Bakers Cyst Knee

Bakers cyst knee makes bending the joint painful because of the large mass.

Baker's cyst

Unlike Housemaid's knee, also known as Patello Femoral Pain Syndrome which is directly caused by too much work whilst on the knee, or a fall on the patella, a Baker's cyst has nothing to do with kneeling or baking! It's named after a surgeon.

Baker's cysts are painful swellings behind the knee, more on the inner side of the leg. In the so called popliteal fossa so it's sometimes called a popliteal cyst.

Between the insertion of the muscles behind the knee, on the inner side, medial, lies a small bursa that prevents friction between the tendons and the bone.

Specifically, the semimembranosis branch of the hamstring behind the upper leg, and the medial gastrocnemius behind the lower leg.

In certain conditions of the knee, in particular arthritis, a connecting tube develops between the sac of fluid in the knee, the synovial fluid, and the bursa. If the knee is suddenly forced into flexion, for example, the fluid may squirt into the cyst.

So, what are the causes of a Bakers cyst?

The most usual occurrence is the patient with an arthritic knee, who then in a moment of enthusiasm goes through some over-exertion like they used to do in their long-lost youth. A long hike, a trip to Europe that involved climbing umpteen steps, or some trauma, often forced over-flexion of the knee.

The repeated or sudden increase in pressure in the knee forces synovial fluid from within the knee into the semi membranosis bursa: Baker's cyst.

Baker's cyst knee
Knee hyaline cartilage

Ruptured Baker's cyst

Bakers cyst knee can cause very sharp pain behind the leg.

Sudden trauma to the lower limb, a slip, for example, which forcibly flexes the joint can cause the Bakers cyst knee to rupture. The fluid forms a large mass behind the knee, draining down into the calf muscle.

Taking up space and putting pressure on the other structures behind the knee, it causes acute pain and prevents you from bending the joint.

A lady, an otherwise healthy seventy year old woman, first consulted me with knee pain and stiffness some twelve months ago. She had been obese, but weary of the disability that goes with obesity she had already made the decision to lose a lot of weight, which she had successfully done following a vegen weight loss programme.

She admitted that it had been difficult, but less hardship than the increasing pain and disability of her knee arthritis.

But the damage was done. Increased pressure of femoral on tibial cartilage had caused a severe hole to develop in the hyaline.

Despite my doubts she responded well to gentle mobilisation of the knee, a quite strange diet and joint exercises. Within two months she was walking normally, undertook a trip to visit family in England and was enjoying the normal life of a grandmother.

Interestingly research shows that the most effective treatment for knee arthritis is weight loss. Simply unloading the femoral on tibial cartilage stress; for her it was working.

Then six months ago she slipped on a bank, forcing the knee into full  flexion. Ouch; she hobbled in, and again responded surprisingly well to some basic chiropractic treatment. A small mass behind the knee made me wonder if a Baker's cyst was developing.

Then two weeks ago she went for a long walk over difficult terrain down a deep river gorge with family. Next day she could barely bend her knee, limping in agony into the clinic. 

On examination, it was clear she had a very large mass  in the posterior knee fossa, extending down into the medial calf muscle.

With the next trip overseas imminent, I thought an ultrasound scan wise. Indeed, a very large Bakers cyst knee with blood in the fluid. The radiologist recommended that the cyst be drained immediately.

She declined, without any encouragement from me, being about 30 percent better after the first chiropractic treatment.

Baker's cyst posterior knee

Arthritis symptoms

Arthritis symptoms are common in the Bakers cyst knee, and it's a common sequela in degenerative joint disease.

Baker's cyst ultrasound scan
Baker's cyst rupture

Radiologist's Report: A large cystic mass is noted in the posterior knee measuring 36 x 57 mm. Internal content is noted within the cyst and this is suggestive of haemorrhage within the cyst. There appears to be communication with the joint space (arrow) and this is suggestive of a Baker's cyst. No features of an aneurysm.

In short, a large bloody mass somewhere between the size of a golf and tennis ball.

Bakers cyst treatment

Hesitantly, I've never seen such a large and alarming ruptured Bakers cyst, I used:

  • alternating ice and heat.
  • electrical stimulation.
  • gentle soft tissue effleurage - lymphatic drainage - to force the fluid out of the Baker's cyst, either back into the knee proper, or into the lymph channels. 
  • checked the SI joints where there were no fixations or pain.

Within three treatments, she had almost no pain and was walking normally.

We added knee exercises:

She has again surprised me, and will go on her overseas trip tomorrow after all.

Taking with her serious warnings that the communicating channel between the inner knee and the Bakers cyst knee still exists. She's not to attempt the Thirty-nine steps, and any over-flexion of the knee will again force synovial fluid into the ruptured Bakers cyst.

I will report again in a month on her progress.

The moral of the story?

Gentle, sensible chiropractic treatment is successful with many conditions that would not normally pertain to the chiropractic domain.

Omega 3 and its place in arthritic inflammatory conditions.

There is now very strong research that omega 3 fatty acids helps enormously with arthritic conditions. There are three of these healthy fats:

  • ALA
  • EPA
  • DHA

They are found predominantly in foods like fatty fish, freshly ground flax seeds, freshly cracked walnuts, avocado; start eating them regularly when developing swollen painful joints. Better still, before as they also prevent heart attack and many other cardio vascular and neurological diseases including Alzheimer's disease. Preferably before the heart attack or Bakers cyst knee.

Patello femoral pain syndrome

Patello femoral pain syndrome remains one of the most common knee afflictions, and the easiest to treat.

Pain and grating behind the kneecap is a common degenerative condition; it may by the prelude to Bakers cyst knee.

Art and science of chiropractic

The first step in dealing with pain in the knee is a careful and thorough examination; special scans may be necessary to make the correct diagnosis. Having said that, many conditions can be assessed by the astute clinician without the use of expensive tests.

But it takes a combination of art and science of chiropractic to fix these conditions.

Useful links @ Bakers cyst knee

» Bakers cyst knee

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Interesting challenges of the day

1. Mr S is a 76 year old man with neck pain of some 9 months duration. Luckily, most of the discomfort is upper cervical which is only rarely arthritic; his lower cervical spine is a degenerative mess that I have left alone. After seven treatments his pain and stiffness is 50 percent better, and he is happy in the circumstances. He can sleep through the night now and that makes a huge difference.

2. Mr P is 32 year old man with very severe lower back pain radiating to the big toe which is 30 percent numb. He had an episode three weeks ago, took anti-inflammatories and was soon better as is typical of the medial disc herniation. But before it healed, after a trivia it came roaring back, much worse. The characteristic crossed sign was evident; sitting in a chair, straightening the right leg provoked severe left back pain and tingling in the leg. He is doing well.

3. Severe lower back pain is scary; just ask Mrs P. Just watching her get out of the car I she was in trouble; she had a slipped disc at L4 making her lean towards the opposite side; luckily she had no pain in the leg. Despite family pressure that this was far too severe for a chiropractor, she persevered. Within five days she was standing upright, and after two weeks almost pain-free. 

Despite a hectic job, she wisely took my advice and stayed home for what I call exercising bed rest.

4. Mr S has had lower back, groin and back of thigh and calf pain for fourth months.

He has a pincer deformity in the hip causing the stabs in the groin, and a degenerative facet causing the sciatica. Both are responding well to chiropractic and he is well pleased; sixty-five percent better after three treatments.

5. Mr T is a wise man; he has taken a warning TIA seriously and has lost 15 pounds, and has at least as much again to lose. A change to a low starch diet and half hour daily stroll has made the difference; but the walking is making his foot and back miserable. The expensive orthotic is hopeless; luckily his hips and back are fine, but he needs a simple heel lift; he has a short leg.

6. I too have had serious lower back issues, luckily fixed by my own chiropractor; so I too have to do my exercises, take care when lifting supers full of honey, gardening and using the chainsaw. Regaining the function of your spine is just as important as the pain.

7. My own granddaughter, only 7 is hypermobile giving her pelvic, knee and ankle issues. X-rays show a mildly dysplastic hip. Years ago we would have called it growing pains. She too regularly needs chiropractic care and luckily responds well. Increased range of motion is more difficult than too stiff in my opinion. Our care is for kids too.

8. This 65-year old lady is a serious gardener; every day she is bending, lifting and digging for 2 to 3 hours a day. It regularly catches her in the sacroiliac joint, so she has a treatment once a month that sorts it out. She does her lower back exercises faithfully.

9. This 88-year old lady is an inspiration; every day she is busy in the community. With a nasty scoliosis she manages very well with a chiropractic adjustment every six weeks and exercises faithfully done. 

10. Mr X is a 71-year old retired man who wants to continue with maintenance care every six to eight weeks; he had suffered from two years of lower back pain when he first came a few months ago. He has no discomfort now after 8 chiropractic treatments, but is aware that danger lurks.

11. Mrs C has been having severe headaches, and taking a lot of analgesics. It is a non-complicated upper cervical facet syndrome, and she is doing well.

12. Mr D is a 38-year old year man with chronic shoulder pain after a rotator cuff tear playing cricket. It responded well to treatment, but he knows he must do his exercises every day; for two years he could not sleep on that shoulder.

13. Mr D, a 71-year old man, has a severe ache in the shoulder and midback since working above his head. Trapped nerve tests are negative but he has advanced degenerative joints of Luschka; after just two treatments he is 50 percent better. Can we reach 90?

And so the day goes; chiropractors should not be treating the elderly most medical sites state but that is so much bunkum.

Have a problem that is not getting better? Looking for a different slant on your pain? Want to pose a question?

Interesting questions from visitors

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