Bakers cyst in knees
by Nathan Wei, MD, FACP, FACR
Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.
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A Baker's cyst is a welling occurring in the back of the knee due to fluid accumulation. Baker’s cysts may not cause symptoms early on. With further swelling, more discomfort may be noted. This is magnified by bending and straightening the knee.
The cyst is best seen when the patient is standing and is examined from behind. Any form of arthritis that affects the knee can lead to a Baker’s cyst.
A naturally occurring communication exists between the knee joint and the semimembranous bursa which is located next to the gastrocnemius muscle.
A one-way valve mechanism exists between the knee joint and the bursa so that fluid from the knee joint can enter the bursa but cannot go back.
Baker’s cysts are common in rheumatoid arthritis, osteoarthritis, mechanical derangements of the knee, reactive arthritis, gout, pseudogout, and psoriatic arthritis. When the cyst pushes back it may cause pressure on the veins leading to edema of the leg that mimics thrombophlebitis (blood clot).
A doppler ultrasound will exclude the presence of a blood clot. An ultrasound or magnetic resonance imaging scan will also help determine the presence of a Baker’s cyst.
A history of a knee effusion (fluid in the knee) generally points towards a Baker’s cyst as opposed to a blood clot. However, the blood clot should be excluded first before presuming that a Baker’s cyst is present.
Treatment of the cyst involves withdrawing fluid from the knee and injecting a glucocorticoid into the knee. This should be done using ultrasound guidance.
Supplementation with leg elevation and ice is also beneficial. For patients who don’t respond to the above, very rarely is surgery needed to remove the cyst.
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