• What is a Baker’s Cyst?

    Posted by Orthopaedic Specialists

    Unfortunately it has nothing to do with chocolate cake…A Baker’s cyst is a collection of fluid that accumulates in the back of the knee. It typically occurs from one of three different sources.

    1. The most common reason people develop a Baker’s cyst is from osteoarthritis. If you have an arthritic joint that gets inflamed, and is in the inflammatory stage, it produces fluid. The fluid can leak out of the knee joint and accumulate in the back (posterior) part of the knee outside of the actual knee joint.
    2. The second source of a Baker’s cyst is a tear of the meniscus. When you have a meniscal tear fluid can leak out of the knee joint. It creates a one way valve where fluid leaks out and cannot get back into the knee joint. Therefore it collects and forms a cyst.
    3. You can also have a tear in one of your tendon sheath that surrounds your hamstring tendons and fluid can leak out in that area and create a Baker’s cyst as well.

    Can Baker’s cyst get bigger and smaller?

    Yes, if your arthritis goes into a non-inflammatory stage. When the knee joint produces less fluid, the baker cyst will get smaller and sometimes completely resolved. Baker’s cysts can also get so big that they rupture on their own. If you have a meniscal tear and you undergo surgery, the bakers cyst tends to go away on its own.

    Frequently Asked Questions:

    1. Can a Baker’s cyst become malignant or cancerous? – No
    2. If a Baker’s cyst is drained will it come back? – Yes, you must stop the source of the fluid that’s creating the Baker’s cyst. Simply draining the cyst with a needle will decompress the cyst for a short period of time typically less than 24 hours and then the fluid will accumulate again. If you have arthritis, reducing the inflammatory phase of the arthritis will reduce the size of the Baker’s cyst. If you have a meniscal tear, having a knee arthroscopy will eliminate the Baker’s cyst.
    3. Can a Baker’s cyst be surgically removed? – Yes, but they tend to come back very quickly if you don’t stop the source of the fluid that is causing the bakers cyst to occur.
    4. What is inside of a Baker’s cyst? – Synovial fluid, located inside of your knee joint that helps to lubricate your knee.
    5. Will you remove the Baker’s cyst at the time of a knee arthroscopy which is being done for a meniscal tear? – No, the Baker’s cyst is actually located outside of the knee joint and outside of the capsule of the knee. You cannot access the Baker’s cyst from the inner part of the knee joint while doing a knee arthroscopy. By resecting the meniscal tear the Baker’s cyst typically will go away.

    What Happens If You Remove the Whole Meniscus?

    Posted by Orthopaedic Specialists

    1. The force on the cartilage in the knee joint increases by almost 300%.
    2. This huge increase of force accelerates the wear of the articulations cartilage which ultimately results in early onset osteoarthritis.
    3. Prior to knee arthroscopy: pre 1980’s, Orthopaedic surgeons would remove the whole meniscus when there was a tear and a large majority of those folks went on to develop advance osteoarthritis in their knee; resulting in knee replacement surgery at an early age.

     

     

    Carpal Tunnel Release

    Posted by Orthopaedic Specialists

    Now that is a hand I would NOT like to do a carpal tunnel release on in the operating room. Instead of having to stand on to step stools like I typically do when operating, I would need a full-fledged extension ladder.

    Carpal tunnel syndrome is a condition where the retinaculum, which is a structure that lies over your median nerve, gets inflamed and thickened. When this occurs the inflamed retinaculum can push on the median nerve which irritates it. This causes pain, numbness and tingling involving your thumb, index finger and middle finger. Pain can shoot up to your elbow with carpal tunnel syndrome.
    The treatment starts with physical therapy, wearing a night brace, taking B vitamins and sometimes a cortisone injection. Diagnostic imaging includes a plain x-ray and an EMG/nerve conduction study.
    If this treatment fails surgery is an option.

    Can a Torn Meniscus be Repaired?

    Posted by Orthopaedic Specialists

    Yes, but not often, only less than 5% of the time. Why?

    The meniscus is divided up into three zones. Two of the three zones have a very poor blood supply. Blood is needed to aid in a repair. Sutures can be placed to hold the torn meniscus together, but if there is no blood supply the meniscus will not heal.

    Most meniscus tears occur in the area where there is poor blood supply. Therefore repairing the meniscus is not an option, only removing the torn portion is the treatment. The majority of people when they have their knee scoped are NOT getting a meniscal repair they are undergoing a partial menisectomy.

    Those that can get their meniscal tear repaired usually have tears that occur at the same time an ACL injury occurs. The meniscal tear pattern in that injury tends to occur in the region of the meniscus that has a good blood supply.

    This image with red circle reveals a tear in the red zone of the meniscus.


    The blue arrow in this image indicates the white zone, while the red arrow points to the red zone.


    The blue arrow in this next image shows the white zone of the meniscus while the red arrow indicates the red zone.


    This shows an ACL tear.

    Does Removing a Torn Meniscus Harm the Knee Joint?

    Posted by Orthopaedic Specialists

    The meniscus is a shock absorber in the knee. The part of the meniscus that tears no longer has shock absorber properties.

    The torn part of the meniscus causes pain, irritation to the knee and on occasion mechanical symptoms such as catching and locking. By removing the torn part of the meniscus it doesn’t not harm the knee because the torn part of the meniscus was not functioning.

    If large portions of the meniscus are torn, that can lead to early onset osteoarthritis because a large portion of the meniscus is missing and therefore a larger portion of the shocker absorber is gone. The knee scope just removes the torn portion of the meniscus removing the pain source.

    Below are tools I use to remove the torn portion of the meniscus.

    Snowboarder Vs. Skier

    Posted by Orthopaedic Specialists

    The skier lost …

    Image on left is a normal pelvis. Image on right with red circle and arrows points to the fracture of the inferior and superior pubic rami.

    What is that area in the bone?

    Posted by Orthopaedic Specialists

    What is that area in the bone that is white, where the red arrow is pointing ?

    This patient fell and has acute onset pain involving her ankle. She has a bone cyst also known as a aneurysmal bone cyst. She was most likely born with this cyst and never knew it until she had a trauma. We took an x-ray in the office which showed the cyst and then obtained an MRI scan. The arrow is actually pointing to where she broke through the bone where the cyst is located. This does not appear to be malignant. This will heal with immobilization in a cast boot.

    Five Signs You Have Torn Your Meniscus

    Posted by Orthopaedic Specialists

    1. Sharp, stabbing pain located in your knee joint.
    2. It is easy to localize the pain in the knee and it is consistently in the same place.
    3. No pain occurs when resting. Pain occurs with a plant and a twist, lateral motion or flexion of the knee.
    4. Slight swelling is present and the knee can feel tight with a slight limit of motion.
    5. Clicking, locking of the knee and popping may occur.

    Girl Bosses

    Posted by Orthopaedic Specialists

    Attended a great meeting this morning on girl bosses at the Kentucky Derby Museum with my two amazing hard working and motivated #girlbosses! An amazing panel of women: Tonya Abeln, Raeshanda Johnson, Iris Wilbur and Elizabeth McCall.

    My favorite quote of the morning was from Raeshanda, “If somebody closes a door, I go back and buy the building.” Tonya is the director of Community Relations at Churchill Downs. Raeshanda owns and runs her own fashion house: All is Fair in Love and Fashion. Iris is the Director of Government Affairs and Public Policy at Louisville Inc. Elizabeth’s an Assistant Master Distiller at Woodford Reserve. Amazing women!!!

    Five Ways to Prevent Tennis Elbow as a Tennis Player

    Posted by Orthopaedic Specialists

    1. Purchase a racket that is flexible. Stiff, high power level rackets will transmit the force the ball produces when it strikes the racket up to the elbow area, irritating the common extensor tendon.
    2. Use strings that are poly filament. A monofilament string tends to increase the force on the players elbow.
    3. Have your tennis pro string your racket about 2 to 3 pounds lower than normal.
    4. Over wrap the grip on your racket by one or two layers. A smaller grip encourages and transmits more tension on the common extensor tendon when holding the racket.
    5. Take a lesson from your friendly tennis pro. How many times have you watched a major tennis tournament on television or live and saw one of the pro players wearing a tennis elbow band. You don’t. Because they have perfect technique. Hitting the ball late can contribute to tennis elbow.