Article by Dr Raghuram Y.S. MD (Ay) & Dr Manasa S, B.A.M.S
Baker’s Cyst
A fluid stuffed swelling or bump fashioned on the again of the knee is named Baker’s Cyst. It is usually referred to as a popliteal cyst or synovial cyst. When injury happens to the knee joint or its surrounding tissues, extreme fluid drains into the knee joints and accumulates behind the joint and types a sac. That is referred to as Baker’s Cyst. These cysts trigger ache, discomfort or limit the actions within the joint, all of them can also happen.
Irritation, an infection or harm could trigger Baker’s cyst. A number of causes could also be causal.
To place it brief, ‘when the knee joint produces an extreme quantity of synovial fluid, it will probably accumulate within the popliteal bursa, resulting in the formation of a Baker’s cyst’.
Baker’s Cyst: Ayurveda Understanding
Dosha connection
Overproduction and accumulation of synovial fluid within the popliteal bursa is the principle occasion behind formation of Baker’s Cyst. From an Ayurveda perspective we are able to contemplate this situation as extreme formation and accumulation of kapha within the knee joint.
Shleshaka Kapha is a subtype of kapha which is positioned within the bony joints of the physique. In a state of steadiness, it lubricates the joints and facilitates straightforward motion of joints. When shleshaka kapha will increase past regular permissible limits inside and across the joints, it will probably trigger swelling, both within the entrance or sides or again of the joints (knee joint on this context), impart stress on the joints and trigger signs like ache and heaviness.
Granthi / Kaphaja or Shlaishmika Granthi
Since Baker Cyst is a fluid stuffed lump, it may be thought of as kaphaja / shlaishmika granthi. Since they’re benign growths, they can’t be categorized underneath arbuda.
These cysts are fashioned because of the extreme vitiation of kapha. The signs triggered on this situation are additionally attributable to kapha involvement.
On this situation, the cysts are chilly to the contact and are of the color of the pores and skin, have much less of ache and extreme itching, are stony onerous in consistency and develop very slowly in dimension. After they break open, they discharge white colored pus.
If such a granthi is fashioned behind the knee it may be thought of as Baker’s cyst. Baker’s Cyst can be triggered attributable to an infection. When there’s an infection and suppuration, there shall be discharge of pus. So, Kaphaja or Shlaishmika Granthi might be correlated with contaminated Baker’s Cyst or Baker’s cyst triggered attributable to an infection.
Medoja Granthi
That is one other kind of granthi whose look and consistency resembles that of Baker’s Cyst.
The cyst herein is unctuous, giant in dimension and is related to itching and devoid of ache. When it breaks open, fatty discharge resembles the paste of sesame seeds or ghee.
The looks of discharge resembles that of synovial fluid. Medoja Granthi can happen wherever within the physique however when it happens on the again of the knee joint, it resembles the medical presentation of Baker’s Cyst.
Shotha
Baker’s Cyst and the swelling occurring therein are both triggered or triggered by an infection, irritation or harm. We have to take a look at this from the attitude of ‘Shotha’ defined in Ayurveda texts.
Shotha is a time period which encompasses numerous sorts of swellings, inflammatory and non-inflammatory, every part.
With irritation being an necessary occasion within the causation of this situation, pittaja shotha might be considered in its nearest correlation. Abhighataja shotha which is a swelling attributable to harm might be introduced into nearer correlation with Baker’s cyst triggered attributable to harm.
Pittaja Shotha
The swelling attributable to vitiated pitta is clean in texture, emits particular odor, is black, yellow or crimson in color, related to giddiness, fever, extreme sweating, thirst, intoxication, burning kind of ache, has clear ache and redness of eyes. It presents with a extreme burning sensation and suppuration.
All these signs point out that the swelling is inflammatory in nature. Baker’s Cyst can be attributable to irritation and may exhibit inflammatory signs.
Kaphaja Shotha
The swelling attributable to vitiated kapha is heavy, agency (mounted, motionless), pale in color and is related to anorexia, nausea, extreme sleep, vomiting and low digestion power (hearth). The looks and disappearance of this swelling may be very gradual. When pressed for a couple of seconds and the stress launched, the swelling rises to the floor very slowly. The swelling is predominant throughout the night time time.
Abhighataja Shotha
The swelling attributable to exterior harm or contact of something which causes swelling might be thought of as abhighataja shotha. It’s attributable to harm from sharp / blunt devices or weapons, contact of heavy breeze, snow, juice of Semecarpus anacardium or bristles of Mucuna pruriens and many others. These swellings are inclined to unfold in all instructions, and shall be related to rise in temperature, redness of the affected half and signs of pitta aggravation. This image appears to be like just like inflammatory swelling or edema. Irritation and harm are the necessary causes of Baker’s Cyst. Abhighataja Shotha, which exhibits indicators of harm and irritation, when happens on the posterior area of the knee joint might be thought of as Baker’s Cyst.
Sandhi Vikruti
Varied sorts of arthritis may cause Baker’s cyst – osteoarthritis, rheumatoid arthritis and gouty arthritis affecting the knee joint. Shotha is part and parcel of sandhigata vata, amavata and vatashonita too, which correlates intently with the above-mentioned circumstances respectively. In line with Ayurveda, all these circumstances additionally current with shula or Vedana – ache, and knee ache can be defined amongst the signs of Baker’s cyst. Ache worsening with bodily exercise or extended standing in Baker’s Cyst is because of stress on nerves and surrounding tissues, which can occur attributable to extreme accumulation of shleshaka kapha or vata getting aggravated attributable to harm or pitta attributable to irritation. Rakta and ama may additionally be concerned within the pathogenesis as in vatarakta and amavata respectively. Stiffness and restricted mobility of the knee joint / joints can happen because of the affliction of the joint by morbid kapha, vata or each.
Kroshtuka Shirsha
It’s a swelling which happens on the centre of the knee joint (may additionally happen behind the knee as in Baker’s Cyst), attributable to mixed aggravation of vata and shonita (rakta, blood) and is related to extreme ache. The swollen knee joint appears to be like like the top of kroshtuka / srugala – jackal and therefore the identify Kroshtuka Shirsha.
Dhatu Connection
Since we’re talking in regards to the knee joint, janu sandhi – all buildings concerned in formation of the joint must be thought of to be troubled within the illness. The joint is made up of bones of thigh and leg. So asthi dhatu is the principle dhatu concerned. The rakta, mamsa and majja dhatu therein are additionally concerned within the illness course of.
Marma Connection
Janu Sandhi is a crucial Marma and is positioned within the janu sandhi – knee joint. It’s a ‘sandhi marma’. Mamsa – muscle tissues, Sira – blood vessels, Snayu – ligaments and tendons, Asthi – bones and Sandhi – joints are the parts in every marma. The class to which it belongs will depend on which part is predominant in that marma. In Janu Marma, Sandhi part is predominant compared to the opposite parts and therefore is a Sandhi Marma.
It is usually a Vaikalyakara Marma – i.e. a significant spot which causes deformity when injured.
When Baker’s Cyst progresses and entails the marma part because it will get power, and when not addressed by correct and well timed interventions, the prognosis turns into tough or regardless of correct therapy, the illness would go away its footprints and current within the type of frequent occurrences or relapses.
Ayurveda Therapy Ideas and Concerns for Baker’s Cyst
Nidana Parivarjana
The principle method shall be ‘avoiding’ the causative elements or triggers of the illness. They could be etiological elements inflicting or triggering the illness, illness inflicting doshas or each.
Panchakarma therapies
Vamana could also be excellent when there’s loads of fluid accumulation within the cyst, when there’s extreme vitiation of kapha afflicting the knee joint and there’s additionally systemic aggravation of kapha and the swelling is giant and related to heaviness, stiffness, onerous and actions restricted.
Virechana is good when irritation causes the swelling of the cyst, when there’s extreme vitiation of pitta afflicting the knee joint and there’s additionally systemic aggravation of pitta with widespread irritation, when there’s aggravation of rakta, or when the swelling is attributable to aggravated vata and rakta, as in vatarakta and when the swelling is related to different pitta signs like redness, burning sensation and raised heat across the swelling.
Exterior Therapies
Lepa Chikitsa – Utility of medicinal pastes like Dashanga Lepa or Rasnadi (churna) Lepa that are hygroscopic in nature are efficient. As per dosha predominance, totally different medicinal powders can be utilized to arrange lepas and apply on the troubled jjoint / joints. Helpful powders embody Kottamchukkadi Churna, Ellum Nishadi Churnam and Grihadhumadi Churnam.
Dhanyamla Dhara – shall be finished in presence of inflammatory indicators across the swelling and if irritation can be causal.
Pradhana Vyadhi Chikitsa
Baker’s Cyst generally is a symptom of inflammatory ailments of the knee, harm or an infection as already stated. These causes or no matter causes them must be handled.
From Ayurveda perspective, Baker’s Cyst could also be handled on the rules of treating the beneath talked about circumstances –
– Shotha – pittaja, kaphaja, abhighataja
– Granthi – kaphaja, medoja,
– Sandhi Vikriti / Roga – Amavata, Sandhigata Vata, Vatarakta, Kroshtuka Shirsha
Shastra Chiktsa
In excessive circumstances when the swelling / cyst must be reduce open and the contents drained to guard the knee joint and when the medicinal approaches are usually not yielding outcomes, surgical procedure must be most well-liked. Chedana – incision (indication – granthi), Bhedana (indication – vataja, pittaja and kaphaja granthi), Visravana – drainage (indication – eka deshaja shopha – inflammatory edema confined to 1 place or one a part of the physique and granthis) are the popular surgical procedures for Baker’s Cyst.
Useful Formulations
– Dashamula Kashayam
– Punarnavadi Kashayam
– Rasnaerandadi Kashayam
– Patoladi Kashayam
– Guggulutiktakam Kashayam
– Varanadi Kashayam
– Brihahtyadi Kashayam
– Amavatari Kashayam
– Kokilaksham Kashayam
– Dashamularishtam
– Punarnavasavam
– Kanchanara Guggulu
– Kaishora Guggulu
– Simhanada Guggulu
– Triphala Guggulu
– Gokshuradi Guggulu
– Punarnavadi Guggulu
– Punarnavadi Mandura
– Shothari Mandura
