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Dear Colleagues: This month I would like to take a look at the subject of Baker's cysts. These cysts are common and often no more than a nuisance, but occasionally they become painful. They may even lead to complications affecting nerve supply and leg circulation creating a situation resembling deep vein thrombosis. Most Baker cysts develop in the gastrocnemius-semimembranous bursa of arthritic knees (rheumatoid or osteoarthritis). They typically contain synovial fluid that is continuous with that of the knee joint space. However there are other less common causes and they may even develop in the knees of young children, where no communication exists between the cyst and the knee joint. For more on unusual presentations, see this review. Many cases need no treatment. Often the cysts subside after a year or two. If pain or discomfort develops, the standard treatment is rest, elevation and avoidance of strenuous activity. Compresses are also prescribed at times. Surgery may be resorted to in more severe cases. A recent report favours arthroscopic excision of the cyst rather than a direct approach. Does neural therapy have a role in treating Baker's cysts? Probably not in most cases, but there are always exceptions. How about this case? A 68 year-old woman, a self-described religious "hermit," lived a physically active life in a rural setting, growing her own food, hauling in firewood, carrying water, etc. Over a period of about six months she began to experience "tight cords" in her left posterior kneegradually spreading into her posterior thigh muscles. Prolonged standing made her symptoms worse. She could feel swelling behind her knee, but it was not consistent and changed in size from day to day. Her knee had a mild chronic valgus and she had a history of knee strains and chronic left foot problems for which she had used orthotics in the past. She had never undergone surgery and there was no history of serious trauma. However she had a mild uterine prolapse for which she used a pessary, but not consistently. At her first visit, there was no swelling of her knee, posteriorly or anywhere. The knee had a full range of passive extension and about 10 degrees limitation of passive flexion. Because she insisted that there was intermittent swelling behind her knee, and a physiotherapist had said she had a Baker's cyst, an ultrasound was ordered. The ultrasound report indicated no Baker's cyst and no sign of any other knee pathology - yet there was (on the second visit) a fluctuant posterior-knee swelling, 30 degrees limitation of passive flexion and no limitation of extension. Those readers familiar with the late James Cyriax's teaching of joint pathology may remember that arthritic joints, no matter the cause, will have a "capsular pattern" of passive motion restriction. Each joint has its own pattern and for the knee the pattern is restriction of both flexion and extension, but more of flexion. In the case of my patient there was no limitation of extension at all. Since Baker's cysts develop in association with arthritic knees, what was going on? Did the patient really have an arthritic knee? Clearly something unusual was going on. This necessitated a search for interference fields, and yes, an interference field was found (through autonomic response testing) in the coccyx. The interference field was treated using the Tenscam device (a procaine injection would have been at least as effective. See page 192 of my book.) A week later the patient returned declaring that the "knee stiffness was greatly reduced". The discomfort in her hamstrings was gone and swelling developed in her posterior knee only after standing more than an hour. An interference field was again present in the coccyx and treated with the Tenscam. 10 days later the knee was asymptomatic and has remained so, with no swelling. From my review of the literature and this case, it is clear that not all Baker's cysts are the same. My patient's cyst varied in size markedly from day to day. She also had a history of injury to her knee, a slight valgus and recurring ankle and foot problems, all on the same side. The interference field in the coccyx was interesting as there was no history of local injury, but she had pelvic floor problems and needed to use a pessary from time to time. This is probably why her coccyx, or more likely the pre-coccygeal ganglion, was in a hyper-sympathetic state or had become an interference field. __________________________________________________________________________ New neural therapy research article: Weinschenk S. et al: Local Anesthetics, Procaine, Lidocaine, and Mepivacaine Show Vasodilatation but No Type 1 Allergy: A Double-Blind, Placebo-Controlled Study. ------------------------------------------------------------------------------------------------------- Neural therapy workshops: Introductory Neural Therapy for Osteopaths - in Australia Organized by George Stylian DO, mail to: georgestylian@gmail.com ------------------------------------------------------------------------------------------------- Integrative Biological Medicine, Neural therapy and Dental injections. The Best of Pure Neural Therapy: an exclusive training in NY Organized by Dr. Michael Gurevich. Register early to receive discount.
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