Baker's Cyst

A baker's cyst is a fluid filled sac and are found in the popiteal region of the knee. These capsule may contain a gaseous or semisolid substance. Baker's cyst are formed from fluid built up with in the knee joint that over time becomes compressed into a sac. The name Baker came from the physician William Morrant Baker who originally described this condition. This fluid sac may be the result of an injury to the meniscus or arthritis in the knee. Symptoms may include pain, tightness behind the knee while fully flexed or extended. Some patients may not present any symptoms at all. These may be diagnosed by an examination, with ultrasound, or MRI scans. Some patients have these cyst drained or injected with cortisone shots to relieve symptoms. Arthroscopic surgery may be used to surgically remove the baker cysts.

Ganglion Cyst

Ganglion cyst is a fluid filled sac that grow out of connective tissue between muscles and bones of tendons. Constant stress to the wrist seems to be a common indicator for developing ganglion cysts. Most are not painful, but some that are large enough to press on nerves may become painful. Ganglion cysts may be diagnosed with ultrasound or MRI scans. On an MRI these cysts appear very bright on T2 scans and dark on T1 scans. Treatment may include immobilization since constant activity my cause the ganglion cyst to get bigger. Aspiration or draining the ganglion cyst may help relieve the pain. Finally, surgery may be utilized, but there is no guarantee the cyst will not grow back.

Synovitis of the Shoulder

Inflammation and the build up of fluid within the lining of the shoulder joint is called synovitis. The most common symptom is pain with motion and at rest. Sampling the fluid can be done to confirm the diagnosis of synovitis. Treatment may include cortisone injections and anti-inflammatory medications. In extreme cases arthroscopic surgery may be done to remove the infected synovium. If synovitis of the shoulder is left untreated, patients may be faced with cartilage, ligament, tendon, and bone damage.

Avascular Necrosis of the Hip

Avascular necrosis occurs when blood flow is hindered due to a fracture or joint dislocation. Lack of blood supply to a joint is called ostenecrosis. Over time this can lead to the eventual collapse of the bone. Alcohol abusers or patients on high doses of steroids are also at risk for developing avascular necrosis otherwise known as AVN. The hip joint is most commonly affected by AVN. Symptoms may include decrease range of motion and hip pain that may radiate into the groin area. Symptoms may occur suddenly if caused by an injury. Otherwise most patients pain levels increase over time. In some cases, patients may not experience any symptoms at all. Avascular necrosis occurs when there is lack of or limited blood flow to a a bone. If left untreated lack of nutrients and oxygen will cause the bone to deteriorate. Medications and surgeries may be used to slow down this process, but ultimately extreme cases require a hip replacement.

Renal Calculi

A kidney stone is made up of a hard mineral material. These stones may be found in the kidney or the urinary tract. Calculi are formed when there is an excessive amount of stone forming substances in the urine. These may include calcium, amino acid cystine, and phosphate. Dehydration increases the risk of developing stones. Also, frequent urinary tract infections may result into kidney stones. High calcium in the urine is the highest risk factor for developing stones. Symptoms may include flank or abdominal pain and obvious blood in the urine. Intravenous pyelograms were more commonly used to diagnose kidney stones. This more invasive test has since been replaced by a non-contrast CT scan. The CT scan has less radiation, no prep and quicker results then the IVP's. Pregnant women should have an ultrasound to rule out kidney stones. Kidney stones may be passed with medication and an increase in consumed fluids. Stones larger than 9mm may need a procedure called lithotripsy. With this treatment, shock waves are used to aid in the breaking up of larger stones so they may be small enough to pass. The main preventative is to drink lots of water. Patients who may still develop kidney stones may have to look into dietary changes and medications.

Thoracic Aortic Aneurysm

A thoracic aortic aneurysm is the widening of the wall of the aorta. When there is a weakening in the wall of the aorta it causes swelling. Most thoracic aneurysms develop in the descending aorta. Arthersclerosis seems to be the cause of a thoracic aortic aneurysm. Long term high blood pressure, trauma, history of Marfan's syndrome and syphilis are also risk factors associated with aortic aneurysms. Most patients do not have any symptoms until the aneurysm begins to leak. A good indicator of that would be chest or back pain. Most thoracic aortic aneurysms are found incidentally. Especially if they have not presented with any of the symptoms. A chest x-ray and more importantly a CT scan can show enlargement of the aorta. A CT scan specifically determines the exact location and size of the aneurysm. An aortogram may also be utilized to determine all areas of the aorta affected. If the aortic aneurysm is in the aortic arch and is larger than 5-6 centimeters then the aorta should be replaced with a fabric substitute. This is a more risky surgery because the patient will need to be placed on a heart-lung bypass machine. This prevents blood flow during the surgery. If the patient presents with an aneurysm in the descending aorta they will have to have it replaced with fabric substitute if it is larger than 6 centimeters. The second option for descending thoracic aortic aneurysms is endovascular stenting. This stent is placed through the groin and is placed at the site of the aneurysm to help keep the aorta open. This procedure is less invasive for the patient. The prognosis is highly determined by the patients history. Their prognosis determines how many risk factors contributed to the aortic aneurysm.

Multiple Myeloma

Multiple myeloma is a cancer in which abnormal cells called myeloma cells collect in the bone marrow and form tumors. If only one single tumor forms within the bone this is referred to as a plasmacytoma. Multiple myeloma occurs when these cells collect in multiple bones and forming more than one tumor. This type of disease generally affects patients above the age of 60. Symptoms may include back pain and kidney dysfunction. MRI scans are utilized for diagnosing multiple myeloma. Typical multiple myeloma appearance is low signal intensity on a T1 weighted image. On a T2 weighted image signal intensity is high. Multiple myeloma lesions some what enhance post injection of gadolinium injections. Mulitple myeloma may present in MRI's as other musculosketal tumors so other blood tests and or bone marrow aspirations will have to be utilized for proper diagnosis. Treatment may include chemotherapy and radiation therapy. The prognosis of patients with multiple myeloma are dependant upon success of treatment and how extensive the disease has progressed.