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Question: I havea Baker's cyst in

my right knee. I'vehad it drainedtwice, but it keepscoming back. Arethere any othertreatments for itbesides draining?Is there an opera-tion that can fix itonce and for all?

Answer: Your sit-uation is fairlycommon. A Baker's

cyst (also called apopliteal cyst) is afluid-filled sac thatcan develop in thepopliteal space, thehollow at the backof the knee joint.

Baker's cysts arenamed for WilliamMorrant Baker, a19th-century sur-geon who first de-scribed thecondition. The cystis filled with syn-ovial fluid, a vis-cous material thatlubricates the kneeoint. Synovialfluid reduces fric-tion between thevarious parts of allyour joints, includ-ing your knee,which needs lubri-cation to flex andextend smoothly.

Although thereare several ways totreat a Baker's cyst,surgery is an un-common choice.Whatever the treat-ment, however, thecyst will oftenrecur if the under-lying cause hasn't

een corrected.A Baker's cyst

can be caused byan injury to theknee, such as a tearin a meniscus.Damage to the car-tilage from condi-tions such asrheumatoid arthri-tis or osteoarthritiscan also lead toBaker's cysts. Theseconditions maycause the synovialcells lining theknee joint to pro-

duce excess fluid. Ifthe fluid bulges

into the poplitealspace, a cyst candevelop. The ex-cess fluid can alsocause the wholeknee to becomeswollen.

A Baker's cyst isoften found inci-dentally during aphysical exam oran ultrasound per-formed for other

reasons. It maycause no symp-toms at all. It may

be a painless bulgeat the back of theknee. But it canalso cause pain,swelling and jointstiffness. Some-times the bulge isso large that it'shard to fully bendor straighten the

leg.Baker's cystsaren't dangerous,and they may goaway on their own.But occasionallythey burst. If thathappens, synovialfluid can leak intoyour calf below,causing pain andswelling.

These symptomsare similar to thesymptoms associ-ated with having a

blood clot in yourcalf. This is calleddeep vein throm-

bosis (DVT), and itis a common prob-lem. Most of theseclots develop be-cause blood flow inthe calf is slow.This is usually as aresult of inactivity.DVT is a seriouscondition that re-quires immediatetreatment. That'swhy it's importantto find the sourceof the problemright away. (Apainless Dopplerultrasound canusually identify aDVT in the calf.)

If your Baker'scyst causes discom-

fort or interfereswith your daily ac-tivities, there areseveral things youcan do. To bringdown swelling,apply a cold packto the area or use acompression wrap.To reduce inflam-

mation, take anover-the-counternonsteroidal anti-inflammatory drugsuch as ibuprofen(Motrin, Advil,others).

Because stress onthe knee joint canincrease inflamma-tion, rest your legand keep it ele-vated whenever

you can. Whenyou're up andabout, use a cane orcrutch. Sometimes,as in your case, aBaker's cyst needsto be drained. Yourdoctor may want toinject cortisone intoyour knee joint atthe same time, toquell inflamma-tion.

If, despite thesetreatments, the cyst

recurs and remains

troublesome, MRIimaging may be

done to detect anunderlying menis-cal tear or otherpossible cause ofincreased jointfluid and cyst for-mation.

While you'reconsidering youroptions, protectyour knee by doinggentle (non-weight-bearing)

range-of-motionand muscle-strengthening exer-cises. Strength orresistance training,which typicallyemploys equip-ment such asweight machines,free weights, andresistance bands ortubing, protects

against bone lossand builds muscle.

It also improvesyour body's ratio oflean muscle massto fat, improvingyour overall health.Consult your doc-tor or a physicaltherapist to set up aprogram that'sright for you.

You'll probablywant to scale backon activities such

as jogging, tennisor golf. And try tolower the stress onyour knee by main-taining a healthy

body weight. Withcommon sense andthe help of yourdoctor, you should

be able to cook up aprogram to controlyour Baker's cyst.

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Bakers cyst can recur unless underlying cause is foundBy the faculty of Harvard Medical School

Copyright 2012 the President and Fellows of Harvard

College. Developed by Harvard Health Publications(www.health.harvard.edu).Distributed by Universal Uclick for UFS. Submit

questions to harvard_adviser@hms. harvard.edu.

Chronicle-Express.com The Chronicle-Express Wednesday, April 11, 2012 B7