Jump to content
We need you! See something you could improve? Make an edit and help improve WikSM for everyone.

Bakers Cyst Aspiration and Injection

From WikiSM

Other Names

  • Bakers Cyst Aspiration and Injection
  • Gastrocnemius-Semimembranosus Bursa Aspiration and Injection

Background

Comparison of Knee Joint Anatomy (A) Normal; (B) Baker's Cyst patient[1]

Key Points

  • Needle: 1.5 to 3.5 inch, 18 gauge
  • Transducer: high frequency, linear probe
  • Typical approach is distal to proximal to avoid popliteal neurovascular bundle

Anatomy of the Semimembranosus Gastrocnemius Bursa

Palpation Guidance vs Ultrasound Guidance

  • Because of the neurovascular structures in the popliteal fossa, this procedure can not be safely performed by palpation guidance

Indications

Contraindications

  • Absolute
    • Anaphylaxis to injectates
    • Overlying cellulitis, skin lesion or systemic infection
  • Relative
    • Can be treated with less invasive means
    • Hyperglycemia or poorly controlled diabetes
    • Lack of symptom improvement with previous injection

Procedure

Short-axis view of the posteromedial popliteal fossa, demonstrating the relationship between the semimembranosus tendon (SM), medial gastrocnemius (MG), medial femoral condyle (MC), semitendinosus tendon (ST), and the expected location of a semimembranosus-gastrocnemius bursa (SM-MG B)[2]
Long axis view with needle in plane[3]
Needle and probe position for long axis approach (top) and short axis (bottom)[2]

Equipment

  • Sterile prep (i.e. chloraprep, chlorhexidine, iodine, etc)
  • Gloves
  • Needle: typically 21-25 gauge, 1.5 inch
  • Syringe: 5-10 mL
  • Gauze
  • Ethyl Chloride
  • Bandage
  • Injectate
    • Local anesthetic
    • Corticosteroid
  • Sterile probe cover

Ultrasound Findings

  • Approach
    • Transducer: high frequency, linear array
    • Best visualized in both long and short axis
  • Common ultrasound findings include:
    • Typically anechoic fluid collection
    • Septations and complex fluid collections with hyperechoic foci can be seen[4]
    • If bursal rupture, anechoic fluid can leak distally into the calf

Technique: Long or Short Axis, In Plane

  • Patient Position
    • Prone
  • Transducer position
    • Can be either short or long axis
    • Long axis is preferred
  • Needle Approach/ Orientation
    • In plane
    • Distal to proximal (long axis)
    • Medial to lateral (short axis)
  • Target
    • Middle of cyst
  • Pearls and Pitfalls
    • Needle can be redirected to breakup loculations
    • Identify the neurovascular bundle prior to beginning procedure
    • Following aspiration, switch syringes to inject the corticosteroid
    • Do not confuse the semimembranous tendon which can appear hypoechoic due to anistropy

Aftercare

  • No major restrictions in most cases
  • Can augment with ice, NSAIDS
  • Consider Knee Compression Sleeve to reduce re-accumulation

Complications

  • Infection
  • Damage to surrounding tissue

See Also

References

  1. ↑ Hutagalung, Muhammad Bayu Z., Panji Anugerah, and Safrizal Rahman. "The Role of Ultrasonography Exam in Baker’s Cyst: Case Report." The 1st Syiah Kuala International Conference on Medical and Health Sciences. 2017.
  2. ↑ 2.0 2.1 Malanga, Gerard A., and Kenneth R. Mautner. "Atlas of ultrasound-guided musculoskeletal injections." (No Title) (2014).
  3. ↑ Image courtesy of https://sonotool.net/
  4. ↑ Ward EE, Jacobson JA, Fessell DP, et al. Sonographic detection of Baker’s cysts: comparison with MR imaging. Am J Radiol 2001:176:373–380.
Created by:
John Kiel on 21 November 2024 16:55:02
Authors:
Last edited:
21 November 2024 18:27:03
Categories:
Retrieved from "https://wikism.org/w/index.php?title=Bakers_Cyst_Aspiration_and_Injection&oldid=26552"