Baker’s Cyst of the Knee

THE CLINICAL SYNDROME

A common finding on physical examination of the knee, Baker’s cyst is the result of an abnormal accumulation of synovial fluid in the medial aspect of the popliteal fossa. Overproduction of synovial fluid from the knee joint results in the formation of a cystic sac. This sac often communicates with the knee joint, with a one-way valve effect causing a gradual expansion of the cyst. Often, a tear of the medial meniscus or tendinitis of the medial hamstring tendon is the inciting factor responsible for the development of a Baker’s cyst. Patients suffering from rheumatoid arthritis are especially susceptible to the development of Baker’s cysts.

SIGNS AND SYMPTOMS

Patients with Baker’s cyst will complain of a feeling of fullness behind the knee. Often, they will notice a lump behind the knee that becomes more apparent when they flex the affected area. The cyst may continue to enlarge and may dissect inferiorly into the calf. Patients suffering from rheumatoid arthritis are prone to this phenomenon, and the pain associated with dissection into the calf may be confused with thrombophlebitis and inappropriately treated with anticoagulants. Occasionally, the Baker’s cyst may spontaneBaker’s Cyst of the Kneeously rupture, usually after frequent squatting.

The patient suffering with Baker's cyst will often complain of a sensation of fullness or a lump behind the knee.

TREATMENT

On physical examination, the patient suffering from Baker’s cyst will have a cystic swelling in the medial aspect of the popliteal fossa. Baker’s cysts can become quite large, especially in patients suffering from rheumatoid arthritis. Activity that includes squatting or walking makes the pain of Baker’s cyst worse, with rest and heat providing some relief. The pain is constant and characterized as aching in nature. The pain may interfere with sleep. Baker’s cysts may spontaneously rupture, and there may be rubor and color in the calf that may mimic thrombophlebitis. Homan’s sign will be negative, and no cords will be palpable.

To inject a Baker’s cyst, the patient is placed in the prone position with the anterior ankle resting on a folded towel to slightly flex the knee. When bursae become inflamed, they may overproduce synovial fluid, which can become trapped in saclike cysts due to a one-way valve phenomenon. This occurs commonly in the medial aspect of the popliteal fossa and is called a Baker’s cyst. The aforementioned injection technique is extremely effective in the treatment of pain and swelling secondary to Baker’s cyst. Coexistent semimembranosus bursitis, medial hamstring tendinitis, and/ or internal derangement of the knee may also contribute to knee pain and may require additional treatment with more localized injection of local anesthetic and methylprednisolone acetate.

Low intensity laser therapy as well as a coordinated wellness program is also effective in treating this disorder.

Low Intensity Laser Therapy (LILT)

The low intensity Laser (LILT) sends photons (light) into the injured tissues and can penetrate two to three inches to treat affected areas. It uses a natural enhancement of the cellular machinery that can and has been dynamically measured in published studies to promote healing without burning affected tissue .Once the photons find the injured tissues, they stimulate and energize the cells to repair and strengthen at a remarkable rate. The treatment does not hurt, takes about 30 minutes and is very cost advantageous.

Wellness Program

A wellness program whichindividualizes treatment for age, performance and function has been shown in pilot studies to improve the overall health and well being of the individuals evaluated. A well conceived dietary and supplementary regimen based on scientific age–related decline in certain necessary compounds can improve quality of life, correct the ravages of hormone imbalance, balance critical neurotransmitter function without resorting to powerful drugs for depression that often have unfavorable side-effect profiles and restore vitality and youth in daily exercise routines. Furthermore, when wellness products are utilized with success, individuals often seek less costly interventions including unnecessary surgeries and narcotic options to treat pain. For more information go to www.drpwellness.com.