Transient (toxic) synovitis

Background

• Self-limiting inflammatory process of the hip
• Most common cause of acute hip pain in children <10yr
  • Peak incidence 3-6yr
• Usually unilateral
• 70% present after recent viral URI
• Possible posttraumatic or allerigc pathologies

Clinical Features

• Abrupt onset of unilateral hip pain, limp, and restricted hip motion
• Nontoxic appearance
• May have a low grade fever

Diagnosis

• Must distinguish from septic arthritis
  • Septic arthritis favored by:
    • Temp >38.5
    • ESR >40
    • WBC > 12,000
    • CRP>2
    • Severe pain with ROM
• Imaging
• Plain films or ultrasound can show effusion
  • If effusion found consider arthrocentesis
  • Presence of effusion does not rule in or out transient synovitis

DDX

Hip Pain (Peds)

Treatment

• Non-weightbearing until pain resolves (usually 3-7d)
  • Limited activity for 1-2wk
• NSAIDs

Disposition

• If dx is certain, PMD f/u within 2wk

See Also

• Hip Pain
• Hip Pain (Peds)

Source

Tintinalli