Re: Large Popliteal Cyst Responses
Ferris, Peter (WHSCC)
Description
Collection
Title:
Re: Large Popliteal Cyst Responses
Creator:
Ferris, Peter (WHSCC)
Date:
6/27/2002
Text:
RE: Large Popliteal Cyst
Below are four pages of list serve responses to my question about fitting
BK's with a large reoccurring popliteal cyst. Thanks for taking the time to
respond with advice.
The original question was:
I've a BK patient with a large reoccuring cyst(2 inch diameter) in the
popliteal fossa. It has shown itself about once a year since a 1998
railway crush accident. The family doctor has ruled out a Baker's cyst
for
the time. Antibotics and bedrest are being given to defend against the
current staff infection.
Attempts to relieve for the cyst and minimize pressure on it have been
made
but with limited success. He currently uses a Pathfinder foot with an
Alpha
pin lock system. In the past gel socks and a PTB socket with sleeve
suspension were used primarily. A thigh corset was attempted two years
ago
but it caused distal end discomfort at the time. This last occurrence
developed in one afternoon just after taking a shower.
Has anyone had an experience with large(2 inch diameter) reoccurring
cyst in
a below knee amputee? What possible procedures or prosthetic treament
might benefit him and allow him to work again full-time again?
RESPONSES:
1)I had a similar patient. I thought I could design around it, but it
didn't
work. Really to tell the truth your patient should have surgery for this
problem. The problem is chronic....so get rid of it. I did attend the
surgery of my patient in the OR. In the area we thought was a cyst was alot
of scar tissue. This tissue looked like hard yellow plastic and was about 1
1/2 inches long and 1/2 wide with an irregular border. When I saw all that
pulled out I was amazed.
2)Is your patient wearing a gel liner or just pelite or hard socket?
If pelite or hard socket I have done the following: I have faced this
problem many times over the years - always with prostheses made buy some
else (I employed several). It is very difficult to accept but the cause has
always been the posterior wall is too low. Some times the patient wants it
low and the prosthetist gives in. But in every case where the patient
accepted the higher modification the cyst disappeared in a short time.
The problem is you need to eliminate it before the final new socket is
provided. This is accomplished by adding material (socket and liner
material) to gradually raise the posterior socket. As the cyst dissipates
you will need to fill the void in a timely manner. Each time the cyst
dissipates you may also need to raise the posterior wall slightly.
If the patient is wearing a gel liner with the Iceross socket design cysts
are usually not a problem but unwanted rotation can be. In an effort to
eliminate unwanted rotation sometimes the posterior popliteal area is
flattened causing cysts to reappear. If this is the case just go back to the
original design and find another way to eliminate the rotation.
3)Had a similar problem about 15 years ago and the reoccurance trigered the
memory. After repeated reoccurances the only satisfactory relief was gained
by surgical removal, and closure. Did not see patient for 12 months after
refitting, then I moved interstate. Cyst reoccured more often than your
patient, 4 to 6 months over a 4 year period. Possible problem is bone grain
from trauma, as i have seen this in sinus expulsion up to 10 years after
trauma. Very hard to find even with xray. Bone grain is transported by blood
flow through woft tissue. Good luck.
4)A couple of years back a now former patient of mine had such a problem. He
added to his woes by attempting to lance it himself. The final solution was
surgery to remove the cyst. He was trouble free in that area afterwards. If
your client has a short stump you are looking at quite a struggle. Opening
your AP can open its own can of worms. Good luck!
5)I would suggest putting him in a SACH foot and raising the posterior brim
ABOVE the affected area. The foot should relieve the pressure experienced
in the popietial area when walking and raising the brim will help to stop
agitation on the area when walking and flexing the knee. I am a B-K amputee
that experienced problems very similar to the ones you stated and this is
how I solved my problems.
6)I had a patient back in the 80's that fits your description.
The individual had a recurrent cyst type swelling in the popliteal fossa.
I did everything I could think of, but to no avail!
The patient was a service connected veteran, so I refered him to the Ortho
Dept. and they decided to lance the subcutaneous cyst, as it turned out
he had to have a rather more extreme procedure. The surgeon removed a mass
approximately the size of a golf ball from the fossa.
The report and the biopsy may be available from the Veterans Hospital in
Denver, Colorado. I do not remember the patients name, sorry
You may be faced with a similar situation, unfortunately.
6)Peter, I had a gentleman that fell into that category several years ago.
We
changed him into an Iceross comfort plus liner and recontoured the socket
placing more pressure distal to the cyst formation. We found the primary
causes of his cysts were too much pressure on the medial posterior tibial
condyle and excessive pistoning.
My experience with other locking liners is they do not suspend as well as
the
comfort plus. My first suggestion would be to get rid of the Alpha - they
suspend the worst and tend to stretch in a few short weeks, then try socket
recontouring.
7)I had a patient with a similar problem. Turned out that there was scar
tissue which was causing recurring infections and a cyst formation in the
popliteal space. After many attempts to relieve the area prosthetically and
multiple occasions of the physician draining the cyst coupled with rounds of
antibiotics only to have this return some months later, it was finally
determined that the scar tissue must be removed surgically. After surgical
removal of the scar tissue the patient is now having no recurring problems.
8)I would make sure the posterior proximal trimline is
high enough for starters.
9)I have run into this several times and have tried
several things but the one that worked the best was to
open the AP and to take more pressure on the medial
tibial flair. This happened alot before going to this
system.
10)Better give him crutches.
11)There is very likely no fitting technique that you can use to prevent
this from recurring - surgery is probably indicated and MUST include the
COMPLETE removal of the cyst. I'm a prosthetist and not a surgeon so I
can't say how the operation is done, but it seems that there is a technique
that would be suitable for removing this cyst from most places on the body
but is not extensive enough to prevent cyst recurrence on a residual limb.
Once completely removed, it is possible to make a socket for some clients -
not those with soft or fleshy limbs - that does not put pressure on the
surgical site. The technique is not generally accepted but is
biomechanically sound if the client has the right sort of residual limb -
give me a call if you want more information, since it'll take some
explaining!
END
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questions, send e-mail to the moderator
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OANDP-L is a forum for the discussion of topics
related to Orthotics and Prosthetics.
Public commercial postings are forbidden. Responses to inquiries
should not be sent to the entire oandp-l list. Professional credentials
or affilliations should be used in all communications.
Below are four pages of list serve responses to my question about fitting
BK's with a large reoccurring popliteal cyst. Thanks for taking the time to
respond with advice.
The original question was:
I've a BK patient with a large reoccuring cyst(2 inch diameter) in the
popliteal fossa. It has shown itself about once a year since a 1998
railway crush accident. The family doctor has ruled out a Baker's cyst
for
the time. Antibotics and bedrest are being given to defend against the
current staff infection.
Attempts to relieve for the cyst and minimize pressure on it have been
made
but with limited success. He currently uses a Pathfinder foot with an
Alpha
pin lock system. In the past gel socks and a PTB socket with sleeve
suspension were used primarily. A thigh corset was attempted two years
ago
but it caused distal end discomfort at the time. This last occurrence
developed in one afternoon just after taking a shower.
Has anyone had an experience with large(2 inch diameter) reoccurring
cyst in
a below knee amputee? What possible procedures or prosthetic treament
might benefit him and allow him to work again full-time again?
RESPONSES:
1)I had a similar patient. I thought I could design around it, but it
didn't
work. Really to tell the truth your patient should have surgery for this
problem. The problem is chronic....so get rid of it. I did attend the
surgery of my patient in the OR. In the area we thought was a cyst was alot
of scar tissue. This tissue looked like hard yellow plastic and was about 1
1/2 inches long and 1/2 wide with an irregular border. When I saw all that
pulled out I was amazed.
2)Is your patient wearing a gel liner or just pelite or hard socket?
If pelite or hard socket I have done the following: I have faced this
problem many times over the years - always with prostheses made buy some
else (I employed several). It is very difficult to accept but the cause has
always been the posterior wall is too low. Some times the patient wants it
low and the prosthetist gives in. But in every case where the patient
accepted the higher modification the cyst disappeared in a short time.
The problem is you need to eliminate it before the final new socket is
provided. This is accomplished by adding material (socket and liner
material) to gradually raise the posterior socket. As the cyst dissipates
you will need to fill the void in a timely manner. Each time the cyst
dissipates you may also need to raise the posterior wall slightly.
If the patient is wearing a gel liner with the Iceross socket design cysts
are usually not a problem but unwanted rotation can be. In an effort to
eliminate unwanted rotation sometimes the posterior popliteal area is
flattened causing cysts to reappear. If this is the case just go back to the
original design and find another way to eliminate the rotation.
3)Had a similar problem about 15 years ago and the reoccurance trigered the
memory. After repeated reoccurances the only satisfactory relief was gained
by surgical removal, and closure. Did not see patient for 12 months after
refitting, then I moved interstate. Cyst reoccured more often than your
patient, 4 to 6 months over a 4 year period. Possible problem is bone grain
from trauma, as i have seen this in sinus expulsion up to 10 years after
trauma. Very hard to find even with xray. Bone grain is transported by blood
flow through woft tissue. Good luck.
4)A couple of years back a now former patient of mine had such a problem. He
added to his woes by attempting to lance it himself. The final solution was
surgery to remove the cyst. He was trouble free in that area afterwards. If
your client has a short stump you are looking at quite a struggle. Opening
your AP can open its own can of worms. Good luck!
5)I would suggest putting him in a SACH foot and raising the posterior brim
ABOVE the affected area. The foot should relieve the pressure experienced
in the popietial area when walking and raising the brim will help to stop
agitation on the area when walking and flexing the knee. I am a B-K amputee
that experienced problems very similar to the ones you stated and this is
how I solved my problems.
6)I had a patient back in the 80's that fits your description.
The individual had a recurrent cyst type swelling in the popliteal fossa.
I did everything I could think of, but to no avail!
The patient was a service connected veteran, so I refered him to the Ortho
Dept. and they decided to lance the subcutaneous cyst, as it turned out
he had to have a rather more extreme procedure. The surgeon removed a mass
approximately the size of a golf ball from the fossa.
The report and the biopsy may be available from the Veterans Hospital in
Denver, Colorado. I do not remember the patients name, sorry
You may be faced with a similar situation, unfortunately.
6)Peter, I had a gentleman that fell into that category several years ago.
We
changed him into an Iceross comfort plus liner and recontoured the socket
placing more pressure distal to the cyst formation. We found the primary
causes of his cysts were too much pressure on the medial posterior tibial
condyle and excessive pistoning.
My experience with other locking liners is they do not suspend as well as
the
comfort plus. My first suggestion would be to get rid of the Alpha - they
suspend the worst and tend to stretch in a few short weeks, then try socket
recontouring.
7)I had a patient with a similar problem. Turned out that there was scar
tissue which was causing recurring infections and a cyst formation in the
popliteal space. After many attempts to relieve the area prosthetically and
multiple occasions of the physician draining the cyst coupled with rounds of
antibiotics only to have this return some months later, it was finally
determined that the scar tissue must be removed surgically. After surgical
removal of the scar tissue the patient is now having no recurring problems.
8)I would make sure the posterior proximal trimline is
high enough for starters.
9)I have run into this several times and have tried
several things but the one that worked the best was to
open the AP and to take more pressure on the medial
tibial flair. This happened alot before going to this
system.
10)Better give him crutches.
11)There is very likely no fitting technique that you can use to prevent
this from recurring - surgery is probably indicated and MUST include the
COMPLETE removal of the cyst. I'm a prosthetist and not a surgeon so I
can't say how the operation is done, but it seems that there is a technique
that would be suitable for removing this cyst from most places on the body
but is not extensive enough to prevent cyst recurrence on a residual limb.
Once completely removed, it is possible to make a socket for some clients -
not those with soft or fleshy limbs - that does not put pressure on the
surgical site. The technique is not generally accepted but is
biomechanically sound if the client has the right sort of residual limb -
give me a call if you want more information, since it'll take some
explaining!
END
********************
To unsubscribe, send a message to: <Email Address Redacted> with
the words UNSUB OANDP-L in the body of the
message.
If you have a problem unsubscribing,or have other
questions, send e-mail to the moderator
Paul E. Prusakowski,CPO at <Email Address Redacted>
OANDP-L is a forum for the discussion of topics
related to Orthotics and Prosthetics.
Public commercial postings are forbidden. Responses to inquiries
should not be sent to the entire oandp-l list. Professional credentials
or affilliations should be used in all communications.
Citation
Ferris, Peter (WHSCC), “Re: Large Popliteal Cyst Responses,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 5, 2024, https://library.drfop.org/items/show/219067.
