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Ruptured Baker's cyst causes ecchymosis of the foot. A differential clinical sign

Article  in  The Bone & Joint Journal · April 1993

DOI: 10.1302/0301-620X.75B2.8444957 · Source: PubMed

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 RUPTURED BAKER’S CYST CAUSES ECCHYMOSIS
OF THE FOOT

A DIFFERENTIAL CLINICAL SIGN

HERBERT P. VON SCHROEDER, F. MICHAEL AMELI, DIEGO PIAZZA, ALAN G. LOSSING

From the University ofToronto and the Wellesley Hospital, Toronto, Canada

Three consecutive patients with ruptured Baker’s cysts, We report ecchymosis as an additional sign of a
verified by duplex scan, were found to have ecchymosis on ruptured Baker’s cyst ; this may be of value in making the
the dorsum of the foot. The appearance of ecchymosis can correct diagnosis.
be helpful in differentiating a ruptured cyst from cellulitis
or deep-vein thrombosis.
CASE REPORTS

Case 1. A 25-year-old van driver, who had been diagnosed

JBoneJointSurg[Br] 1993; 75-B:3l6-7.
Received 11 May 1992; Accepted 14 August 1992
as having Reiter’s syndrome nine months earlier, pre-
sented with a two-week history of pain in the left knee
Cysts in the popliteal region were first described in 1840 and swelling for three days. He had a well-defined
by Adams, but were named after William Baker following ecchymosis anterior to the lateral malleolus. The knee,
his definitive description in 1877 (Baker 1877, 1885). calf and ankle were oedematous and the skin was
They are often associated with osteoarthritis, rheumatoid erythematous. He was admitted to hospital with a
arthritis, cartilage tears, trauma, or, less commonly, with presumed deep-vein thrombosis and cellulitis. Veno-
infections or gout (Baker 1 877, 1885 ; Burleson, Bickel graphy was normal and a duplex scan of the calf and
and Dahlin 1956; Harvey and Corcos 1960; Maudsley popliteal fossa revealed a ruptured cyst (5.6 x 1 .6 x
and Arden 1961 ; Wolfe and Colloff 1972) and result from 1 .0 cm) and no evidence of deep-vein thrombosis. After
a collection of synovial fluid in the gastrocnemius- two weeks of conservative management, the bruise on
semimembranosus bursa which communicates with the the foot was still present (Fig. 1) but the pain and oedema
knee (Burleson et at 1956; Bryan, DiMichele and Ford had resolved. A click was noted in the knee, and flexion
1967 ; Jayson and Dixon 1970). Signs and symptoms may was limited to 110#{176}.
include a local mass, pain and tenderness, peripheral Case 2. A 48-year-old electrician gave a two-day history
swelling, stiffness and effusion of the joint, a positive of pain in the left knee and a one-day history of calf
Homan’s sign, and a limp (Burleson et al 1956; Maudsley swelling. He had suffered mild chronic pain in the left
and Arden 1961 ; Good 1964 ; Bryan et al 1967). The cyst
may cause, or coexist with, thrombophlebitis of the leg
(Beatty 1959 ; Bryan et al 1967), but this is more often a
differential consideration (Perri, Rodnan and Mankin
1968). Other differential diagnoses include cellulitis,
popliteal varices, aneurysm, haemangioma, and tumour.

.i
H. P. von Schroeder, MD, Resident
Division of Orthopaedic Surgery, Mt Sinai Hospital, 600 University .‘ .“.

Avenue, Suite 476A, Toronto, Ontario, Canada M50 lXS. -

F. M. Ameli, FRCS, FRCS C, FACS, Associate Professor

A. G. Lossing, MD, FRCS C, Assistant Professor
D. Piazza, MD, Resident
Division of Vascular Surgery, The Wellesley Hospital, 160 Wellesley
Street East, Suite 31 3, Toronto, Ontario, Canada M4Y lJ3.
Fig. 1
Correspondence should be sent to Dr F. M. Ameli
Left ankle of case I , two weeks after the acute onset of symptoms,
©l993 British Editorial Society ofBone and Joint Surgery
showing a well-defined ecchymosis on the front of the ankle from a
030l-620X/93/2532 $2.00
ruptured Baker’s cyst.

316 THE JOURNAL OF BONE AND JOINT SURGERY

 RUPTURED BAKER’S CYST CAUSES ECCHYMOSIS OF THE FOOT 317

knee in the past. There was no history of recent fever, The blood which caused the ecchymosis may have
rheumatoid arthritis, venous thrombosis or trauma, come from within the cyst, which can be haemorrhagic
although he had fallen 15 feet four years earlier and since (Hench, Reid and Reames 1966 ; Bryan et al 1967), from
then had experienced chronic pain in the right ankle. He the ruptured wall of the cyst, or from other soft tissues
had a mildly swollen and tender left calf, the knee was a dissected by the extruded cyst contents.
little swollen, with no effusion, and radiography showed The presence of ecchymosis of the foot, although
osteophytes at the joint line. Homan’s test was negative; non-specific, may be of value in diagnosing a ruptured
full extension of the knee caused discomfort in the calf. Baker’s cyst.
Diffuse ecchymosis was present on the dorsum of the
No benefits in any form have been received or will be received from a
foot. A venogram was attempted but could not be
commercial party related directly or indirectly to the subject of this
performed because of inadequate veins in the foot. A article.
duplex scan of the calf and popliteal fossa revealed a
ruptured cyst (4.5 x 1 .1 x 1 .0 cm) and no evidence of
deep-vein thrombosis. The symptoms gradually subsided REFERENCES
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DISCUSSION Hench PK, Reid RT, Reames PM. Dissecting poplitealcysts simulating
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VOL. 75-B, No. 2, MARCH 1993

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