Final answer:
The patient with a bulge on the posterior knee, absent of other concerning features, likely has a Baker's cyst, and the most appropriate initial management is conservative treatment, including rest, ice, compression, elevation, and possibly NSAIDs.
Step-by-step explanation:
The question describes a 66-year-old male with a non-painful, non-inflammatory swelling on the posterior aspect of the right knee, which is visible as a large bulge, accompanied by bilateral knee crepitus. The absence of pain, instability, warmth, or redness, along with the location of the swelling, suggests this could be a case of a Baker's cyst, also known as a popliteal cyst. A Baker's cyst is a fluid-filled sac that forms behind the knee due to an accumulation of synovial fluid, often secondary to other knee conditions such as arthritis or meniscus tears.
Given the clinical presentation and the absence of other alarming features such as knee instability or signs of infection, the most appropriate management for an uncomplicated Baker's cyst typically includes conservative treatments. These can consist of rest, ice applied to the affected area, compression with a knee sleeve or wrap, and elevation. Moreover, nonsteroidal anti-inflammatory drugs (NSAIDs) may help manage any associated discomfort. If the cyst is causing significant symptoms or complications, further interventions like aspiration or surgical removal may be considered, often alongside treatment of the underlying knee disorder. Referral to a musculoskeletal specialist for further evaluation may be warranted, especially if there is uncertainty in diagnosis or if symptoms persist despite initial conservative management.