Transient (toxic) synovitis

Background

Short-lived acute inflam of synovium of hip

Usually unilateral

Ages 2y-10y (peak 3-6)

Presentation

- 70% present after recent viral URI

- pts may have a low grade fever

-Pain at hip radiates to thigh & knee

-Hip held in flex & adduction

Radiography:

-AP pelvis may show effusion (joint widening)

-Ultrasound: effusion present in 95%

Labs:

-CBC and ESR/CRP nl to slightly elevated

if any of following think septic hip: T >37.5, ESR >20. Pts w/ this had lower temp w/ avg wbc of 11.2 vs 13.2 if septic hip, but large degree of overlap! best test to differentiate is PE, w/ septic hip xtreme pain w/ minimal movt, TTS usu can tolerate ranging until xtreme movts!

-Bed rest

-NSAIDs

-75% have resolution of sxs w/in 2 weeks; may last up to a month

-Repeat XR in 6 mo to r/o L-C-P (2-6% will develop L-C-P)