Some aspects of “Baker’s Cyst” with homoepathic mode of treatment

Also known as a ‘Popliteal Cyst’, Baker cyst is a distended bursa caused by knee joint fluid protruding to the back of the knee. It is thus a benign swelling & is named after Dr William Morrant Baker who first described this health condition. The term is a misnomer as it is not a true cyst but is due to synovial fluid distending the bursa.
Aetiology-
(1) Idiopathic- Baker cysts may sometimes develop without any apparent cause particularly in children.
(2) Infection- Local infection may cause a retention of fluid with the subsequent formation of a Baker cyst.
(3) Trauma or injury to the knee- It may cause an effusion, thus triggering the formation of a Baker cyst.
(4) Arthritis-Arthritis is the most common & osteoarthritis probably the most frequent among arthritides.
(5) Internal derangement of knee- Internal derangement of knee like meniscal tears etc. may cause an effusion resulting in the formation of a Baker cyst.

Location- It is located posterior to the medial femoral condyle, between the tendons of the medial head of the gastrocnemius & the semimembranosus muscles.

Age- Baker cysts appear much less frequently in children than in adults.

Pathology- Being an extension of the knee joint, a Baker cyst is a synovial cyst lined with a true synovium. In most cases herniation of synovial membrane through posterior part of capsule takes place. . Escape of fluid through the normal communication of bursa with knee is the other mode. The knee joint effusion caused by intrinsic intra-articular disorders or any other cause is displaced into the popliteal bursa, thus reducing potentially destructive pressure in the joint space. So a Baker cyst may have a protective role to play for the knee. In such cases, the popliteal bursa becomes filled up with fluid & consequently expands resulting in the formation of a swelling. The cyst usually communicates with the joint by way of a slit-like opening or may pinch off.

Associated health conditions-Medical conditions associated with Baker cysts are as follows-
(1) Arthritis is the most common among which osteoarthritis is the most important. Rheumatoid arthritis, Juvenile rheumatoid arthritis etc are also common.
(2) Internal derangement of knee like meniscal tears etc.
(3) Infection like septic arthritis.
(4) Miscellaneous- Hypothyroidism, Gout, Psoriasis, Systemic lupus erythematosus, Sarcoidosis, Haemophilia, etc.

Clinical features- May be asymptomatic or may have the following features in addition to the features of the underlying primary cause-
(1) A slight swelling behind the knee which is particularly noticeable on standing & when compared to the opposite uninvolved knee.
(2) The swelling is usually soft & fluctuant & is with or without pain. Typically these cysts are not painful unless swelling is extensive.
(3) A sensation of tightness behind the knee, especially when the knee is extended or fully flexed.
(4) Restricted mobility of the knee joint.
(5) Transillumination- Transillumination by a shining light through the cyst may show a mass filled with fluid.
(6) In case there is rupture of the cyst, calf tenderness & bruising at the ankle may be present.

Investigations-
(1) X-ray- An X-ray of the knee joint will not show any cyst, but it may show the presence of other abnormalities which may cause development of a Baker cyst.
(2) MRI- An MRI helps to show a cyst with its size & location.
(3) Ultrasound- An ultrasound can also determine the location & contents of a cyst.
(4) Arthrogram- Arthrograpgy may also be utilized for its detection & it is more sensitive than ultrasonography in its detection.

Complications- A Baker cyst may sometimes compress vascular structures & may cause a deep vein thrombosis. It may also rupture & cause extravasation of fluid in the calf. There may also be haemorrhage into the cyst in some cases, particularly if there is any associated bleeding disorder. Infection in case of a Baker cyst is very rare.

Differential Diagnosis- A Baker cyst may sometimes be confused with thrombophlebitis or deep vein thrombosis from which it is to be differentiated by urgent blood tests & other investigations. It may also sometimes be confused with septic arthritis or a ganglion cyst.

Treatment-
[A] General measures to be taken are-
(1) Treatment of underlying cause like arthritis or torn knee cartilage.
(2) Temporarily avoiding activities that may increase the load on the knee joint. (3) Physiotherapy.
(4) Exercises to maintain mobility & strength of the knee joint.
[B] Homeopathic medicines to be used – Homeopathy can be very effective if properly used. Homeopathic medicines to be used depend on the size of the cyst along with its cause & the symptoms produced. Ruta Graveolens (Ruta), Rhus toxicodendron (Rhus tox), Bryonia etc. may be used. The potency & frequency of dosage as well as duration of treatment varies with the severity of the condition & the individual

Prevention- Prevention of knee injury is essential for reducing the risk of development of a Baker cyst for the first time or its recurrence after treatment. Hence supportive footwear appropriate to the activity of an individual is to be worn as well as stoppage of the activity & seeking of medical advice after an injury is needed.
Prognosis- Prognosis of Baker cysts depends on the presence of any underlying knee pathology & the degree of its response to treatment। Most Baker cysts without any underlying knee pathology disappear spontaneously after several years, particularly in children & young adults in whom usually there is no underlying knee pathology। But in some cases a Baker cyst continues to grow with worsening of the symptom & ultimately may rupture & produce acute pain behind the knee & in the calf & swelling of the calf muscles।

In short, a Baker cyst manifests itself as a soft swelling behind the knee with or without pain & can be treated by Ruta, Rhus tox or Bryonia.

But in every case, a doctor should be consulted.

Some aspects of “Housemaid’s knee” with homoepathic mode of treatment-

Also known as roofer’s knee, it is a benign swelling over the knee on account of an enlargement of the bursa named prepatellar bursa in front of the patella, which in turn is due to an inflammation of the said bursa. Housemaid’s knee is so named because of the fact that this health problem was once found to be a major occupational hazard of Housemaid’s knee & was believed to be caused by leaning too much on the knee by them.

Pathology- Prepatellar bursa is a superficial bursa with a thin synovial lining in front of the patella in between the skin & the patella. It is seen in the lower half of patella & upper half of ligamentum patella. The bursa develops after birth within a few years of life as a result of mechanical pressure & friction. It helps in reducing friction on the underlying structures & thus allows maximal range of motion in the knee. The inflammation of the bursa usually due to repeated trauma to the knee with excess fluid causes restricted movement of the joint with pain, swelling & heat.

Age- Any age group can be affected.

Sex- It is more common in males.

Predisposing factors-
(1) Repeated rubbing or pressure on the knees from kneeling on hard surfaces in an occupation.
(2) A direct blow or a fall on the knee causing rupture of blood vessels & subsequent swelling of the prepatellar bursa.
(3) Spread of an infection from a surface injury, such as a skin wound over the kneecap. Infection is usually the main cause of Housemaid’s knee in children. Infection is also the main cause in people in whom the immunity is deranged such as those on steroid therapy or chemotherapy for cancer.

Clinical features-
(1) Swelling over the kneecap.
(2) Warmth over the kneecap.
(3) Limited motion of the knee.
(4) Painful movement of the knee.
Kneeling usually aggravates the symptoms, while sitting still relieves them.

Treatment-
[A] General measures to be taken are-
(1) Avoidance of the aggravating activity.
(2) Wearing of knee pads while kneeling.
(3) Exercise to strength the quadriceps muscle.
(4) Physiotherapy.

[B] Homeopathic medicines to be used are- Specific remedies include Arnica, Bryonia or Ruta graveolens (Ruta)। The potency & frequency of dosage varies with the severity of the condition & the individual। Usually a lower potency is to be used first for thrice daily & to be continued till the persistence of the symptoms। If improvement is seen, the same medicine is to be continued. But if there is no significant improvement or improvement has come to a standstill, the frequency of dosage should be increased. And in cases where there is no response within a reasonable amount of time, the medicine should be stopped & a different medicine is to be started. It is to be kept in mind that Housemaid’s knee caused by infection needs to be recognized quickly & treated promptly.


Prevention- Use of knee pads by those whose work necessitates kneeling for extended periods of time. This is especially true for those who had already an episode of Housemaid’s knee to prevent recurrence.

Prognosis- Housemaid’s knee may interfere with physical activity, but otherwise it is relatively harmless. But if left untreated, there may be associated loss of quadriceps muscle strength which in turn may cause the leg to give out.

In short, Housemaid’s knee manifests itself as a swelling over the kneecap & can be treated by Arnica, Bryonia or Ruta.

But in every case, a doctor should be consulted.

Some aspects of Internal Hordeolum with homoepathic mode of treatment-

It is the suppurative inflammation of a meibomian gland of exactly same nature as stye but is comparatively rare. It is often called a suppurative chalazion and sometimes may be due to secondary infection of a chalazion.

Causative agent- Staphylococcus.

Symptoms-They are same as for stye but are more severe.

Signs-
(1) A tender, painful swelling within the substance of the lid in the tarsal plate, a little distance away from the lid margin.
(2) The point of maximum tenderness is away from the lid margin.
(3) If the lesion enlarges, the pus points on the tarsal conjunctiva and not on the root of an eyelash. It rarely points on the skin.

Treatment-
(1) Lid hygiene should be properly maintained.
(2) Blood sugar should be controlled in case of diabetes mellitus.
(3) General health of the patient should be improved with good nutrition and vitamins.
(4) Refractive errors, if any, should be corrected with suitable glasses (spectacles) or contact lenses।

(5) Hot compresses may be applied.
(6) Homoeopathy plays a good role in its treatment. Of the different medicines, Hepar Sulph (Hepar Sulphuris Calcareum) 30 should be given six times daily for a week if there is intense pain. Silicea 30 may also be used & should be given six times daily for a week if the pain is stitching in nature.

Labels-Blood sugar, Chalazion, Conjunctiva, Contact lens, Diabetes mellitus, Hepar Sulph (Hepar Sulphuris Calcareum), Eyelash, Glass, Health, Homoeopathy, Refractive errors, Spectacle, Hygiene, Internal Hordeolum, Nutrition, Patient., Pus, Silicea, Skin, Vitamin.

IN SHORT- Internal Hordeolum is manifested as a tender, painful swelling within the substance of the lid a little distance away from the lid margin. Treatment is followed as mentioned above.

But in every case, a doctor should be consulted.