Synovial Cysts, Bakers Cysts & Popliteal Cysts
"No patient in the control group presented with synovitis or cartilage damage, while these were quite frequent findings in the Lyme disease group. Baker's cysts were more frequent in the Lyme disease group, but this was statistically non-significant." ... "Baker's cysts occur and can rupture if not aspirated." Source
Eur J Pediatr. 2006 Mar;165(3):178-81. Epub 2005 Dec 13.
Uncommon synovial cysts in children.
Pediatric Rheumatology, Charite-Universitaetsmedizin, Berlin, Germany. email@example.com
Popliteal synovial cysts (Baker's cysts) are a common occurrence in children and adults. Synovial cysts in other locations and/or with atypical extension are less common and may be confounded with tumors or other medical conditions.
In this article we describe the underlying disease, clinical presentation and clinical course in six children with a sudden onset of paraarticular soft tissue masses or non-specific chronic pain. Ultrasound was the initial imaging method used in all cases; this was supplemented by MRI in three patients.
Four children were diagnosed to be suffering from juvenile idiopathic arthritis (JIA), one child from Lyme Arthritis, whereas in one child no underlying disease was identified.
Well-demarcated hypoechogenic lesions without signs of perfusion extending from the shoulder (two patients), elbow (one patient), hip (one patient), knee (1) or ankle (one patient) far into the adjacent musculature were detected on ultrasonography.
A direct connection to the joint was demonstrated in all cases. All synovial cysts in the five arthritic patients resolved rapidly with medical treatment for arthritis, whereas the cyst persisted in the non-JIA patient.
Uncommon synovial cysts occur in particular as a complication of arthritis. Ultrasonography is the initial and follow-up imaging method of choice, which can be supplemented by MRI in unusual cases. Apart from treatment for arthritis, no specific therapeutic interventions were required in the present cases.
J Pediatr Orthop. 2006 Nov-Dec;26(6):725-7.
Lyme disease presenting as popliteal cyst in children.
Department of Orthopaedics and Rehabilitation, Milton S. Hershey Medical Center, The Pennsylvania State University College of Medicine, Hershey, PA 17033, USA. firstname.lastname@example.org
Lyme disease is the most common tick-borne disease in North America. Our review of the literature found few reports of Lyme disease presented in the orthopaedic literature. However, Lyme disease presenting as a popliteal cyst, with or without rupture, is rarely reported.
We present 4 cases of Lyme disease that initially presented to our pediatric orthopaedic clinic for treatment of a popliteal cyst.
The early diagnosis and treatment of Lyme disease may help prevent the often-devastating long-term sequelae of Lyme disease. The goal of this article is to increase the awareness of Lyme disease presenting in children as a popliteal cyst.
Med Mal Infect. 2007 Jul-Aug;37(7-8):523-31. Epub 2007 Mar 26.
[Clinical diagnosis of Lyme borreliosis in case of joint and muscular presentations].
[Article in French]
The diagnosis of Lyme borreliosis in case of joint and muscular presentations is generally suggested by epidemiological factors. However, as a rule, laboratory testing is required to confirm the diagnosis. When considering the epidemiology of Lyme borreliosis in France, the only areas free of ticks infected by Borrelia burgdorgeri sl, are those close to the Mediterranean sea or at high altitude.
The risk is greatest in the Alsace region. Exposure is particularly high among forest workers and people who use the countryside for their leisure activities. The likelihood of infection following a tick bite is difficult to assess; indeed, the bite site may remain unnoticed.
A medical history of erythema migrans, if untreated, is a major diagnostic clue, although the association appears to be less consistent in France than in the US. Lyme arthritis generally arises apparently spontaneously. It is characteristically mono- or oligo-articular, asymmetrical, predominantly affects the knee, and has an intermittent course.
Synovial cysts and enthesitis are common. Myositis is rare, polymorphic, and has been linked to other symptoms in the same localizations. Minor arthralgia and myalgia frequently occur, principally early in the course of the infection. It was suggested that sequels of the disease include so-called fibromyalgic syndromes.
The principal differential diagnosis as far as arthritis is concerned, is made on spondylarthropathy and chronic juvenile arthritis. Rheumatoid arthritis is another pathology, although Lyme arthritis does sometimes evolve to chronicity.
Steelman TJ, Wagner SC, Jex JW.
Pediatr Infect Dis J. 2015 May;34(5):548. doi: 10.1097/INF.0000000000000610. No abstract available.
Kishimoto M, Nguyen M, Solitar B, Mitnick HJ.
J Clin Rheumatol. 2007 Dec;13(6):365-6. doi: 10.1097/RHU.0b013e31815c5ebc. No abstract available.
Pediatr Infect Dis J. 2015 May;34(5):548. doi: 10.1097/INF.0000000000000610.
Popliteal cyst with positive antinuclear antibodies as the presentation of Lyme disease.
Department of Orthopaedics, Walter Reed National Military Medical Center, Bethesda, Maryland Division of Orthopaedics, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland.