Bakers cyst

Definition

Baker's cyst is an accumulation of joint fluid (synovial fluid) that forms behind the knee.

Alternative Names

Causes

Baker's cyst is a fluid collection behind the knee. This cyst may be formed by the connection of a normal bursa (a normal lubricating fluid sac) with the knee joint. This type is more common in children.

The condition can also be caused by the herniation of the knee joint capsule out into the back of the knee, which is more common in adults. This type of Baker's cyst is commonly associated with a tear in the meniscal cartilage of the knee. In older adults, this condition is frequently associated with degenerative arthritis of the knee.

A large cyst may cause some discomfort or stiffness but generally has no symptoms. Baker's cysts usually disappear spontaneously, but the time in which they do so is variable.

Symptoms

• There may be a painless or painful swelling behind the knee
• The cyst may feel like a water-filled balloon
• Occasionally, the cyst may rupture, causing pain, swelling, and bruising on the back of the knee and calf

It is very important to tell the difference between a ruptured Baker's cyst and a blood clot (deep venous thrombosis), which can also cause pain, swelling, and bruising on the back of the knee and calf. A blood clot may be dangerous and requires immediate medical attention.

Exams and Tests

During a physical exam, the doctor will look for a soft mass in the back of the knee. If the cyst is small, comparing the affected knee to the normal knee can be helpful. There may be limitation in range of motion caused by pain or by the size of the cyst. In some cases there will be signs and symptoms of a meniscal tear.

Transillumination, or shining a light through the cyst, can demonstrate that the mass is fluid filled.

If the mass demonstrates any abnormal signs, like rapid growth, night pain, severe pain, or fever, a more involved work-up is indicated to rule out non-cystic tumors that can grow in the back of the knee.

X-rays will not show the cyst or a meniscal tear but will show other abnormalities that may be present including arthritis.

MRI can be helpful to visualize the cyst and to demonstrate any meniscal injury.

Treatment

Often no treatment is necessary and the practitioner can observe the cyst over time. If the cyst is painful, treatment is usually aimed at correcting the underlying problem, such as arthritis or a meniscus tear. Remove the cyst is generally not done because it may damage nearby blood vessels and nerves.

Sometimes, a cyst can be drained (aspirated), if the fluid inside it has become solid and gel-like.

Outlook (Prognosis)

A Baker's cyst is a benign lesion that will not cause any long-term harm, but can be annoying and painful. Long-term disability is very rare, as most cases improve with time or arthroscopic surgery.

Possible Complications

Complications are unusual, but may include:

• Long-term pain and swelling
• Complications from associated injuries, like meniscal tears

When to Contact a Medical Professional

Call for an appointment with your health care provider if there is a swelling behind the knee that becomes large or painful. Pain could be a sign of infection, which is not normally associated with Baker's cyst.