Treatment of Bakers cyst

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.

Click here: Second Opinion Arthritis Treatment Kit

Baker’s cysts are common in rheumatoid arthritis, osteoarthritis, internal mechanical derangement of the knee, reactive arthritis, gout, and psoriatic arthritis.

Bakers cysts develop when fluid accumulates in the knee joint and pushes backward. There is a one way valve mechanism that allows fluid to escape but not to return. As a result, there is an accumulation of joint fluid in a pocket in the back of the knee. This is called a Bakers cyst.

When the cyst pushes to the back of the knee, it may cause pressure on the veins leading to edema of the leg. This looks like thrombophlebitis (blood clot in the leg). The first step in treating Bakers cyst is to make sure it is a Bakers cyst in the first place.

A Doppler venous study will exclude the presence of a blood clot. An ultrasound or magnetic resonance imaging scan will 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, a 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. Ultrasound guidance is critical since there are neurovascular structures that need to be avoided. Supplementation with leg elevation and ice is also beneficial. For patients who don’t respond to the above, sometimes surgery is needed to remove the cyst. This is a rare occurrence.

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