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Episacral Lipoma

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I had a serious fall 18 years ago. Shortly after my accident and recovery from a broken heel & wrist I noticed a nodule in my right lower back that would move around or dissappear if I pushed on it. Although I reported this to my orthopedic surgeon nothing was done and the nodule either disappeared or just hardened in place. I soon developed intermittent lower back pain on my right side and persistent numbness/pain on the outside of my right hip. I was told I should ignore this issue unless my leg muscles began to weaken. So 16 years have passed and this issue only grows worse. Sometimes my entire leg will be unresponsive until I change position or give a good shake. Lately I have been having some residual numbness in my foot and toes after these incidents. I have read about the episacral lipoma as a possible cause. Any one have comments?
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First Helper Gids
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replied July 14th, 2004
A strength and a weakness of westren approach to illness and recovery is over specialisation in terms of cause and effect. Whatever the cause or technical name, sounds to me tai chi or chi kung exercises should help you. What your body needs is a wholistic approach. It need chi energy, oxygen, general movements, and a good non acidic constitution will surely reduce your pain.

I would like to hear from you in your own words whether you have done your best in terms of keeping your body fit and flexible, move /exercise properly and careful to stay away from acidic food and taking care of your posture.
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replied July 25th, 2004
Episacral Lipoma
I'm an operating room nurse and if there is only 1 thing i've learned working there - it's that nothing gets smaller and goes away - everything just gets bigger and more complicated. What could easily be removed in 10 mins under local anesthesia will eventually need general anesthesia and probably wrap itself around nerves and muscles. Of course i'm not referring to everything but i'd surely get it taken out.

If one doctor won't do it - go to another and another.
I had one on my right side and it definitely causes chronic dull pain.
These are right next to the natural dimples in the sacral area.
Good luck.
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replied July 21st, 2013
Hey apeni. I am a nurse also. I was working actually when I hurt my back lifting a patient. I have had MRIs done and it showed bulging discs. I have had all sorts of treatment and medication. This is the most horrible thing to have to live with. I recently found out that "back mice" or more technically correct, "episacral lipomas" could be causing this pain. To my relief, I found they could be removed. I really hope I can find a surgeon who can remove them and I can have a normal life again. So, you have had these removed or have assisted in removing them? Can you give me any surgeon's information who performed the surgery? I will be willing to travel. Thanks.
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replied July 25th, 2004
Episacral Lipomas
Dynamic chiropractic
september 4, 2000, volume 18, issue 19

low back pain and episacral lipomas

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by david bond,dc
a cause of low back pain and disability often overlooked by practitioners who treat patients suffering from acute and chronic musculoskeletal complaints is the episacral lipoma. Although usually thought of as a minor condition, it is capable of producing considerable low back pain.
First described by ries in 1937,1 episacral lipomas are small, tender, "tumor-like" nodules occurring mainly over the sacroiliac region which can cause disabling low back pain. The term "lipoma" is descriptive only in that through direct palpation over the region, the examiner is able to detect a subcutaneous mass similar to the benign tumors; however, it is not a tumor, but is subfascial fat which has herniated through the overlying fascial layer.

Perhaps a better term is that of the lumbar fat herniation as described in 1944 by copeman and ackerman.2 in their research, they reported 10 cases of severe and disabling low back pain in which they identified the fatty tumors as the principle cause of the patient's complaints. They subsequently excised the herniation, which produced striking relief of the pain. In 1945, hertz reported the cases of six women with excruciating low back pain.3 all of the women had a history of a traumatic strain prior to its occurrence of, which was sometimes accompanied by unilateral leg pain. The low back pain in all six women was dramatically relieved by the removal of a herniated fat tumor.

In a followup study by copeman and ackerman, 11 new cases were described.4 in all 11 patients, a biopsy confirmed the presence of edematous fat lobules herniating through deficiencies of the fibrous compartments. It was felt that the pain was produced in the fibro-fatty tissue and not in the musculature itself.

Hucherson and gandy reported in 1948 that of 32 patients who had undergone surgical removal of the lipoma, only two patients failed to experience relief of pain.5 many other researchers have reported that in patients with backaches and occurrence of the nodules, relief was obtained immediately by injection of a local anesthetic and some by operation. At times, dramatic relief was obtained, and there was no recurrence of pain over time.6,7,8,9 in a study by singewald,10 1,000 persons were evaluated for lipomas. They were found in 16% of the subjects; however, only 10% had reported back pain. Therefore, it is not an uncommon finding in the general population, although it is usually asymptomatic.

Fat herniations occur in predictable sites along the edge of the sacrospinalis muscle just above the iliac crest, very close to the natural "dimple" in the sacroiliac area.10 in this area, through abnormal tension, trauma, or by inherent weaknesses of the fascia, as well as through foramina for cutaneous nerves, the underlying fat pad may herniate through the fibrous tissue between the superficial and deep layers. Copeman and ackerman4 mapped the basic fat pattern of the lumbar region from 14 cadaver studies with reference to the most common sites for the occurrence of fat herniations, which were felt to be extremely corresponding. The researchers reported that during dissections, it was not uncommon to find the fascia to be of non-uniform thickness. They also found actual deficiencies of the fascia in which underlying fat tended to bulge through.

In addition, they were able to describe three basic types of herniations: pedunculated, nonpedunculated and foraminal. The nonpedunculated hernia appears as a tense swollen nodule, which protrudes frequently along the iliac crest. Pedunculated hernias have the appearance of a strangulated polyp through the fascia connected by a fibrous pedicle. In the foraminal type, the fat herniates through the foramina containing the cutaneous branches of the posterior rami of the first three lumbar nerves as they pierce the deep fascia after leaving the body of the muscle. A horizontal fold of membrane acts as a valve that prevents the herniation from occurring during flexion of the back; however, a failure to function normally may result in a herniation. Of the three, the nonpedunculated herniation appears to be the most common. Biopsy of the specimens revealed that they were composed entirely of normal adipose tissue with some edema present. In some cases, there was evidence of patches of fibrous tissue growing in the fatty tissue and others with nerve tissue present; however, this has not been a consistent finding. From a clinical standpoint, the mechanism of pain is not fully understood; however, pain appears to be the primary feature, which seems to be due to the expansion of the fat herniation in the otherwise unyielding fibrous capsule, in that removal of the lipoma alleviates the pain.

The pain pattern of the fat herniation originates in a focal region; however, it may radiate in an ill-defined distribution and may be variable in intensity and duration.9 upon palpation, the patient is usually able to describe the exact point of extreme, or pinpoint, tenderness. It is different from a trigger point as described by travell13 in that the examiner can palpate a definite mass rather than a taut band of skeletal muscle. However, like a myofascial trigger point, firm pressure may produce pain that radiates in a general and segmental distribution.11

depending upon the severity of the pain, there may be a restriction of the lumbar range of motion, and the pain may increase with positioning.9 there may well be a significant degree of paraspinal muscle spasming which may also be related to the referred pain, as well as the nature of the original incident.2 no specific structural abnormality of the spine has been identified. Nerve root traction tests are usually normal, with a production of primarily low back and sacral pain upon testing, unless there is a concomitant disc herniation.8 reports of pain radiating down the side affected with the lipoma are frequent; however, there is no uniformity of the radiation area.5 diagnosis is usually confirmed by the injection of local anesthetic, which significantly alleviates the pain, at least temporarily.12
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replied September 15th, 2012
Episacral Lipoma aka Lumbar Fat Herniation aka Lumbar Hernia
I think an even better - more modern term - is lumbar hernia. Symptoms the same, fix is the same, and surgeons know what a lumar hernia is. They do not seem to be familiar with "episacral lipoma" or "lumbar fat herniation". If you have this and see a surgeon, the next challense is for the surgeon to acknowledge you have this - can be confused for a lipoma even on a catscan. Odd the literature says these are so "rare" - I think it would be more accurate to say they rarely diagnosis correctly...
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replied July 25th, 2004
Extremely eHealthy
I have learned to avoid sugery at all costs due to post durgical scar tissue, you fix one thing and the next thing gets weaker every time.
This does sound like it might be a different situation.
Good luck and god bless!
Sincerely,
sandy
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replied October 4th, 2004
I doubt the lipoma is causing any sensory problems in the feet. It mostly is a cause for local, and some radiating pain, typically, down into the buttock.

Ive scene a number of these, and have found they generally respond well to vigourous massage *around* the lipoma, rather than over it - which mainly just aggravates the pain.

Ice can be used afterwards to prevent any excessive fibrosis at the massage site.

Various myofascial effleurage techniques can be used between vigourouss massage to encourage circulation and reduce tissue degrangement of new scar tissue formation.
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replied December 3rd, 2004
Episacral
Hello,
I am seeking information concerning the sacral iliac joint. Not sure if this subject is the same thing? Would like to find a website that would help me. Will be having an injection this month in mine and want to know more. Like...Where do I go from here if this is only temporary? What can I do to help prevent further problems, etc.
Just getting down to finding out what this is.
Thanks anyone!!!
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replied December 21st, 2011
Hello, I just had a sacral iliac joint injection done today by my pain specialist and it was a breeze. I can tell you this I had multiple injections in my neck, shoulder, hips, back and the worst was the hips. I will state that this injection was not very painful. I would do it with a pain specialist using xray guidance, it is only temporary usually less than 3 months.
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replied January 28th, 2010
Lipoma in my back
hey im 30 and 4 to 5 year ago i notice lipoma on my lower back (leftside), i think it is growing and causing a lot of pain and numbness especially after whole day of work.... is it because of this or is it because my CPK is high aswell...... i dont what to do any advice
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replied January 28th, 2010
Extremely eHealthy
Re: Lipoma in my back
imranhanif wrote:
hey im 30 and 4 to 5 year ago i notice lipoma on my lower back (leftside), i think it is growing and causing a lot of pain and numbness especially after whole day of work.... is it because of this or is it because my CPK is high aswell...... i dont what to do any advice


Have you actually been diagnosed with a spinal lipoma or have you made the diagnosis on your own?

If you have not been diagnosed by a doctor and just self diagnosed, I suggest you see your primary doctor for a diagnosis.

If you have been diagnosed and you do have a spinal lipoma, then you need a referral to a spine specialist, either an orthopedic surgeon who specializes in spines or a neurosurgeon that specializes in spines only.

Either of those spine specialists, are properly trained in diagnosing and treating all kinds of spine issues.

You will probably need an MRI but let he spine specialist order it so that the proper type of MRI is done and then go from there.

The fact that you are having symptoms of nerve compression is of concern and that makes you in need of the spine specialist as soon as possible.


Good luck and let us know how you are doing.

Fran
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replied April 24th, 2010
I have severe lower back pain that I've only noticed when I've done a lot of walking, like going to the mall for 3 hours like I did yesterday. My roommate said there was a knot in my lower left back and tried to massage my back there to help.

My back is not hurting right now, but the "knot" to me feels weird. It's sore to the touch (which may be from massaging, I don't know). But it moves. Kind of like your kneecap when you push on it. I've been trying to find something online to find out what exactly muscle knots feel like and I'm getting frustrated.

The only thing that sounded like it felt the same has been an episacral lipoma. I'm not one to diagnose myself so I have no idea. I'm currently unemployed so I'm looking for any answers to avoid going to the doctor if it is indeed JUST a knot in my back.

Anyone have any idea if what I'm feeling is a knot or would it be something else because of how it moves under my skin when I push on it?
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replied August 14th, 2010
Episacral Lipomas..
Yeah l have a couple of these lumps in my back near the dimples of my lower back on both sides.
The lumps move when l press on them and seem to hurt when i'm very stressed out or when l over do it in the gym and strain them.
The lumps also hurt when l press hard on them.In general if l'm careful with my back they don't bother me but sometimes when l'm not careful and agitate the lumps or my back l'm in a lot of pain and can bend over (as if to touch my toes)only very slowly.
I usually find that if l put vicks on my back and lay on my back for a couple of hours over 2 or 3 days that l will recover...L'm considering surgery to remove these lumps so l have an appointment to see what the specialist thinks about surgery to fix this problem for good...but with the back l don't think you can ever truly fix it for good but i'll see what he says.
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replied December 21st, 2011
Hello Paul,

I have multiple lipomas as well located on both sides of lower back. I went to both pain specialist and general surgeon whom both say basically deal with it and its non cancerous. They both do not recommend surgery however there growing and very painful. I have my theories on where mine came from, past surgerical procedure at Laser Spine Institute or from hip injections or from the pools. I basically believe I am on a mission to find out where they developed. Do you know where yours came from? If so, I love to hear back either way. Thanks
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replied July 21st, 2013
Hey, did you ever get your lipomas removed?
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replied April 29th, 2011
I have been diagnosed as having Lumbar Subfascial fat herniation
what type of surgeon have you found that is willing to remove these painful nodules? I my self have more than one discovered after a recent back injury. In my case the one on the left is compressing on my nerves and burning my back. And, when I move it moves causing my leg to go numb. Very dibilitating at times. I have been doing Physical therapy to alleviate my pain and get my back readjusted but the therapist is having a difficult time mannipulating my back due to theses Things, and suggesting removal. My Doc is saying that surgery is not an option. Although I did not respond well to an injection of nerve blocker. If anyone has any opinions on my situation please help!I am however gonna see a pain specialist soon. But ultimately I know it is just bandaid treatments. I want this resolved.
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replied June 30th, 2012
lipoma
Did you ever find out? I have them too.
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replied April 29th, 2011
I have been diagnosed as having Lumbar Subfascial fat herniation
what type of surgeon have you found that is willing to remove these painful nodules? I my self have more than one discovered after a recent back injury. In my case the one on the left is compressing on my nerves and burning my back. And, when I move it moves causing my leg to go numb. Very dibilitating at times. I have been doing Physical therapy to alleviate my pain and get my back readjusted but the therapist is having a difficult time mannipulating my back due to theses Things, and suggesting removal. My Doc is saying that surgery is not an option. Although I did not respond well to an injection of nerve blocker. If anyone has any opinions on my situation please help!I am however gonna see a pain specialist soon. But ultimately I know it is just bandaid treatments. I want this resolved.
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replied April 29th, 2011
Question If a MRI identifies episacrial lipoma. What are the options for treatment?
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