Transient (toxic) synovitis: Difference between revisions

Revision as of 07:25, 27 June 2011

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

Diagnosis

Diagnosis of exclusion
- Must distinguish from septic hip
  - Temp >37.5, ESR >20, severe pain with ROM favors septic joint
  - May require arthrocentesis if effusion noted on imaging

Presentation

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

Radiography

AP pelvis may show effusion (joint widening)
Ultrasound: effusion present in 95%

DDX

SCFE
Legg-Calvé-Perthes disease
Septic arthritis of hip
Acute rheumatic fever
Juvenile idiopathic arthritis

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

@@ Line 1: / Line 1: @@
 ==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
-Usually unilateral
+**Peak incidence 3-6yr
+*Usually unilateral
-Ages 2y-10y (peak 3-6)
+*70% present after recent viral URI
 ==Diagnosis==
-Diagnosis of exclusion
+*Diagnosis of exclusion
+**Must distinguish from septic hip
-Concern for septic hip if:
+***Temp >37.5, ESR >20, severe pain with ROM favors septic joint
-#T >37.5
+***May require arthrocentesis if effusion noted on imaging
-#ESR >20
-best test to differentiate is PE, w/ septic hip xtreme pain w/ minimal movt, TTS usu can tolerate ranging until xtreme movts
 ===Presentation===
-* 70% present after recent viral URI
+*Abrupt onset of unilateral hip pain, limp, and restricted hip motion
-* pts may have a low grade fever
+*Nontoxic appearance
-*Pain at hip radiates to thigh & knee
+*May have a low grade fever
-*Hip held in flex & adduction
-CBC and ESR/CRP nl to slightly elevated
+===Radiography===
+*AP pelvis may show effusion (joint widening)
+*Ultrasound: effusion present in 95%
-===Radiography===
+==DDX==
-#AP pelvis may show effusion (joint widening)
+*SCFE
-#Ultrasound: effusion present in 95%
+*Legg-Calvé-Perthes disease
+*Septic arthritis of hip
+*Acute rheumatic fever
+*Juvenile idiopathic arthritis
 ==Treatment==
-#Bed rest
+*Non-weightbearing until pain resolves (usually 3-7d)
-#NSAIDs
+**Limited activity for 1-2wk
+*NSAIDs
-==Prognosis==
+==Disposition==
-#75% have resolution of sxs w/in 2 weeks; may last up to a month
+*If dx is certain, PMD f/u within 2wk
-#Repeat XR in 6 mo to r/o L-C-P (2-6% will develop L-C-P)
 ==See Also==