What’s the cause of the painless lump in my thigh?

Dr Flo,

I have had a painless lump on my thigh for quite some time.

Several weeks ago I went to hospital for a different reason, and I mentioned it to the doctor. After looking at it, he told me it had some fat tissue in it,  but that it’s not dangerous.

What causes such lumps to form? Will it go away if I lose weight? What can be done to get rid of it?

Patrick

Dear Patrick,

What you are describing is called a lipoma. It is a growth of fat cells located just below the skin. It may be found anywhere in the body, but is most common on the arms, thighs, neck and armpits.

The lump usually grows slowly, and is painless. It does not normally grow beyond five centimetres, though some people have quite large lumps. It usually moves under the skin, and it feels soft and rubbery, and may feel like it is slipping from your fingers. There is no known cause for developing lipomas. In some people, it may grow at the site of a minor injury.

It also seems to run in families i.e. if you have one, there is a likelihood that you also have a family member who has one. The growth of a lipoma has nothing to do with your weight or cholesterol levels, and losing weight will not get rid of the lump.

It is diagnosed by examining it, but for confirmation, the doctor may ask for an ultrasound scan and an aspirate test for the cells in the lump to be examined.

The lump is not cancerous and usually does not require treatment. It can be removed if it becomes painful, becomes infected, if it is growing very fast, or if you request for it to be removed. The only way to remove it is through minor surgery if the lump is just below the skin. There is no way to make sure you never get another lipoma, though most people who get them usually get only one lipoma in their lifetime.

******* 

Dr Flo,

I am 29 years old. One morning in January 2010 I woke up with a sharp needle-like pain in my right lower back. For the entire February up to mid-March I couldn’t bend forward due to the pain in my right leg.

I sought treatment and used all sorts of painkillers and though I was able to resume my normal activities, life has never really been the same again. The pain later migrated to my right hip joint and since then I have tried all sorts of treatments, but the pain won’t go away.

I have had an X-ray and MRI done at a Nairobi hospital. This was the impression from the MRI:

• L3/L4 to L5/S1 disc bulges causing effacement of the right neural exit foramina with exit nerve root compression; and moderate to severe stenosis of the left neural exit foramina with indentation of the exit nerve roots.

• Normal glutei and piriformis muscles.

• Normal pelvic viscera.

When I took this report to an orthopaedist at the same hospital, anti-inflammatory drugs and gel were prescribed. I used them for two weeks and felt some relief, but as soon as I stopped, the pain came back. As I write this, the pain is now radiating from my hip down to the foot. At times when I sit, I feel a needle-like pain in my right foot. There is no pain when walking.

What could be the problem?

John

Dear John,

Let me start by describing a normal spine. The spinal column is made up of 33 small bones, called vertebrae, which are stacked on top of each other. Each of those bones has a hole in the middle, so when they are joined together, a canal is formed, which is where the spinal cord passes, carrying all the nerves. At the space between one bone and the next, a nerve leaves the spinal cord, heading to its specific destination e.g. a finger. Also, between one bone and the next, there is a sort of cushion, called an inter-vertebral disc.

If this disc protrudes or bulges out of its specific space, it can press on the nerves that are leaving through that space, or cause the space that the spinal cord is in to become smaller, in what is called stenosis. In your case, this disc has protruded out in two places in your lower back, causing both stenosis and pressing on the nerves that are leaving. When this happens, there is back pain, and there is also pain along the path that the compressed nerve is taking.

For you, this means that the nerves that were pressed are coming from the back, to the right thigh, leg and foot. The bulging of the inter-vertebral disc can occur when disease wears out the disc, when it is worn out by constant sitting or driving and even squatting. In some people, the disc can bulge when they lift heavy loads or from sport injuries. The disc that is bulging cannot be pushed back into place.

However, there are some things that can be done to manage the pain, including use of painkillers for a short while, back exercises with a skilled personal trainer when there is a lot of pain, and physiotherapy, and surgery as a last resort, when the symptoms are unbearable. You should not lift anything beyond your ability and make sure you get adequate rest after straining, and even with seemingly smaller loads, like a bucket of water, make sure you do not lift while your back is bent. You would rather squat and lift slowly with your back straight. Also, maintain good posture.

Fatty lumps

A growth made of fat cells just below the skin is called a lipoma. Such growths usually form in the arms, thighs, neck and armpits. They seem to run in families, are painless and are not cancerous and therefore do not usually require treatment.