Transient (toxic) synovitis: Difference between revisions
| Line 36: | Line 36: | ||
**CRP >2 | **CRP >2 | ||
**severe pain with ROM | **severe pain with ROM | ||
====Kocher Criteria for [[septic hip]]==== | |||
''4 criteria: non-weight bearing, ESR>40, WBC>12,000, fever'' | |||
*4/4 99% probability of septic hip | |||
*1/4 3% probability of septic hip | |||
==Management== | ==Management== | ||
Revision as of 13:32, 27 February 2018
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
- Acute rheumatic fever
- Developmental dysplasia of hip
- Femur fracture
- Juvenile idiopathic arthritis
- Legg-Calve-Perthes disease
- Septic arthritis of the hip (peds)
- Lyme disease arthritis
- Slipped capital femoral epiphysis
- Transient (toxic) synovitis
- Osteosarcoma
Other Causes of Limping
- Developmental dysplasia
- Fracture
- Toddler's fracture
- Tillaux fracture, adolescent
- Neoplasm:
- Leukemia
- Ewings
- Osteogenic sarcoma
- Metastatic neuroblastoma
- Osteomyelitis
- Myositis
- Other:
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 hip
4 criteria: non-weight bearing, ESR>40, WBC>12,000, fever
- 4/4 99% probability of septic hip
- 1/4 3% probability of septic hip
Management
- Return to full activity as tolerated
- NSAIDs
Disposition
- If diagnosis is certain, follow up with primary care provider within 1 week as needed