View source for Transient (toxic) synovitis

==Background==
*Self-limiting inflammatory process of the hip
*Most common cause of acute hip pain in children <10yr
**Peak incidence 3-8yrs, with a mean of 6 yrs
*Male:Female is 2:1
*Usually unilateral
*32-50% present after recent viral URI
*Possible posttraumatic or allergic pathologies

==Clinical Features==
*Abrupt onset of unilateral hip pain, limp, and restricted hip motion
*Nontoxic appearance
*May have a low grade fever

==Differential Diagnosis==
{{Pediatric hip DDX}}

==Evaluation==
===Work-up===
*X-ray if suspicious for fracture
*Plain films or ultrasound can show effusion
**If effusion found consider arthrocentesis
**Presence of effusion does not rule in or out transient synovitis as bilateral effusions can occur in 25% of children

===Evaluation===
''Must distinguish from [[septic arthritis]]''
*Transient Synovitis favored by:
**Temperature <38.5
**ESR <20
**WBC <12,000
**CRP <2
*Septic arthritis favored by:
**Temperature >38.5
**ESR >40
**WBC >12,000
**CRP >2
**severe pain with ROM

{{Kocher criteria}}

==Management==
*Return to full activity as tolerated
*[[NSAIDs]]

==Disposition==
*If diagnosis is certain, follow up with primary care provider within 1 week as needed

==See Also==
*[[Hip pain (peds)]]

==References==
<references/>
[[Category:Pediatrics]]
[[Category:Orthopedics]]