What are subchondral bone cysts. How do they form in joints. What symptoms can they cause. How are subchondral bone cysts diagnosed. What treatment options are available for managing subchondral bone cysts.

The Nature of Subchondral Bone Cysts

Subchondral bone cysts are fluid-filled sacs that develop in the bones forming a joint, typically just beneath the cartilage. These cysts are most commonly found in the knee and hip joints. Medical professionals may refer to them by various names, including osteoarthritic cysts, pseudocysts, geodes, or Egger cysts (specifically in the hip socket).

Why do these cysts form? The primary culprit is often osteoarthritis (OA), a condition that leads to the breakdown of cartilage. OA can result from natural wear and tear over time or from a sudden joint injury. As the smooth gliding motion between bones is disrupted, increased friction occurs, potentially leading to cyst formation.

Are subchondral bone cysts always associated with osteoarthritis? While OA is the most common cause, other conditions can also result in cyst formation. For instance, in advanced stages of rheumatoid arthritis, where the immune system attacks and inflames the joints, subchondral bone cysts may develop. Additionally, certain joint injuries can lead to cyst formation even in the absence of OA.

Recognizing the Symptoms of Subchondral Bone Cysts

Interestingly, subchondral bone cysts themselves often do not directly cause symptoms. However, in rare instances, they may exert pressure on surrounding soft tissues, leading to localized pain. More commonly, any discomfort experienced is attributed to the underlying osteoarthritis rather than the cysts themselves.

How does the pain associated with subchondral bone cysts and OA manifest? Initially, the pain may be intermittent, coming and going. Over time, it tends to worsen, especially with increased activity. Many patients report more severe pain upon waking. As the condition progresses, the pain may become constant.

Are there other symptoms besides pain? Indeed, as osteoarthritis advances, patients may experience:

• Stiffness in the affected joint
• Swelling
• Reduced joint mobility
• Gradual weakness, making everyday tasks challenging
• A grinding or scraping sensation during joint movement

Where might pain be felt when subchondral bone cysts affect the hip or knee? Pain may be experienced in the:

1. Groin
2. Thigh
3. Buttocks
4. Area behind the knee

Diagnosing Subchondral Bone Cysts

How do medical professionals diagnose subchondral bone cysts? The process typically involves a combination of physical examination, patient history, and imaging tests. During the examination, your doctor will assess your symptoms and inquire about any pain, stiffness, or mobility issues you’re experiencing.

If osteoarthritis or joint injury is suspected, what diagnostic tools are employed? X-rays and other imaging tests are usually ordered. These imaging techniques can effectively reveal the presence of subchondral bone cysts, providing valuable information about their size, location, and potential impact on the joint.

The Importance of Early Detection

Why is early diagnosis crucial? While subchondral bone cysts may initially be asymptomatic, they can continue to grow over time. As they enlarge, they may begin to alter joint function. Early detection allows for prompt intervention, potentially preventing or minimizing joint damage and preserving mobility.

Treatment Approaches for Subchondral Bone Cysts

What treatment options are available for subchondral bone cysts? The approach to treatment often focuses on addressing the underlying cause, typically osteoarthritis or joint injury, rather than the cysts themselves. However, in cases where cysts continue to grow and impact joint function, direct intervention may be necessary.

When might draining a cyst be considered? If a cyst significantly alters joint function, your doctor may recommend using a needle to drain the fluid-filled sac. This procedure, known as aspiration, can provide relief and improve joint mobility.

How is the underlying osteoarthritis managed? While there is no cure for OA, several strategies can help manage symptoms:

• Over-the-counter pain medications
• Prescription drugs
• Application of ice or heat
• Physical therapy
• Use of assistive devices like splints or crutches

In rare cases, is surgery an option? For severe cases that don’t respond to conservative treatments, joint replacement surgery might be considered. However, this is typically a last resort and requires careful consideration and discussion with your healthcare provider.

Living with Subchondral Bone Cysts

How can individuals manage daily life with subchondral bone cysts? While the condition can be challenging, many people learn to adapt their lifestyle to minimize discomfort and maintain joint health. This may involve:

• Regular, low-impact exercise to maintain joint flexibility and strength
• Weight management to reduce stress on affected joints
• Use of assistive devices when necessary
• Adhering to prescribed treatment plans

Can dietary changes help? Some studies suggest that certain anti-inflammatory foods may help manage symptoms associated with osteoarthritis. These include:

1. Fatty fish rich in omega-3 fatty acids
2. Colorful fruits and vegetables high in antioxidants
3. Nuts and seeds
4. Olive oil

However, it’s important to consult with a healthcare provider or nutritionist before making significant dietary changes.

Preventive Measures and Risk Factors

Is it possible to prevent subchondral bone cysts? While not all cases can be prevented, certain measures may reduce the risk of developing these cysts or slow their progression:

• Maintaining a healthy weight to reduce joint stress
• Engaging in regular, low-impact exercise to strengthen muscles around joints
• Avoiding repetitive stress on joints
• Promptly addressing joint injuries

Who is at higher risk for developing subchondral bone cysts? Risk factors include:

1. Advanced age
2. Obesity
3. History of joint injuries
4. Occupations or activities that place repetitive stress on joints
5. Genetic predisposition to osteoarthritis

Advances in Research and Future Treatments

What new developments are emerging in the treatment of subchondral bone cysts? Ongoing research is exploring several promising avenues:

• Regenerative medicine techniques, including stem cell therapy
• Advanced imaging methods for earlier detection
• Novel drug therapies targeting the underlying causes of cyst formation
• Minimally invasive surgical techniques for cyst removal

How might these advancements impact patient care? As our understanding of subchondral bone cysts and their relationship to osteoarthritis grows, we may see more targeted and effective treatments emerge. This could lead to improved outcomes, reduced pain, and better preservation of joint function for affected individuals.

The Role of Personalized Medicine

Is personalized medicine playing a role in managing subchondral bone cysts? Indeed, there’s a growing trend towards tailoring treatments to individual patients based on factors such as:

1. Genetic profile
2. Lifestyle factors
3. Specific characteristics of their condition
4. Response to previous treatments

This approach may lead to more effective management strategies and improved quality of life for those affected by subchondral bone cysts.

Patient Education and Self-Management

Why is patient education crucial in managing subchondral bone cysts? Empowering patients with knowledge about their condition can lead to better outcomes. Understanding the nature of subchondral bone cysts, their relationship to osteoarthritis, and the importance of adhering to treatment plans can significantly impact disease management.

What self-management strategies can patients employ? Effective self-management may include:

• Maintaining a consistent exercise routine
• Practicing good posture and joint protection techniques
• Using hot or cold therapy as recommended by healthcare providers
• Managing stress, which can exacerbate pain perception
• Keeping a symptom diary to track changes and identify triggers

How can patients effectively communicate with their healthcare team? Open and honest communication is key. Patients should:

1. Report any new or changing symptoms promptly
2. Discuss the effectiveness of current treatments
3. Ask questions about their condition and treatment options
4. Share their goals and concerns regarding their joint health

This collaborative approach can lead to more personalized and effective care.

The Impact of Lifestyle Modifications

Can lifestyle changes significantly impact the progression of subchondral bone cysts? While lifestyle modifications alone may not cure the condition, they can play a crucial role in managing symptoms and potentially slowing disease progression. Key areas to focus on include:

• Maintaining a healthy body weight
• Engaging in regular, joint-friendly exercise
• Adopting an anti-inflammatory diet
• Quitting smoking, if applicable
• Managing stress through relaxation techniques or mindfulness practices

How do these lifestyle changes benefit patients with subchondral bone cysts? By reducing inflammation, decreasing joint stress, and improving overall health, these modifications can contribute to:

1. Reduced pain and stiffness
2. Improved joint function
3. Enhanced quality of life
4. Potentially slower disease progression

Subchondral Bone Cyst: Symptoms, Causes, and Treatments

Written by Paul Frysh

Medically Reviewed by David Zelman, MD on November 02, 2022

• What Is a Subchondral Bone Cyst?
• Causes of Subchondral Bone Cysts
• Symptoms of Subchondral Bone Cysts
• Diagnosis of Subchondral Bone Cysts
• Treatment

It’s a fluid-filled sac that forms in one or both of the bones that make up a joint. They’re especially common at the knee or hip. The cysts show up just under the tough spongy tissue (called cartilage) that covers the bone near the joint.

Your doctor might call them:

• Osteoarthritic cysts
• Pseudocysts
• Geodes
• Egger cysts (in the hip socket).

Osteoarthritis (OA) is the most common. It breaks down the cartilage. OA can happen from simple wear and tear over time, or because of a sudden injury to a joint.

Either way, the normal, smooth, gliding of one bone against another in your joints starts to cause more friction. That leads to the cyst.

In cases of late rheumatoid arthritis, where your immune system attacks and inflames your joints, subchondral bone cysts can also form.

In other cases, a joint injury might lead to a cyst without OA.

The cysts themselves don’t seem to cause symptoms. But in rare cases, they can push on soft tissue in the area. That can cause pain.

More often, if you have pain, it’s due to the osteoarthritis that causes the cysts. The pain tends to come and go at first. But it gets worse over time, or if you’re very active. It might be especially serious when you wake up. Eventually, the pain can become constant.

As OA gets worse, stiffness and swelling can make it harder for your joints to work the way they should. You might also feel weaker over time — so much so that it gets harder to do simple things, like open a jar or bend down.

With OA of the hip or knee — where cysts are more common — you might have pain in your:

• Groin
• Thigh
• Buttocks
• Area behind the knee

You might also feel a grinding or scraping sound when you move your joint.

Over time, the cyst itself can start to damage your joint. That can keep you from being able to make some movements.

Your doctor will examine you and ask about any pain or stiffness you’re having.

If you have pain, swelling, or stiffness that could be from OA or a joint injury, your doctor will order X-rays or other imaging tests. Any cysts you have will show up on these tests.

Subchondral cysts may not cause any symptoms. But sometimes, they continue to grow. That may start to change the way your joint works. If this happens, your doctor might suggest using a needle to drain the cyst.

Other than that, your doctor will try to treat the cause of your cyst — in most cases, OA or a joint injury.

Though there is no cure for OA, your doctor can help you manage your symptoms with:

• Over-the-counter pain meds
• Prescription drugs
• Ice
• Heat
• Physical therapy, as well as splints, crutches, and other devices.

In rare cases, you might have surgery to replace a joint.

Talk with your doctor about which treatment might be best for you.

Top Picks

Subchondral Bone Cyst: Symptoms, Causes, and Treatments

Written by Paul Frysh

Medically Reviewed by David Zelman, MD on November 02, 2022

• What Is a Subchondral Bone Cyst?
• Causes of Subchondral Bone Cysts
• Symptoms of Subchondral Bone Cysts
• Diagnosis of Subchondral Bone Cysts
• Treatment

It’s a fluid-filled sac that forms in one or both of the bones that make up a joint. They’re especially common at the knee or hip. The cysts show up just under the tough spongy tissue (called cartilage) that covers the bone near the joint.

Your doctor might call them:

• Osteoarthritic cysts
• Pseudocysts
• Geodes
• Egger cysts (in the hip socket).

Osteoarthritis (OA) is the most common. It breaks down the cartilage. OA can happen from simple wear and tear over time, or because of a sudden injury to a joint.

Either way, the normal, smooth, gliding of one bone against another in your joints starts to cause more friction. That leads to the cyst.

In cases of late rheumatoid arthritis, where your immune system attacks and inflames your joints, subchondral bone cysts can also form.

In other cases, a joint injury might lead to a cyst without OA.

The cysts themselves don’t seem to cause symptoms. But in rare cases, they can push on soft tissue in the area. That can cause pain.

More often, if you have pain, it’s due to the osteoarthritis that causes the cysts. The pain tends to come and go at first. But it gets worse over time, or if you’re very active. It might be especially serious when you wake up. Eventually, the pain can become constant.

As OA gets worse, stiffness and swelling can make it harder for your joints to work the way they should. You might also feel weaker over time — so much so that it gets harder to do simple things, like open a jar or bend down.

With OA of the hip or knee — where cysts are more common — you might have pain in your:

• Groin
• Thigh
• Buttocks
• Area behind the knee

You might also feel a grinding or scraping sound when you move your joint.

Over time, the cyst itself can start to damage your joint. That can keep you from being able to make some movements.

Your doctor will examine you and ask about any pain or stiffness you’re having.

If you have pain, swelling, or stiffness that could be from OA or a joint injury, your doctor will order X-rays or other imaging tests. Any cysts you have will show up on these tests.

Subchondral cysts may not cause any symptoms. But sometimes, they continue to grow. That may start to change the way your joint works. If this happens, your doctor might suggest using a needle to drain the cyst.

Other than that, your doctor will try to treat the cause of your cyst — in most cases, OA or a joint injury.

Though there is no cure for OA, your doctor can help you manage your symptoms with:

• Over-the-counter pain meds
• Prescription drugs
• Ice
• Heat
• Physical therapy, as well as splints, crutches, and other devices.

In rare cases, you might have surgery to replace a joint.

Talk with your doctor about which treatment might be best for you.

Top Picks

Treatment Meniscus cyst – Orthopedics Ruslana Sergienko

A meniscus cyst is a cavity liquid formation in the thickness of the meniscus of the knee joint. This disease is a reaction of the menisci to prolonged overload of the joints.

A mucoid (mucus-like) substance forms in the tissues of the meniscus, which accumulates over time. Further, the substance is converted into a cyst. In most cases, a cyst forms at the edge of the meniscus.

What is the danger of the disease?

The main danger of the disease lies in the fact that with minor loads a rupture can occur. Most often, patients with a cyst of the meniscus of the knee joint, a cyst of the lateral meniscus, and a cyst of the medial meniscus turn to specialists.

Causes

• microtraumas and repeated injuries of the meniscus
• excessive load on the knee joint
• hard physical labor with carrying heavy objects
• constitutional predisposition
• tumor, lymphatic, degenerative manifestations in tissues

Risk group – athletes, people with constant physical labor.

There are three degrees of cyst development:

I degree – clinical manifestations are usually absent, pathology can only be determined histologically or on MRI diagnostics. The pain is insignificant, only under load on the affected joint.

II degree – not only the meniscus but also the capsular zone is involved in the pathological process. Pain intensifies, swelling is palpable

III degree – the meniscus, capsular zone and ligaments of the knee joint are affected. The presence of a cyst is determined by palpation and visually, there is an acute pain syndrome, swelling.

The main symptoms of a meniscus cyst

Among the main symptoms are acute pain at rest, fever in the area of ​​damage, clicks during flexion, joint enlargement.

Diagnosis

In orthopedic traumatology, the diagnosis of a meniscus cyst is made on the basis of the clinical picture, the results of an ultrasound of the knee, diagnostic arthroscopy or MRI of the knee.

Treatment

As a rule, the patient is advised to reduce the load on the knee joint. In severe pain syndrome, painkillers and non-steroidal anti-inflammatory drugs are prescribed. The final cure of the meniscus cyst is impossible without surgery, however, the complete removal of the altered meniscus leads to the rapid development of deforming arthrosis. Therefore, surgery should be as gentle as possible. The preferred option is to remove the meniscus by arthroscopic surgery, which reduces the trauma of the operation and reduces the likelihood of complications. Depending on the location and size of the meniscus cyst, the cyst is incised or the damaged part of the meniscus is removed.

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Chondromalacia of the patella – symptoms, causes, treatment

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Chondromalacia patella

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Chondromalacia of the patella occupies not the last place among the clinical syndromes encountered in orthopedic and traumatological practice. Chronic overload of the intercondylar articulation leads to a gradual softening of the cartilaginous surface and exposure of the underlying subchondral bone. And only timely medical care can avoid further destruction and significantly improve the patient’s quality of life.

CMRT specialist tells

Kuchenkov A.V.

Orthopedist • Traumatologist • Surgeon • Phlebologist • Sports doctor • 24 years of experience

Publication date: April 26, 2021

Verification date: January 08, 2023

All facts have been verified by a doctor.

Contents of the article

Causes of chondromalacia of the patella

Symptoms of chondromalacia of the patella

At its core, softening of the cartilaginous surface of the patella is the initial manifestation of the degenerative-dystrophic process. A gradually developing disease first makes itself felt in adolescence or adolescence. The main complaint of patients: constant or intermittent pain. Initially, pain occurs after intense physical exertion or prolonged sitting with knees bent at an angle of 90°. Further – even with minor stresses, when climbing and descending stairs, squats, etc.

In the case of frontal instability, the patella deviates (“jumping”), accompanied by sharp and very severe pain. In response to gradual softening of the cartilage, reactive synovitis (inflammation of the synovium and accumulation of fluid) may develop. It is followed by immunological reactions that increase inflammation and destruction of cartilage and subchondral tissue.

Stages of chondromalacia

According to the results of arthroscopy and MRI, 4 stages of chondromalacia of the patella are determined: tissue, separation into fragments, appearance of surface cracks

• III – local ulceration, increased fibrillation of collagen fibers, destruction of the patella by half its thickness
• IV – total cartilage degradation, exposure, decrease in the density of the underlying bone under the joint

Depending on the prevalence of the pathological process, 2 types of patella injuries are distinguished: chondromalacia of the lateral (external) and medial (internal) facets. If the degenerative process affects all structures, a combined lesion of the patella is diagnosed.

Diagnosis

Diagnosis is based on history and physical examination. For the final diagnosis, functional tests and instrumental imaging methods are used:

• X-ray, in the standing position on the diseased leg (determination of the angle of deviation of the limb and the central axis)
• Computed tomography (assessment of the underlying bone, detection of cystic cavities)
• MRI (obtaining informative images of all soft tissues of the patellofemoral joint, detection of subchondral changes , discongruence of articular surfaces, pathological proliferation of blood vessels in cartilage tissue)
• diagnostic arthroscopy (quantitative characterization of degenerative lesions)

Magnetic resonance imaging is recognized as the most highly sensitive diagnostic method. Safe non-invasive imaging technology allows you to accurately determine the degree of chondromalacia of the patella, assess the syndrome of imbalance and develop further treatment tactics.

Restoration of the knee joint: material of the specialists of the RC “Laboratory of Movement”

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Which doctor should I contact?

Quote from rehabilitation specialist

Braescu Marina Nikolaevna
Physical Therapist • 11 years of experience

Quote from Rehabilitation Specialist

Injuries and diseases of the musculoskeletal system can significantly reduce the level of activity, both in sports and at the household level. Rehabilitation in the “Laboratory of Movement” is aimed at the maximum possible recovery, compensation for impaired or completely lost functions.
A multidisciplinary, comprehensive, but at the same time individual approach allows you to reduce recovery time. The specialists of the clinic strive to form a responsible attitude of the patient to the rehabilitation process and their health.

Braescu Marina Nikolaevna
Physical Therapist • Experience 11 years

How to treat chondromalacia patella?

Consequences

Prevention

Rehabilitation after treatment of chondromalacia patella in CMRT

The material was prepared with the participation of specialists from the rehabilitation center CMRT

• Individual selection of rehabilitation methods
• Personal and group training
• The latest sports equipment of varying degrees of load

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Moskaleva V.V.

Editor • Journalist • Experience 10 years

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