Baker's Cyst

Baker's cyst is an accumulation of joint fluid (synovial fluid) that forms behind the knee. When an excess of knee joint fluid is compressed by the body weight between the bones of the knee joint, it can become trapped and separate from the joint to form a fluid-filled sac, referred to as a Baker cyst. Extra capsules or sacs of fluid, known as bursae, cushion and help reduce friction between tissues, produced by movement. Baker's cyst is a pronounced swelling on the back of the knee, caused by the abnormal collection of fluid inside the bursae. The doctor can usually make a diagnosis by asking the person specific questions about symptoms and feeling a swelling behind the knee or in the calf. Ultrasound, magnetic resonance imaging (MRI), or arthrography, can sometimes aid in the diagnosis and document how far the cyst extends. Thus, even when the injury has resolved, you still have the swelling in the back of your knee. This is associated with pain usually described as dull and aching. The pain is worse with prolonged walking or standing. It is sometimes improved with rest, elevation and taking pain medication. These cysts occur most often in adults between 55 and 70 and in children between 4 and 7 years old. Up to one in five people with other knee problems may develop a Baker's cyst.

The knee is a hinge joint, situated between the thigh bone and shin bones. The eponym honors the work of Dr William Morrant Baker. In 1877, Baker described 8 cases of periarticular cysts caused by synovial fluid that had escaped from the knee joint and formed a new sac outside the joint. The synovial sack of the knee joint can, under certain circumstances, produce a posterior bulge, into the popliteal space, the space behind the knee. When this bulge becomes large enough, it becomes palpable and cystic. This then spills into the bursa at the back of the knee causing it to increase in size. This is Popliteal Cyst. Sometimes a cyst can burst open (rupture) and leak fluid into your lower leg. Although a ruptured cyst is not life-threatening, its symptoms mimic those of thrombophlebitis, a very serious condition in which a blood clot forms inside a swollen vein. When arthritis causes chronic knee swelling, the doctor may need to remove the fluid with a needle (a procedure called joint aspiration) and inject a long-acting corticosteroid (such as triamcinolone acetonide) to prevent the formation of a Baker's cyst. If the ruptured cyst causes thrombophlebitis in the popliteal vein, this is treated with bed rest, elevation of the leg, warm compresses and anticoagulants. Occasionally, antibiotics are needed also.

Causes of Baker's Cyst

The common Causes of Baker's Cyst :

• Trauma or injury to the knee can cause an accumulation of fluid (effusion), which triggers Baker's cyst.
• usually affecting the cartilages that bolster the knee joint on both sides.
• particularly rheumatoid arthritis and osteoarthritis of the knee joint.
• The condition can also be caused by the herniation of the knee joint capsule out into the back of the knee, which is more common in adults.
• An injury, inflammation of the joint lining, or a disease such as arthritis or gout can damage the knee, causing the synovium to produce too much fluid.
• Local infection can cause fluid retention around the knee joint.
• Any damage within the knee joint may cause swelling and therefore a Baker's Cyst.

Symptoms of Baker's Cyst

Some common Symptoms of Baker's Cyst :

• There may be a painless or painful swelling behind the knee.
• Persistent pain or aching .
• The cyst may feel like a water-filled balloon.
• Restricted mobility of the joint.
• The lump looks most obvious when the person is standing.
• A sensation of tightness at the back of the knee when the leg is straightened.
• Occasionally, the cyst may rupture, causing pain, swelling, and bruising on the back of the knee and calf .
• A sensation of pressure in the back of the joint which can go down into the calf muscle.

Treatment of Baker's Cyst

• Treatment for the underlying cause, such as medication for arthritis or surgery for torn knee cartilage
• Soft tissue therapy, including massage.
• Physiotherapy exercises to increase mobility and strength.
• Conservative treatment is recommended with children as it commonly subsides spontaneously.
• Cortisone injections.
• Your doctor may inject a corticosteroid medication, such as cortisone, into your knee to reduce the volume of fluid being produced. This may relieve pain, but it doesn't always prevent recurrence of the cyst.
• Arthroscopic surgery to decompress the cyst and treat any meniscal tear may become necessary if the cyst is extremely large or painful

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