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.

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.

Cartilage is the tough, slippery tissue covering the ends of long bones. As we move our bodies and go about daily activities, healthy cartilage permits bones to smoothly and painlessly glide over each other.

In patients with arthritis, particularly osteoarthritis (AH-stee-oh-ar-THREYE-tis), the cartilage is worn away, causing the underlying bones to grind against each other, driving the pain.

In the very common knee osteoarthritis, walking can be very painful, and attended by swelling and stiffness.  Arthritis also affects hips, hands, shoulders and spine.  Cartilage breakdown can be due to normal wear and tear brought on by aging, or due to a previous injury to the joint.

Arthritis is widespread among U.S. adults and is the second most common diagnosis after chronic heart disease.  The United States Center for Disease Control (CDC) reports that 46 million adults in the United States, representing 21% of the adult population, have arthritis (just over 1 in 5 adults).  As the population ages, arthritis is expected to affect an estimated 67 million adults in the U.S. by 2030.  Arthritis affects all races, and its risk increases with age.  Compared to men, women bear a higher burden with 61% of all arthritis cases.

Osteoarthritis makes up more than half of all arthritis cases.  Other forms include rheumatoid arthritis and gout.  Not only do more women have arthritis, women are also more likely to suffer limitations in their day-to-day living, including difficulty climbing stairs, sleeping and walking.

Projected Prevalence of Arthritis in Women (pink) and Men (blue); From: Hootman & Helmick, Arthritis & Rheum (2006).


Women have Distinct Biochemical Profiles
Research indicates that hormonal differences may be one reason why women’s joints are susceptible to injury.  Estrogen (es-tro-jen) is a key hormone, which makes women, women.  Among other functions, estrogen protects cartilage in joints and increases production of its two important building blocks: collagen (KAHL-uh-jen) and proteoglycans (PRO-tee-uh-GLY-kanz).  After menopause, there is a steep drop-off in a woman’s protective estrogen level, leaving joints deprived of these strengthening molecules.  Day-to-day stress on the knee, along with repeated bumps and bruises can now make joints prone to long-term damage and osteoarthritis.

Growth factors promote tissue regrowth and are important in repairing the damage that occurs from daily activities.  Scientific research indicates that levels of growth factors are significantly decreased in women with severe osteoarthritis.  Women thus have a lower ability to repair soft tissue damage and end up with more severe cartilage damage.

Women Get More Knee Injuries
Researchers suggest that during athletic activities, women tend to favor their quadriceps muscles in the front of the thigh to stabilize the knee, instead of the stronger hamstring and gluteal muscles that support the back of the thigh.  Especially during strenuous activities, this over reliance on the quadriceps, strains knee ligaments (fibrous bands connecting bones) leaving them more vulnerable to injury and tearing.  Not surprisingly, compared to male athletes, female athletes are at a two to ten times greater risk of injuring their anterior cruciate ligament (ACL) - an important tissue band that controls knee joint motion.  With a torn ACL, the knee can become unstable during day-to-day activities and lead to a higher risk of osteoarthritis.

Anatomic Differences May Lead to Arthritis
Anatomical differences in women’s hips and knees may also explain the increased severity of osteoarthritis in women.  Women tend to have wider hips, so the femur (thighbone) reaches the knee at a larger angle (called the Q-angle) than in men (see x-ray above).  Thus parts of the quadriceps muscles, which extend the knee, tend to pull the kneecap away from the centerline of the body, leading to eccentric wear of the kneecap and pain during climbing stairs.

There are other bone-related differences in women.  For example, the femur is narrower and the kneecap (patella) is thinner in women, and more prone to cartilage wear and tear.

Delaying the Effects of Arthritis
There are a number of safe and effective ways to prevent or delay the impact of arthritis.  These consist of improving joint flexibility with exercises such as yoga or Pilates, increasing physical exercise and losing excess weight.  These have been shown to decrease arthritis pain and lessen associated disability.  Medical treatment of osteoarthritis typically includes over-the-counter pain medications and muscle strengthening exercises.  Dietary supplements may also be effective.  If arthritis continues to be disabling, the last option is a surgical replacement of the joint.

Although women and men’s knees differ significantly, few treatments take such differences into account.  As we continue to learn about the effect of specific hormones and anatomy on women’s arthritis, more targeted therapies can be used to improve the lives and alleviate the symptoms of our mothers, spouses and daughters.

Selected Resources on the Web:

• Arthritis at the Center for Disease Control
• Arthritis.org
• Osteoarthritis at the National Institutes of Health

• Look for a set of stairs with railings.
• Hold on to the railings for support.
• Place the ball of your left foot on the edge of a step.
• Place entire right foot on the step above for stability.
• Gradually let the heel of your left foot drop while keeping your leg straight.
• Feel the stretch in the sole of your left foot, Achilles tendon and calf muscles.
• Hold this position for 30 seconds.
• Repeat the stretch three to five times for each leg.

Demonstrated by Meg Vitter of Boston, MA.

Also read:
Treating Heel Pain or Plantar Fasciitis;
Heel and Achilles Tendon Stretch;
Toe Extension;
Precautions to take before starting new exercises

See other exercises at Aches & Joints

Response: Low back pain is one of the most common reasons for patients seeking medical advice.  Most patients can find relief by using simple remedies at home.

Rest:  During the initial phase, bed rest may relieve the pain, but should be limited to one or two days.

Medication: Over the counter medications such as ibuprofen (Motrin, etc) or naproxyn (Aleve, etc.) reduce the inflammation and relieve pain.

Talk to your primary care physician if the pain persists despite these measures.  They may initially recommend –
Physical Therapy:  A physical therapist often uses various techniques to decrease inflammation and will walk you through an exercise regimen to improve muscle strength and mobility.  Patients can continue to perform these exercises as part of a home-based program to maintain these benefits over time.

Improvements in Posture:  A simple tip to remember for the next time you are shoveling or lifting a heavy package is to use proper lifting techniques emphasizing the thigh and leg muscles, and not the back.

Healthy spinal discs are soft but tough shock absorbers that separate each vertebral body making up the spine.  Discs allow the spine to bend and twist.  As we age, discs begin to dry out and lose their ability to absorb shocks, resulting in their bulging.  This can put pressure on the spinal cord and nerves, leading to neck or arm pain. 

In current surgical practice, the degenerated disc is removed and adjacent vertebrae are fused together with a metal plate, aiming to lessen the pain.  But it also prevents natural movement of the spine, putting additional stresses on the adjacent (healthy) non-fused discs, quickening their breakdown and possibly leading to additional surgery.

The new artificial discs will be placed between the two vertebral bodies after the affected disc has been removed.  Ideally, the artificial disc acts much like a human disk, providing flexible motion while acting as a shock absorber in the spine.

As part of the approval, the FDA panel has also insisted that the manufacturer Medtronic Sofamor Danek, Minneapolis, MN, conduct additional clinical studies to determine the long term durability of this device.  This process will provide an early warning of complications and unexpected problems in a larger patient population.

“Surgeons here at the Orthopaedic Spine Center at MGH will be involved in the use and study of artificial cervical discs in the months to come,” reports Dr Kirkham Wood MD, Chief of the Orthopaedic Spine Service at MGH, and Assistant Professor of Orthopaedic Surgery at Harvard Medical School.

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

Stationary Lunge

• Take a step forward.  Make sure that your hips are facing forward and the back foot is straight and facing forward as well.
• Start to bend both knees to lower the front thigh until it is parallel to the floor. 
• Make sure your front knee is in line with the ankle.  The knee of your back leg should be nearly touching the floor.
• Push through the front heel and return to the starting position.
• Stand next to a wall if you need to balance yourself.  If your knee hurts, pull back.
• Do three sets of 10 each.

See also, Chair Squats in the previous entry.
Please read these Precautions to Take Before Starting New Exercises

Chair Squats

• Use a kitchen or dining room chair.  Chairs with a cushion or a couch will be too difficult to get in and out of.
• Stand in front of the chair with your feet parallel and shoulder distance apart.
• Extend arms in front and level with the shoulders.
• Start by slowing bending at the hips and lower down to sit on the chair.
• Then, push through heels to lift the body to the standing position.
• Do three sets of 10 each.

See also, Stationary Lunge in the next entry.
Please read these Precautions to Take Before Starting New Exercises