Pain is present on climbing and getting down stairs, also on sitting to standing when the knee joint is bearing more weight in middle range knee flexion. There was a history of using heeled shoes for two to three days since one month back after which these symptoms started. Also mild swelling without any pain present in the ankle and feet. There is no tenderness in the knee joint.
Generally the presence of a Bakers cyst confirms that the patient has synovitis. This can be 1. Inflammatory cause 2. Traumatic/degenerative cause. Essentially from the History, it will be possible to determine if there are any other joints involved and whether there is a relevant past history or family history of inflammation. This can be followed through with a thorough examination and then blood tests for inflammatory arthropathy. If the cause is traumatic or degenerative, there will be synovitis as a result of intra-articular pathology such as meniscal tears or osteoarthritis, most commonly.This will be apparent on a careful clinical examination of the knee. An xray is often the best initial investigation to begin with.
If "Fluid in both knee joints with Baker cyst" exists one should think of synovitis of the knee. This an inflammatory condition of the synovial joint membrane which might be caused by different nosologies: RA, degenerative joint disease (OA), psoriasis, posttraumatic changes (incl. meniscus and ligament lesions), etc. So we need more information about the case and more work up to give a proper advice.
Making a diagnosis at a distance without full history and examination would be preposterous. What age and sex, chronic trauma (sports?), recent infection? (throat), and elementary lab values such as sedimentation and CRP; Röntgen image?; contact with ticks (Lyme disease)...
Ya, that is true first of all need to find out the cause of it and rule out all systemic illness involving joints..
Till then one can go with medication &/or aspiration..
Often no treatment is needed. The health care provider can watch the cyst over time.
If the cyst is painful, the goal of treatment is to correct the problem that is causing the cyst, such as arthritis or a meniscus tear.
Sometimes, a cyst can be drained (aspirated) or, in rare cases, removed with surgery if it becomes very large or causes symptoms.
The cyst has a high chance of returning if the cause is not addressed.
The surgery may also damage nearby blood vessels and nerves.
You are right, dear colleagues. I keep myself to the classical rule: Qui bene diagnoscit, bene curat.
Generally the presence of a Bakers cyst confirms that the patient has synovitis. This can be 1. Inflammatory cause 2. Traumatic/degenerative cause. Essentially from the History, it will be possible to determine if there are any other joints involved and whether there is a relevant past history or family history of inflammation. This can be followed through with a thorough examination and then blood tests for inflammatory arthropathy. If the cause is traumatic or degenerative, there will be synovitis as a result of intra-articular pathology such as meniscal tears or osteoarthritis, most commonly.This will be apparent on a careful clinical examination of the knee. An xray is often the best initial investigation to begin with.
different causes of knee effusion with Baker's cyst include: a torn meniscus, OA, loose body. chondral lesion, synovits, RA. other causes include: overuse & quadriceps weakness.
Der Ms. Fitzpatrick, that is not entirely true. There isn't allways synovitis of the knee at the presence of a Baker cyst. The bakercyst Is known as a hiatus at the junction of semimembranus and medial gastrocnemius with the Joint capsule. Sometimes it Is Seen in Kids 4 yr's old with no known accompanien disease.
The treatment Is based by diagnosis and clinical relevance- meaning mostly pain
Dear Dr. Edelstein I have to disagree with you. Dr. Fitzpatrick is right in saying that "generally there is synovitis" of the knee when Baker's cyst is found. Generally, the popliteal cyst is formed by the bulking of the weaker posterior capsule and the impaired valve mechanism between cyst and joint space. In the example with a 4 year old child , in my opinion it is a kind of ganglion.
Dear Dr. Tanchev, bacercyst is described as a permanent opening, not as a Bückling exakter ca
Sorry my texteditor Is harrassing me severly. The bakercyst Is described as a permanent hiatus, valved by semimembranosus an medial gastrocnemius muscle fibers. Reports are given for bakercysts in kids, other than simple ganglions. And no, no sine qua non for synovitis.
Important in fact Is the size of the bakercyst. If extending in calf or ankle serious problems may arise as compartement syndrome, thrombosis/ embolie, infections such as erysipelas, permanent lymphedema.
So clinical picture and diagnosis matters.
In case of a simple cyst simple measures are shown to be effective. With clinical and ultrasound examination the cyst Is drained and injected with triamcinolone, thus decreasing pressurepain, size and longterm wallthickness as well as reoccurrence rate. And hopefully, further complications may avoided. This treatment Is quick, costeffective , overdiagnostic and overtreatment Is avoided.
If it turns out not sufficient, further diagnostics and treatment Is warranted.
kind regards, JE
Dear Jean, by definition a Baker's cyst is usually the result of a pathological problem with the knee joint (synovial sac) such as rheumatoid arthritis, OA, posttraumatic conditions (meniscus tear, cartilage damage, etc.). All these conditions are related to hyperproduction of synovial fluid (synovitis). Indeed the Baker's cyst is not a true cyst because the open communication (hiatus of which you speak) with the synovial sac is often maintained. The volume of the cyst depends in fact on this communication, especially on the production (more or less) of synovial fluid in the joint. As far as the treatment is concerned, conservative measures may be initiated. The pathology in the knee should be treated. If this does not give satisfactory results the Baker's cyst may be removed surgically. In these cases the hiatus between cyst and joint should be obligatory ligated.
Regards,
Tanchev
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