Compression syndromes of the popliteal neurovascular bundle due to Baker cyst

Abstract

Background: The purpose of this study was to perform a comprehensive search of the literature for all studies, case reports, and series describing Baker cyst compression of the neurovascular bundle in the popliteal fossa and index their findings according to the structures compressed. Method: Case reports and series obtained after a thorough MEDLINE search were indexed according to compressed structures. Patient demographics, main findings, method of diagnosis, cyst size, outcomes, and follow-up were recorded for each publication. Results: Signs and symptoms related to popliteal vein and tibial nerve compression were the most frequent presentation of symptomatic Baker cysts, due to the anatomic vulnerability of these structures within the popliteal fossa and their relative sensitivity to compression. Patients with tibial nerve entrapment demonstrated gastrocnemius muscle atrophy, paresthesias, and pain. Those with popliteal vein compression experienced swelling, pain, and rarely, venous thromboembolism. Isolated arterial compression, presenting with intermittent claudication, is a rare occurrence because it is a relatively stiff-walled vessel, has a higher pressure, and is located deep in the popliteal fossa. Combinations of these compression syndromes are most frequently encountered in the context of cyst rupture and resulting compartment syndrome. Conclusions: Baker cyst is an important pathology for the differential diagnosis of popliteal neurovascular compression phenomena. It has a wide spectrum of presentation, therefore requiring accurate diagnosis for proper patient management. Because Baker cyst is by definition a chronic disorder, long-term follow-up is necessary to monitor patient recovery and prevent recurrence. ( J Vasc Surg 2011;54:1821-9.)

The reliability of the clinical examination for detecting Baker's cyst in asymptomatic fossa

“…Baker's cysts can cause some complications such as calf swelling, pseudothrombophlebitis, compartment syndrome or pain . The association between BCs and pain is unclear.…”

Compressive Neuropathy of the Posterior Tibial Nerve at the Lower Calf Caused by a Ruptured Intramuscular Baker Cyst

“…Since most cysts originate from the gastrocnemius-semimembranosus bursa, they are located in the mid to superficial popliteal tissues [3] and may compress an adjacent neurovascular bundle [2]. Ruptured Baker cysts can cause lower leg and ankle swelling with pain that is clinically indistinguishable from that associated with acute deep vein thrombosis.…”

“…Ruptured Baker cysts can cause lower leg and ankle swelling with pain that is clinically indistinguishable from that associated with acute deep vein thrombosis. For this reason, ruptured Baker cysts have also been called pseudothrombophlebitis [1,2,6]. Occasionally, the ruptured of these cysts may cause tibial nerve entrapment and demonstrate sensory symptoms such as paresthesia, numbness, or pain, and occasionally, they are known to gastrocnemius muscle atrophy [6].…”

“…Baker cyst develops from enlargement of the gastrocnemius-semimembranosus bursa [1,2]. Although most Baker cysts commonly present as an asymptomatic mass occurring just below the popliteal fossa, they may cause clinical problems such as thrombophlebitis, compartment syndrome, and entrapment neuropathy [1-4].…”

Proximal Dissection and Rupture of a Popliteal Cyst: A Case Report

“…Compression syndrome secondary to entrapment of the neurovascular bundle in and around the popliteal fossa is a well-known complication [3]. …”