Baker’s cyst

Alternative Names:  Popliteal cyst; Bulge-knee

Definition:
Like all joints, the knee needs lubrication to function properly. This lubricant is a jelly-like substance called  synovial (si-NO-vee-ul)  fluid.A Baker’s cyst is a fluid-filled cyst that causes a bulge and a feeling of tightness behind your knee. The pain can get worse when you fully flex or extend your knee or when you’re active.

Although a Baker’s cyst may cause swelling and make you uncomfortable, treating the probable underlying problem usually provides relief.

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When the knee’s damaged, more synovial fluid is produced. Under pressure, this fluid stretches the lining of the joint, called the joint capsule, out into the back of the knee. This causes a bulge, known as a Baker’s cyst.

Herniation of the joint capsule is responsible for most Baker’s cysts in adults.

The most common cause of damage that triggers the process is arthritis, usually osteoarthritis. Other types of knee injury, such as tears to the cartilage, may also be responsible.

It is named after the surgeon who first described it, Dr. William Morrant Baker (1838–1896).This is not a “true” cyst, as an open communication with the synovial sac is often maintained.

Symptoms:
In some cases, a Baker’s cyst causes no pain, and you may not even notice it. If you do experience signs and symptoms, you may notice:

*Swelling behind your knee, and sometimes in your leg
*Knee pain
*Stiffness
*Texture similar to a balloon filled with water

A large cyst may cause some discomfort or stiffness, but there are often no symptoms. There may be a painless or painful swelling behind the knee.

The cyst may feel like a water-filled balloon. Sometimes, the cyst may break open (rupture), causing pain, swelling, and bruising on the back of the knee and calf.

It is important to know whether pain or swelling is caused by a Baker’s cyst or a blood clot. A blood clot (deep venous thrombosis) can also cause pain, swelling, and bruising on the back of the knee and calf. A blood clot may be dangerous and requires immediate medical attention.

Causes:
Synovial fluid circulates throughout your knee and passes in and out of various tissue pouches (bursae) throughout your knee. A valve-like system exists between your knee joint and the bursa on the back of your knee (popliteal bursa). This regulates the amount of synovial fluid going in and out of the bursa.

But sometimes the knee produces too much synovial fluid, resulting in buildup of fluid in the bursa and what is called a Baker’s cyst. This can be caused by:

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•A tear in the meniscal cartilage of the knee……
•Knee arthritis (in older adults)
•Rheumatoid arthritis
•Other knee problems

Diagnosis:
During a physical exam, the doctor will look for a soft mass in the back of the knee. If the cyst is small, comparing the affected knee to the normal knee can be helpful. There may be limitation in range of motion caused by pain or by the size of the cyst. In some cases there will be signs and symptoms of a meniscal tear.

Transillumination, or shining a light through the cyst, can show that the growth is fluid filled.

If the mass grows quickly, or you have night pain, severe pain, or fever, you will need more tests to make sure you do not have other types of tumors.

X-rays will not show the cyst or a meniscal tear, but they will show other problems that may be present, including arthritis.

Ultrasound  and or MRIs can help the health care provider see the cyst and look for any meniscal injury.
Treatment:
Baker’s cysts usually require no treatment unless they are symptomatic. Often rest and leg elevation are all that is needed. If necessary, the cyst can be aspirated to reduce its size, then injected with a corticosteroid to reduce inflammation. Surgical excision is reserved for cysts that cause a great amount of discomfort to the patient. A ruptured cyst is treated with rest, leg elevation, and injection of a corticosteroid into the knee. Recently, prolotherapy has shown encouraging results as an effective way to treat Baker’s cysts and other types of musculoskeletal conditions.

Baker’s cysts in children, unlike in older people, nearly always disappear with time, and rarely require excision.

Cryotherapy:
Ice pack therapy may sometimes be effective way of controlling the pain caused by Baker’s cyst. Ice must not be applied directly onto the skin but be separated by a thin cloth. Alternatively, cooling packs may be used, but the total application time for any product is for no more than 15 minutes at a time.

Medication:
Medications bought at pharmacies may be used to help soothe pain. Painkillers with paracetamol, a.k.a. Tylenol(c) (acetaminophen), or with the additional anti-inflammatory action (such as ibuprofen or naproxen), may be used. Stronger non-steroidal anti-inflammatory drugs may be required by prescription from one’s general practitioner.

Heat:
Heat is also a commonly used. The application of a heating pad on a low setting for 10–20 minutes may relieve some pain, but only if instructions are followed carefully.

Bracing:

A knee brace can offer support giving the feel of stability in the joint. If only support is necessary, a simple elastic bandage is recommended; however, braces compress the back of the knee, where it is most tender, and can cause pain.

Rest and specific exercise:
Many activities can put strain on the knee, and cause pain in the case of Baker’s cyst. Avoiding activities such as squatting, kneeling, heavy lifting, climbing, and even running can help prevent pain. Despite this, some exercises can help relieve pain, and a physiotherapist may instruct on stretching and strengthening the quadriceps and/or the patellar ligament.
Prognosis: A Baker’s cyst will not cause any long-term harm, but it can be annoying and painful. The symptoms of Baker’s cysts usually come and go.Long-term disability is rare. Most people improve with time or arthroscopic surgery.

Possible Complications:
Complications are unusual, but may include:

•Long-term pain and swelling
•Complications from related injuries, like meniscal tears

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

Resources:
http://www.bbc.co.uk/health/physical_health/conditions/bakerscyst1.shtml
http://www.nlm.nih.gov/medlineplus/ency/article/001222.htm
http://www.mayoclinic.com/health/bakers-cyst/DS00448
http://en.wikipedia.org/wiki/Baker’s_cyst

http://www.healthcentral.com/osteoarthritis/h/tai-chi-and-arthritis-of-the-hip.html

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2 thoughts on “Baker’s cyst”

  1. My wife had her knee "cleaned up" and the surface smoothed along with some minor tendion repairs but nothing major. The Baker's cyst ( which usually fixes itself we are told over and over again) has come up and burst about 6 to 7 times now. The doctor removed the sac with surgery with now it is still coming back. She tries to do as the doctor perscribes but she stays in constant pain. I have seen people fair better with full knew replacements so I am not impressed by the terms "usually" "most of the time" when describing that it will take care of itself. What if it does not? I find that this is not addressed in most literature. Is this going to be a way of life for her — to be in constant pain because the doctors do not know the answer for the ones that do not go away? Forgive my attitude about this but for God's sake Dr. Switzer, its a CYST! not cancer!

  2. I hav a Baker's cyst and I hav been told it will go away well 2 yrs now it;s still their,and is painful….I hav had it drained 2 times and shot full of cort.i hav had 2 MRI's i no the pain and the term "it will go away don't worry " is bs….just my knee…

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