Transient (toxic) synovitis: Difference between revisions

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==Background==
==Background==
Short-lived acute inflam of synovium of hip
*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


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


Ages 2y-10y (peak 3-6)
==Differential Diagnosis==
{{Pediatric hip DDX}}


==Diagnosis==
==Evaluation==
Diagnosis of exclusion
===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


Concern for septic hip if:
===Evaluation===
#T >37.5
''Must distinguish from [[septic arthritis]]''
#ESR >20
*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


best test to differentiate is PE, w/ septic hip xtreme pain w/ minimal movt, TTS usu can tolerate ranging until xtreme movts
{{Kocher criteria}}


===Presentation===
==Management==
* 70% present after recent viral URI
*Return to full activity as tolerated
* pts may have a low grade fever
*[[NSAIDs]]
*Pain at hip radiates to thigh & knee
*Hip held in flex & adduction


CBC and ESR/CRP nl to slightly elevated
==Disposition==
 
*If diagnosis is certain, follow up with primary care provider within 1 week as needed
===Radiography===
#AP pelvis may show effusion (joint widening)
#Ultrasound: effusion present in 95%
 
==Treatment==
#Bed rest
#NSAIDs
 
==Prognosis==
#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)


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


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

Latest revision as of 19:09, 8 August 2019

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 limp

Hip Related

Other Causes of Limping

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 for septic arthritis of the hip

  • ESR > 40 mm/hr
  • WBC > 12,000/microliter
  • Refusal or inability to weight bear on affected joint
  • Fever 38.5° C or greater
Number of Kocher Criteria Chance of Septic Joint
1 3%
2 40%
3 93%
4 99%

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

References

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