E-ISSN:2456-3110

Case Report

Report on Baker’s Cyst

Journal of Ayurveda and Integrated Medical Sciences

2023 Volume 8 Number 10 October
Publisherwww.maharshicharaka.in

A Single Case Report on Baker’s Cyst - A Successful Ayurvedic Surgical Approach

Hiremath S1, Aradhyamath S2, Aditya J V3, Priyadarshini DJ4*, Rohit5
DOI:10.21760/jaims.8.10.36

1 Savita Hiremath, Professor HOD, Dept of Kriya Shareera, JSS Ayurveda Medical College Hospital, Mysore, Karnataka, India.

2 Siddayya Aradhyamath, Professor HOD, Dept of PG and PhD Studies in Shalya Tantra, JSS Ayurveda Medical College Hospital, Mysore, Karnataka, India.

3 Aditya J V, Assistant Professor, Dept of PG and PhD Studies in Shalya Tantra, JSS Ayurveda Medical College Hospital, Mysore, Karnataka, India.

4* Priyadarshini DJ, Second Year Post Graduate Scholar, Dept Of Pg And Phd Studies In Shalya Tantra, Jss Ayurveda Medical College Hospital, Mysore, Karnataka, India.

5 Rohit, First Year Post Graduate Scholar, Dept of PG and PhD Studies in Shalya Tantra, JSS Ayurveda Medical College Hospital, Mysore, Karnataka, India.

Baker’s cyst or Popliteal cyst is a fluid filled sac, which can be understood as Kaphaja Granthi, as because of character mentioned like slightly discolored, cold to touch, slight pain and itching. The treatment principles in both Modern and Ayurveda is similar i.e., Incision and total Excision. The detailed case study of Khapaja Granthi in 9 year old was girl taken until 2 follow up for discussion. The patient was successfully managed with regular wound care and dressing, patient got complete relief from her complaints. The challenges involved in treatment of a 9 year old girl is damage to the vitals structures like Popliteal artery and Tibial nerve. The complication of Baker’s cyst if it left untreated are Rupture of cyst -Synovial fluid can leak into the calf below causing pain, swelling and reddening, Trapping of Tibial Nerve, Blockage of Popliteal artery. The other treatments of Baker’s cyst are Counter pain medicine, Arthrocentesis to removal excess fluid from the joint space, Steroidal injection into the joint to reduce cyst size.

Keywords: Khaphaja Granthi, Baker’s Cyst, Popliteal Cyst, Chedana, Bhedana, Tibial Nerve, Popliteal Artery

Corresponding Author How to Cite this Article To Browse
Priyadarshini DJ, Second Year Post Graduate Scholar, Dept Of Pg And Phd Studies In Shalya Tantra, Jss Ayurveda Medical College Hospital, Mysore, Karnataka, India.
Email: 		Hiremath S, Aradhyamath S, Aditya J V, Priyadarshini DJ, Rohit, A Single Case Report on Baker’s Cyst - A Successful Ayurvedic Surgical Approach. J Ayu Int Med Sci. 2023;8(10):226-230.
Available From
https://jaims.in/jaims/article/view/2830

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2023-08-05 2023-08-21 2023-09-08 2023-09-22 2023-09-30
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
None declared Nil Yes 22.55

© 2023by Hiremath S, Aradhyamath S, Aditya J V, Priyadarshini DJ, Rohitand Published by Maharshi Charaka Ayurveda Organization. This is an Open Access article licensed under a Creative Commons Attribution 4.0 International License https://creativecommons.org/licenses/by/4.0/ unported [CC BY 4.0].

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Savita Hiremath et al. Case Report on Baker’s Cyst Successful Ayurvedic Surgical Approach

Introduction

Baker’s cyst that forms at the posterior aspect of the knee in popliteal fossa between the semimembranous and medial head of the Gastrocnemius.The eponym ‘Baker’s cyst’ honors British surgeon William Morant Baker’s who wrote a description of 8 cases of popliteal cysts that he had seen.[1] The idiopathic form affects children between 2 to 14 years and adults between the ages of 35 to 70 years[2] tend to be affected more the incidence is between 10% to 41% while the prevalence is 5%.[3] Twice as common as in male usually it is asymptomatic but may cause discomfort and movement limitation, it is commonly found in association with knee joint disorder such as Meniscus tear and Osteo-Arthritis, common symptoms includes swelling or lump behind knee, pain, fluid accumulation around the knee and clicking, locking of knee joint.

Case Report

A 9 year old girl visited to hospital with complaints of painless swelling in right leg behind the knee since 1 year.

History of present illness

As per the statement given by the attender, patient was apparently healthy one year back, then she gradually noticed painless swelling in right leg behind the knee associated with occasional pain and discomfort, for these complaints they approached nearby hospital and taken medicines but did not get relief, so for further treatment they approach to our hospital for management.

History of past illness

No history of past Surgery.

No history of Trauma.

Family History

Nothing significant.

Asta Sthana Pariksha

  • Nadi - 90 bpm
  • Mala - 2 time a day.
  • Mutra - 4 -5 times a day.
  • Jihwa - Alipta
  • Shabda - Prakruta
  • Sparsha - Prakruta
  • Drika - Prakruta
  • Akriti - Madhyama

Systemic Examination

CNS

Higher mental function test: Conscious well oriented with time place person.

Memory: Recent and remote: intact

Intelligence: Intact

Hallucination / delusion / speech disturbance: Absent

Cranial nerve / sensory nerve / motor system: Normal

Gait: Normal

CVS

Auscultation: S1 and S2 heard, no murmur/added sound

RS

Inspection: B/L symmetrical

Palpation: Trachea is centrally placed, Non tender

Auscultation: B/L NVBS heard

GIT

Inspection: No scar marks, No discoloration

Palpation: Soft, non-tender, No organomegaly

Auscultation: Normal peristaltic sound heard

Percussion: Normal resonant sound heard over abdomen

Local Examination / Examination of Cyst

On Inspection

Site: Popliteal fossa

Size: 3 x 1.5cm

Shape: Oval

Surface: Soft and Smooth

Edge: Regular

On Palpation

Tenderness: Not Tender


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Savita Hiremath et al. Case Report on Baker’s Cyst Successful Ayurvedic Surgical Approach

Margin: Well defined

Lymphnode: Not Palpable

Investigation

X-Ray of Left Knee - Ap and Lateral View

Differential Diagnosis

  • Abscess
  • Lipoma
  • Sebacecous Cyst
  • Varicosity
  • Hemangioma
  • Lymphadenopathy

Diagnosis: Baker’s Cyst - Kaphaja Granthi

Treatment Planned

Chedana Karma - Excision of Baker’s Cyst.

Operative Procedure

Pre-Operative

  • Patient was advised for NBM before 6hr of Surgery.
  • Written consent taken.
  • Inj Xylocaine 0.3 ml SC test dose and Inj T.T 0.5 ml IM given.
  • Proctoclysis enema given.
  • Part preparation done.
  • IV fluids started 1hr prior to Surgery.

Operative

  • Under all aseptic precaution patient was shifted to OT.
  • Spinal Anesthesia given.
  • Part prepared and draped with Betadine solution.
  • Linear incision taken vertically over the swelling Skin Superficial fascia Deep fascia.
  • Then gastiocnemius medial muscle separated cyst was identified adhesion cleared and cyst ligated and excised from the bas
  • Layers were sutured with continuous suture with Vicryl 2.0 and skin with Simple interrupted suture.
  • Part painted with Betadine solution and complete wound closure done with bandage.

Post Operative

  • Patient was advised NBM 6hr after surgery.
  • Advise for restricted head movement for 6hrs.
  • Restricted limb movement of operated side.

Image 1: Skin Incision
Jaims_2830_01.jpg

Image 2: Identification of Cyst
Jaims_2830_02.jpg

Image 3: Ligation and Excision of Sac
Jaims_2830_03.jpg


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Savita Hiremath et al. Case Report on Baker’s Cyst Successful Ayurvedic Surgical Approach

Image 4: Ligation and Excision of Sac
Jaims_2830_04.jpg

Image 5: Skin closure done with Vicryl 2-0
Jaims_2830_05.jpg

Image 6: Follow Up after 20 days
Jaims_2830_06.jpg

Discussion

If Bakers Cyst not addressed leads to compression of surrounding vessels. If Cyst begins to enlarge into the calf muscle this too can result in swelling, erythema, distal edema and a positive homan’s sign - similar to thrombophlebitis or DVT. If the Cyst ruptures it may also lead to entrapment of posterior tibial nerve, occlusion of popliteal artery, anterior foot drop, posterior compartment syndrome. As per Acharya Sushruta this can be compared to Kaphaja Granthi with the symptoms like swelling which is cold in touch (Sheeta), Not discolored (Avivarna), has slight pain but severe itching (Rujoathikandu), grown big like a stony appearance (Pashanavath Samhanopanna).[4]

Conclusion

Cysts can be compared to granthi in Ayurvedic texts. In this surgical excision is the line of treatment i.e., Chedhana Karma. As per the Yukti of surgeon one should adopt the surgical excision here, care should be taken not to injure the underlying arteries and viens as the same said by Acharya Sushruta - ‘Marma Sira Snayu Sandhi Asthi Pariharan’.[5] Acharya Sushruta has included every topic related to surgery from the anatomical consideration to description of diseases and their surgical management including surgical instruments to be used. This has been explained prior to development of modern medical system. Hence Acharya Sushruta is regarded as father of surgery.

References

1. Baker WM. On the formation of synovial cysts in the leg in connection with disease of the knee joint. 1877. Clin Orthop Relat Res. 1994;299:2-10.

2. Maximiliano, V. J., Matias, P. D., Pablo, Z. J., Carlos, Y., & Matías, C. P. (2018). Infected Baker’s Cyst: A New Classification, Diagnosis and Treatment Recommendations. Journal of Orthopaedic Case Reports, 8(6),

3. Zhou, X. N., Li, B., Wang, J. S., & Bai, L. H. (2016). Surgical treatment of popliteal cyst: a systematic review and meta-analysis. Journal of orthopaedic surgery and research, 11(1), 1-9.

4. Srikanta murthy, K.R. Grantividradi Alaji adhaya. In: Srikanta murthy, K.R (ed.) Susruta Samhita Vol 1. Varanasi: Chaukhamba Orientalia; 2017. Sloka 6.


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Savita Hiremath et al. Case Report on Baker’s Cyst Successful Ayurvedic Surgical Approach

5. Srikanta murthy, K.R. Agroparaniya adhaya. In: Srikanta murthy, K.R (ed.) Susruta Samhita Vol 1. Varanasi: Chaukhamba Orientalia; 2017. Sloka 7.


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