Understanding and Treating Baker’s Cyst

Introduction to Baker’s Cyst

[00:00] So you got a Baker cyst and you're not even a Baker. What the heck is a Baker cyst? Let's figure it out. I'm Dr. Paul Zalzal. Dr. Brad Weaning. Welcome to Talking with Docs. Sit Down Edition. Sit Down, yes. I like the sitting down. Sitting is the new smoking you just told me. Do you have a light? We should stop smoking. All right, Baker cyst. Okay. Is it named after a Baker?

What Causes a Baker’s Cyst

[00:20] It actually is not. I didn't know that until yesterday when I looked this up and it is Sir William Baker, a surgeon from the 1800s and he was the guy who got it named after him. I'm not sure if he found it or identified it or what. He must have paid off the medical naming committee to get the name for the thing that's up

[00:40] bump behind your knee. Okay and this is a very very common problem I see in the office all the time. Yeah. Someone comes in, they have an ultrasound report printed in their hand, they want to show it to me like doctor I have a bigger cyst and I'm like it's a problem I recognize of it really for me it's more a result of the problem than a specific cause of the problem most often. That's right that's

Fluid Accumulation and Anatomy

[01:00] What I try to emphasize to my patients is the Baker system does not think of it as an entity on its own. I wish William Baker never named this thing because it is really a sign or symptom of something else that is going on like some arthritis in your knee or a meniscal tear in your knee or something in your knee that causes a little leak in the capsule.

[01:20] And the synovial fluid which is in your knee and everybody's knee gets pumped out that little leak into the back of the knee and then it's like a one-way valve and the fluid can't come back in so the cyst forms, it gets a little bit bigger and bigger and it gets a little bit dehydrated so it's not quite liquidy, it's more jelly-like. And it's between most commonly between

Symptoms and Clinical Presentation

[01:40] between the medial head of your gastrocnemius or your calf and something called your semimembranosus muscle, part of your hamstrings. So now what you know is it's a sac of fluid that's in a space where it normally is not supposed to be. What do these people show up with? How do they present? They usually present with symptoms from the underlying condition. So some knee pain.

[02:00] or some mechanical symptoms if it's a meniscal tear. However, some people might say they feel the bump in the neck of their knee as well. Or they say, I can't bend my knee all the way. I can't get it all the way straight because it feels tight or I can't bend it all the way because it feels tight. Okay, so they show up, they got some pain. In your office you can examine them. What do you, what do you, can you feel it?

Examination and Initial Testing

[02:20] When you see it?

[02:40] torn meniscus or your advanced arthritis or whatever. Right, yeah, your generalized decreased range of motion because of what's going on that caused that popliteal cyst, which is another name for it there. That's a more anatomical name, more useful name actually than date naming after yourself. Yeah, sorry, Billy Baker. Okay, so now you know they got this.

[03:00] You see them in the office. Say somehow they didn't have any investigations. Do you order any tests? I just order my usual tests around the knee, which include a standing X-ray. Right. And the X-ray, with respect to the cyst, you can't necessarily see it. I guess if it was really gigantic and had some debris in it, maybe you could see it on the lateral view. But it probably looks normal, except for the fact

When Imaging Like Ultrasound or MRI Is Used

[03:20] fact is you can probably have some arthritis or something else going on. Okay, so you go straight to ultrasound. I almost never order an ultrasound of the knee. If the story doesn't make sense or if I'm worried about a neoplasm or a cancer, a sarcoma or something around the knee, then an ultrasound can be helpful because it would show some kind of

[03:40] blood supply to this mass behind the nose. And even then, would you really order an ultrasound? No, not on the nose. But if it was a concern of story like it's associated with weight loss, there's a strong history of sarcoma, pain, and abortion. It's getting much bigger, rapidly. I don't know if when you palpate it, it feels more solid than cystic. Those kinds

[04:00] of things do make you worry and then you do an ultrasound to see if there is a blood supply going to the thing which is concerning. But then you probably even go to an MRI. We do, yeah. Often you get ultrasound. Yeah, or both, yeah. But yeah, MRI would be the investigation of choice. Okay, so you confirm that you have a Baker cyst and a lot of times the radiologists are very kind, they get very specific dimensions. It's like

Why Surgery Isn’t Recommended

[04:20] 2.6 by 9.5 by 14.3 centimeters in the back. So they range in size. They certainly will fluctuate in size. Patients will say, oh yeah, I feel like the kind is going up and down in size. So some days they have good days, bleat activity or other stuff. So you have this bigger cyst, so now you're gonna book them for surgery, you're gonna cut out that bigger cyst. No.

[04:40] Try. No, we don't. Maybe Billy Baker did back in the 1800s. They may have been excising them many years ago when they excised them, but we do not routinely excise the Baker's cyst for a few reasons. One, it's not the underlying problem with your knee. Two, it will likely recur if you have it removed.

[05:00] three it's in a very dangerous location there are a lot of nerves arteries around that area behind the knee it's kind of like a no person's land back in the knee back in the knee you don't want to be there if you don't have to go there has very real risk for sure even if you're a WWE wrestler you don't want to see the back of your opponent's knee maybe

Treatment of Underlying Knee Issues

[05:20] you're gonna do it's like a figure four leg lock like right the hammer bound time maybe. That's it. No other reason. Okay so you're not gonna have surgery so you're like Doc I just got to live with this there's no treatment for it? What we try and do is treat the underlying cause. Okay. So if it's arthritis we go down our treatment algorithm for arthritis. If it's a meniscal tear that's causing it we

[05:40] go down our treatment algorithm for menisciotares. We have videos about all that stuff. Okay and just on a side note before I forget, if you've had experience with a bigger cyst, you've had one rupture, if you've had it treated in some way, please, I know we're gonna get to that, please leave a comment, share what works for you for other people here. So okay, so maybe an injection before we get to what you're about to say.

[06:00] Yeah, maybe an injection is part of that treatment algorithm before the arthritis, but you mentioned it. Yeah, just wait. Routinely, I would not aspirate them, would you? No. Because like we said, it's just going to, unless someone had a gigantic one that was really tense and I would not put the needle in the back, I maybe would pull some food out of the front if they had a gigantic knee, a fusion that we thought was maybe the cause. Yeah.

Rupture of the Cyst and Emergency Symptoms

[06:20] concern are the most common times for people to show up in the ER or in your office with severe pain in their calf, what has happened? That's a rupture. You mentioned rupture. You asked someone to leave a comment if they rupture. Those things can't, they're cystic structures they can rupture. If they rupture, that fluid leaks down to the back of the calf and that hurts a lot. And

[06:40] can

[07:00] going to be okay. That's about all we can do for that. I feel like some people are like, that's offensive care is what that is. Supportive care means? Really, it's like ice, elevation, compression with a tensor bandage, maybe some pain medication. Analgesic. Analgesic. Right? So that's the Baker cyst that has ruptured. But the good news is the Baker cyst is gone. Yes. Right? Yeah. So people are like, yeah, it was really, really bad for, and it can be three

Ganglion Cyst Comparison and Conclusion

[07:20] four, five, seven days. It can be really uncomfortable, hard to walk because that is so tight in your calf. But yeah, usually it does make it better. And are these things kind of like in the family of gangly insists? I guess kind of. Right? You can see you might have had a gangly insist around your wrist, which is a little bit of the outpouching of the fluid there. Or gangly insist in your foot. You might have had one. Yeah.

[07:40] kind of like that except it just goes out the back of the knee. Yeah, but it can be very very common and people really get bothered by it and unfortunately almost fix it on them a little bit. They're like, oh bigger cysts, bigger cysts, bigger cysts. It's a good news, bad news situation because we don't, you know, the good news is you don't need any specific treatment for your Baker cyst. The bad news is we don't have any specific

[08:00] treatment for your baker cysts. Yeah and then usually then you start to have a conversation well actually it's because you have arthritis maybe that's where you're sore and that's where you're stiff and that's where you're sore. Now you know. We made a video about this before. We did. We're massive for some reason. In the hallway. It's weird. It was a weird video. It was a weird time. If you like this video

[08:20] Please like and subscribe to our channel. And remember, you are in charge of your own health. I feel like you should be holding a banjo. You should not hold a banjo. Can you play the banjo? No, I cannot play the banjo. See you next time.