Pain behind the knee and blood clots
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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The synovial capsule of joints produces a lubricant called synovial (si-NO-vee-ul) fluid. This fluid helps a joint such as the knee knee move smoothly and reduces friction.
Synovial fluid circulates throughout the knee. A valve-like system exists between the knee joint and the bursa in the back of the knee (popliteal bursa). This is a one way valve. Fluid can leave the knee joint to enter the bursa but it cannot return.
Sometimes the knee produces too much synovial fluid. Most commonly, this is caused by an inflammation of the knee joint, such as occurs with various types of arthritis or a knee injury.
When the bursa fills with fluid and expands, the result is a bulge called a Baker's cyst.
As many as one in five people with other knee problems develop a Baker's cyst.
In some cases, a Baker's cyst causes no pain and goes unnoticed. The signs and symptoms that may occur include:
• Swelling behind the knee, and sometimes in the leg or foot
• Knee pain
• Tightness in the back of the knee
Treating the underlying condition, such as rheumatoid arthritis or a cartilage tear, usually relieves the swelling and discomfort of a Baker's cyst. In rare cases, a bulge behind the knee may be a tumor rather than a fluid-filled cyst.
A noninvasive imaging procedure, such as an ultrasound or a magnetic resonance imaging (MRI) scan, can help distinguish between a simple cyst and a tumor.
Sometimes, a Baker's cyst ruptures and synovial fluid leaks into the calf, causing sharp pain in the knee, swelling and sometimes redness of the calf. These signs and symptoms resemble those of a blood clot in the leg. If there is swelling and redness of the calf, a prompt Doppler ultrasound study of the leg needs to be done to exclude the possibility of a blood clot. If a blood clot is present the patient needs to be hospitalized and placed on anticoagulants.
If the cyst is very large and causes a lot of pain, the physician may use the following treatments:
• Fluid drainage. The doctor may drain the fluid from the knee joint using a needle. This should be done using ultrasound guidance. In addition, the cyst itself can be drained and
injected using ultrasound guidance. In our clinic, we have had excellent outcomes with this technique.
• Medication. Your doctor may inject a corticosteroid medication, such as cortisone, into the knee to reduce the volume of fluid being produced. This may relieve pain but doesn't always prevent recurrence of the cyst.
• Follow the P.R.I.C.E. principles. These letters stand for protection, rest, ice, compression and elevation. Protect the leg by using crutches to take the weight off the knee joint and to allow pain-free walking. Rest the leg. Ice the inflamed area. Compress the knee with a wrap. And elevate the leg, especially at night.
• Try nonsteroidal anti-inflammatory drugs (NSAIDs) or acetaminophen. NSAIDs such as aspirin, ibuprofen (Advil, Motrin, others), naproxen (Naprosyn, Aleve, others) and similar drugs can help relieve pain, as can acetaminophen (Tylenol, others).
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