Transient (toxic) synovitis

Background

Short-lived acute inflam of synovium of hip

Usually unilateral

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

Diagnosis

Diagnosis of exclusion

Concern for septic hip if:

1. T >37.5
2. 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
• pts may have a low grade fever
• Pain at hip radiates to thigh & knee
• Hip held in flex & adduction

CBC and ESR/CRP nl to slightly elevated

Radiography

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

Treatment

1. Bed rest
2. NSAIDs

Prognosis

1. 75% have resolution of sxs w/in 2 weeks; may last up to a month
2. Repeat XR in 6 mo to r/o L-C-P (2-6% will develop L-C-P)

See Also

Hip Pain