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Popliteal Cyst / Baker's Cyst

You notice a bulge behind your knee, and you feel tightness there, too. The pain gets worse when you fully extend your knee or when you're active. What could be the cause?

A likely explanation is that you have a Baker's cyst, also called a popliteal cyst. A Baker's cyst is usually the result of a problem with your knee joint, such as arthritis or a cartilage tear. Both conditions can cause your knee to produce too much fluid, which can lead to a Baker's cyst. Treating the probable underlying problem usually relieves the swelling and discomfort of a Baker's cyst.

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.

A door hinge needs oil to swing smoothly, to reduce the friction between its moving parts and to minimize wear and tear. Similarly, the cartilage and tendons in your knees rely on a lubricating fluid called synovial (si-NO-vee-ul) fluid. This fluid helps your legs swing smoothly and reduces friction between the moving parts of your knees.

Synovial fluid circulates throughout your knee and passes in and out of various tissue pouches (bursae) throughout your knee. A

valve-like system exists between your knee joint and the bursa on the back of your knee (popliteal bursa). This regulates the amount of synovial fluid going in and out of the bursa.

But 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, especially a cartilage tear.

When the popliteal bursa fills with fluid and expands, the result is a bulge called a Baker's cyst. In texture, it's similar to a balloon filled with water.

When to seek medical advice :
If you're experiencing pain and swelling behind your knee, see your doctor to determine the cause. Treating the underlying condition, such as arthritis or a cartilage tear, usually relieves the swelling and discomfort of a Baker's cyst. In rare cases, a bulge behind your knee may be a tumor or a popliteal artery aneurysm rather than a fluid-filled cyst.

In some cases, a Baker's cyst causes no pain and goes unnoticed. The signs and symptoms you may notice can include :

  • Swelling behind your knee, and sometimes in your leg or foot
  • Knee pain
  • Tightness in the back of your knee
  • Stiffness

A noninvasive imaging test, such as an ultrasound or a magnetic resonance imaging (MRI), scan can help distinguish a simple cyst. If your doctor suspects a blood clot in your leg (deep vein thrombosis) or an aneurysm, he or she may suggest an ultrasound of your leg or other tests.

Complications :
Rarely, a Baker's cyst bursts and synovial fluid leaks into the calf region, causing sharp pain in the knee, swelling and sometimes redness of the calf. These signs and symptoms closely resemble those of a blood clot in your leg. If you have swelling and redness of your calf, you'll need prompt medical evaluation, because a blood clot may require urgent treatment.

If the cyst is very large and causes a lot of pain, your doctor may use the following treatments :

  • Physical therapy. Icing, a compression wrap, and crutches may help reduce pain and swelling. Gentle range of motion and strengthening exercises for the muscles around your knee may also help to reduce your symptoms and preserve knee function.
  • Fluid drainage. Your doctor may drain the fluid from the knee joint using a needle. This is called needle aspiration.
  • Medication. 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.

Typically though, doctors treat the underlying cause rather than the Baker's cyst itself.

If your doctor determines that a cartilage tear is causing the overproduction of synovial fluid, he or she may recommend surgery to remove or repair the torn cartilage.

In some instances, particularly if you have osteoarthritis, the cyst may not go away even after your doctor treats the underlying cause. If the cyst doesn't get better, causes pain and interferes with your ability to bend your knee, or if — in spite of aspirations — fluid in the cyst hinders knee function, you may need to be evaluated for surgery to remove the cyst.

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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