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Fascia and the Circulatory System
Published in David Lesondak, Angeli Maun Akey, Fascia, Function, and Medical Applications, 2020
Anita Boser, Kirstin Schumaker
Blood vessels can be impinged or entrapped by fascia, similar to entrapment neuropathies. This can result in edema, occasional cramping, or less commonly, in intermittent claudication. For example, the femoral artery can be limited as it passes through the adductor hiatus and knee flexion can create deformation of the femoropopliteal artery.28,36 An ultrasound study found that 72% of femoropopliteal artery occlusions occur at the adductor canal hiatus.37 Noorani et al. describe a type of coeliac artery compression caused by impingement by the median arcuate ligament and detail six types of popliteal entrapment syndrome, two of which are caused by myofascial compression.38 A study using magnetic resonance imaging showed that contraction of the medial gastrocnemius could displace and compress the popliteal neurovascular tract within the proximal tendon of the soleus.39 A review study on popliteal cysts noted that compression of the popliteal vein is more common than compression of the artery, because arteries have stiffer walls and higher internal pressure.40 However, De Oliveira et al. noted that symptoms due to compression of the femoral artery are more prevalent than those due to restriction of the saphenous nerve28 (Figure 6.5).
Reactive arthritis
Published in Biju Vasudevan, Rajesh Verma, Dermatological Emergencies, 2019
An asymmetrical oligoarthritis is usually the main presenting symptom; however, arthritis can also be polyarticular or monoarticular. Joint inflammation could be axial, involving lumbar spine or sacroiliac joints, or it could be peripheral with predilection for the weight-bearing joints of the lower limbs (knees, ankles, foot) (Figure 52.1). Alternatively, the upper extremities can be affected less commonly. The arthritis is characteristically nonsuppurative and associated with an inflammatory type of pain that may range from mild arthralgia to severe disabling arthritis, which may resolve spontaneously or persist for months, progressively causing irreversible damage to joints; hence, there is an urgent need for management. The knee joints may show massive effusions up to 100 mL. Rapid development of massive effusions frequently results in popliteal cysts.
Meniscus
Published in Manoj Ramachandran, Tom Nunn, Basic Orthopaedic Sciences, 2018
Vijai Ranawat, Patrick C. Schottel, Anil Ranawat, John Skinner
Patients with an acute meniscus tear complain of knee pain and can present with swelling and tenderness to knee palpation along the joint line of the affected side. Patients typically describe a twisting or hyperflexion movement that initiated the symptoms. In addition to pain, they may complain of catching, locking or loss of motion secondary to a mechanical block to extension. Meniscal tears are often present in patients presenting with a popliteal cyst. Popliteal cysts, also known as Baker’s cysts when associated with underlying joint pathology such as osteoarthritis, are masses present in the posteromedial aspect of the knee that arise from a pathologic one-way valve communication of synovial fluid between the knee joint and semimembranosus bursa. The accumulation of synovial fluid in this bursa results in distention and eventual formation of a popliteal cyst. Up to 82% of popliteal cysts are associated with a meniscal tear.
An unexpected event after deep vein thrombosis in spinal cord injury: Ruptured Baker’s cyst
Published in The Journal of Spinal Cord Medicine, 2022
Baker’s cyst rupture in patients diagnosed with SCI is extremely rare. The only case report we encountered in the literature was by De Mesa et al.,11 who reported an infected Baker’s cyst rupture in the knee of a patient who developed an L1 AIS grade D SCI after an epidural and bilateral psoas abscess. The same patient, who had fever and leukocytosis, was diagnosed with an infected Baker’s cyst after scintigraphy, and antibiotherapy was applied. In SCI patients, according to the nature of the injury, a Baker’s cyst rupture may occur in insensate limbs, making diagnosis even more difficult. Ultrasound or MRI can be used to diagnose ruptured popliteal cysts. Although MRI is the most appropriate tool for imaging soft tissue abnormalities, ultrasound may be preferred since it is inexpensive and practical.4 MRI of a Baker’s cyst rupture may reveal edema with high signal intensity in fascial planes and adjacent soft tissue, while on ultrasonographic imaging a wide hypoechoic space in the back of the calf muscles may be observed.5,7 In this report, ultrasound imaging was used for diagnosis, follow up, and treatment. In addition, MRI was used to confirm the diagnosis.
Prosthetic joint infection due to Mycobacterium moriokaense in an immunocompetent patient after a total knee replacement
Published in Baylor University Medical Center Proceedings, 2020
A 68-year-old Hispanic man presented with right knee pain and swelling 4 years after a total knee arthroplasty performed for degenerative joint disease. His past medical history included hypertension and prostate cancer (in remission after prostatectomy and radiation). Two years after total knee arthroplasty, he experienced fluid collection to the right posterior knee and had several joint aspirations with recurrence of the fluid accumulation. Fluoroscopic-guided aspiration of the right knee was performed with injection of contrast for a computed tomography arthrogram and showed evidence of communication between the joint and the posterior lateral fluid collection. Aspiration fluid analysis showed >20-30 white blood cells per high-power field, and the microbial cultures were positive for methicillin-resistant S. aureus. He was treated with sulfamethoxazole-trimethoprim 800-160 mg orally twice daily for 2 weeks for treatment of the popliteal cyst. His erythrocyte sedimentation rate and C-reactive protein level were both within normal ranges at that time. After completion of treatment, he underwent a surgical procedure to excise the recurrent popliteal cyst without any complications. The pathology report of the cyst was consistent with a popliteal cyst with no evidence of malignancy.
Structural abnormalities detected by knee magnetic resonance imaging are common in middle-aged subjects with and without risk factors for osteoarthritis
Published in Acta Orthopaedica, 2018
Jaanika Kumm, Aleksandra Turkiewicz, Fan Zhang, Martin Englund
283 (96%) subjects with knee OA risk factors but without radiographic knee OA had at least 1 abnormality present (Table 2). The most common findings were cartilage damage (82%, CI 77–86), bone marrow lesions (60%, CI 54–65), osteophytes (45%, CI 39–50), Hoffa synovitis (44%, CI 39–50), and subchondral cysts (41%, CI 35–46). MRI features like meniscal extrusions (23%, CI 19–28), synovitis–effusion (29%, CI 24–35), popliteal cysts (28%, CI 23–34), and meniscal damage (19%, CI 15–24) were also quite frequently encountered in these individuals with radiographically normal knees. The prevalence of ligamentous lesions was low (1%, CI 0–4).