Transient (toxic) synovitis: Difference between revisions

Revision as of 05:03, 9 June 2011

Short-lived acute inflam of synovium of hip

Usually unilateral

Ages 2y-10y (peak 3-6)

Diagnosis of exclusion

Concern for septic hip if:

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

CBC and ESR/CRP nl to slightly elevated

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 ==Diagnosis==
-Presentation
+Diagnosis of exclusion
-- 70% present after recent viral URI
+Concern for septic hip if:
+#T >37.5
+#ESR >20
-- pts may have a low grade fever
+best test to differentiate is PE, w/ septic hip xtreme pain w/ minimal movt, TTS usu can tolerate ranging until xtreme movts
--Pain at hip radiates to thigh & knee
+===Presentation===
+* 70% present after recent viral URI
+* pts may have a low grade fever
+*Pain at hip radiates to thigh & knee
+*Hip held in flex & adduction
--Hip held in flex & adduction
+CBC and ESR/CRP nl to slightly elevated
-Radiography:
+===Radiography===
+#AP pelvis may show effusion (joint widening)
--AP pelvis may show effusion (joint widening)
+#Ultrasound: effusion present in 95%
--Ultrasound: effusion present in 95%
-Labs:
--CBC and ESR/CRP nl to slightly elevated
-*Dx of exclusion
-*if any of following think septic hip: T >37.5, ESR >20. Pts w/ this had lower temp w/ avg wbc of 11.2 vs 13.2 if septic hip, but large degree of overlap! best test to differentiate is PE, w/ septic hip xtreme pain w/ minimal movt, TTS usu can tolerate ranging until xtreme movts!
 ==Treatment==