a walk in the park. 

Heel and Achilles Tendon Stretch

Tuesday, September 11, 2007

Treating Heel Pain or Plantar Fasciitis

What you can do to reduce heel pain.

Heel Pain Can Be Debilitating: 
“Getting out of bed each morning was painful,” recalls a patient of her yearlong experience with heel pain.  “As I place my foot on the floor, I could feel a sharp pain in my heel and could only shuffle about the room.  It would loosen up after a few minutes, but my foot would continue to hurt as I went through the day.”

Heel pain with the first steps getting out of bed in the morning, or when standing from a seated position, are the most characteristic symptoms of plantar fasciitis (fashee-eye-tiss).  Pain can also occur with prolonged standing and walking.  The sharp pain is usually on the bottom inside part of the heel.  While it most often occurs in only one foot, it can affect both feet.

Plantar Fasciitis Causes Heel Pain:
The plantar fascia is a tough, fibrous tissue band running under the soles of your feet, and connects the heel bone (calcaneus) to the base of the toes.  It also helps support the arch of the foot in its role as a shock absorber.  An injury or continuous irritation of this tissue causes plantar fasciitis and the resulting heel pain.

Multiple factors likely cause plantar fasciitis.  It tends to affect people between 40 and 70 years of age, more likely in women, people who are overweight, or have jobs that require a lot of walking or standing on hard surfaces.  Runners may be at a higher risk.  People with flat feet or high arches are also more prone to plantar fasciitis.

Monday, July 16, 2007

What should I do for back pain?

Question: Since shoveling snow two weeks ago, I have constant low back pain.  What should I do for the pain?

Monday, July 09, 2007

FDA Panel Approves Artificial Cervical Intervertebral Disc

A key Advisory Panel of the Food and Drug Administration (FDA) has recommend approval for an artificial cervical intervertebral disc device.  The panel’s recommendations were based on results of limited clinical trials and the FDA is likely to approve the device for use in patients.

Monday, June 25, 2007

Minimally Invasive Surgery (MIS) of the Hip: Does Length of Scar Matter?

If you are a candidate for a total hip replacement (THR), then you likely have severe osteoarthritis, rheumatoid arthritis, or avascular necrosis.  The primary goal of THR is to predictably relieve pain, and to restore hip function, thus allowing you to go about your activities of daily living.

Minimally Invasive Surgery (MIS) is a series of a new approaches to performing THR.  In this feature article, the advantages and disadvantages of MIS are discussed.

Monday, June 11, 2007

Knee Exercises: Stationary Lunge

Continuing on exercises to strengthen the knees, certified trainer, Janet Livingston from the Clubs at Charles River Park, demonstrates the Stationary Lunge, which you can perform at home or in the office.

This exercise is more challenging, so please do it slowly and carefully

Stationary Lunge

Tuesday, May 22, 2007

Knee Exercises: Chair Squats

If you have arthritis, strengthening surrounding muscles can control movements of the knee, unload the knee joint and reduce pain.  Here, our Certified Trainer Janet Livingston from the Clubs at Charles River Park, demonstrates an exercise that you can perform at home to strengthen your knees and ultimately move in a pain-free manner.

Chair Squats

Monday, May 21, 2007

Precautions to Take Before Starting New Exercises

Speak to your doctor before starting new exercises.  Your doctor may recommend other exercises and additional stretches.  Physical therapists can also tailor an exercise regime for your particular condition.

Start all new exercises slowly at first.  Expect to feel some fatigue in the muscles you are working, but you do not want to feel pain in the affected joint.  Listen to your body.  It will tell you if you are doing too much or if an exercise is inappropriate for you.  The goal is to work the muscles, but be pain free while doing the exercises.

If you see swelling or are in persistent pain, immediately stop the exercises and consult your doctor. 

Walking is one of the best exercises.  It does not require any special skills, equipment and can be done anywhere at your leisure.  Make your walks interesting by picking different routes or bringing along a friend.  And it soothes the mind too.