Transient (toxic) synovitis: Difference between revisions
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==Diagnosis== | ==Diagnosis== | ||
===Work-up=== | |||
*X-ray if suspicious for fracture | *X-ray if suspicious for fracture | ||
*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 as bilateral effusions can occur in 25% of children | **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: | |||
**Temp <38.5 | |||
**ESR <20 | |||
**WBC <12,000 | |||
**CRP <2 | |||
*Septic arthritis favored by: | |||
**Temp >38.5 | |||
**ESR >40 | |||
**WBC >12,000 | |||
**CRP >2 | |||
**Severe pain with ROM | |||
==Treatment== | ==Treatment== | ||
Revision as of 06:43, 7 June 2015
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:
Diagnosis
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:
- Temp <38.5
- ESR <20
- WBC <12,000
- CRP <2
- Septic arthritis favored by:
- Temp >38.5
- ESR >40
- WBC >12,000
- CRP >2
- Severe pain with ROM
Treatment
- Return to full activity as tolerated
- NSAIDs
Disposition
- If diagnosis is certain, follow up with PMD within 1 week as needed