Transient (toxic) synovitis

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

See Also

Hip Pain