Transient (toxic) synovitis: Difference between revisions
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*Must distinguish from septic arthritis | *Must distinguish from septic arthritis | ||
**Septic arthritis favored by: | **Septic arthritis favored by: | ||
***Temp > | ***Temp >38.5 | ||
***ESR > | ***ESR >40 | ||
***WBC > 12,000 | |||
***CRP>2 | |||
***Severe pain with ROM | ***Severe pain with ROM | ||
*Imaging | *Imaging | ||
*Plain films or ultrasound can show effusion | *Plain films or ultrasound can show effusion | ||
**If effusion found consider arthrocentesis | **If effusion found consider arthrocentesis | ||
**Presence of effusion does not rule in or out transient synovitis | |||
==DDX== | ==DDX== | ||
[[Hip Pain (Peds)]] | *[[Hip Pain (Peds)]] | ||
*Legg-Calves-Perthes disease | |||
*Occult fracture | |||
==Treatment== | ==Treatment== | ||
Revision as of 23:02, 14 June 2014
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
Clinical Features
- Abrupt onset of unilateral hip pain, limp, and restricted hip motion
- Nontoxic appearance
- May have a low grade fever
Diagnosis
- Must distinguish from septic arthritis
- Septic arthritis favored by:
- Temp >38.5
- ESR >40
- WBC > 12,000
- CRP>2
- Severe pain with ROM
- Septic arthritis favored by:
- Imaging
- Plain films or ultrasound can show effusion
- If effusion found consider arthrocentesis
- Presence of effusion does not rule in or out transient synovitis
DDX
- Hip Pain (Peds)
- Legg-Calves-Perthes disease
- Occult fracture
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
See Also
Source
Tintinalli