Transient (toxic) synovitis: Difference between revisions
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*Self-limiting inflammatory process of the hip | *Self-limiting inflammatory process of the hip | ||
*Most common cause of acute hip pain in children <10yr | *Most common cause of acute hip pain in children <10yr | ||
**Peak incidence 3- | **Peak incidence 3-8yrs, with a mean of 6 yrs | ||
*Male:Female is 2:1 | |||
*Usually unilateral | *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 | *Abrupt onset of unilateral hip pain, limp, and restricted hip motion | ||
*Nontoxic appearance | *Nontoxic appearance | ||
*May have a low grade fever | *May have a low grade fever | ||
=== | ==Differential Diagnosis== | ||
* | {{Pediatric hip DDX}} | ||
* | |||
==Evaluation== | |||
===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: | |||
**Temperature <38.5 | |||
**ESR <20 | |||
**WBC <12,000 | |||
**CRP <2 | |||
*Septic arthritis favored by: | |||
**Temperature >38.5 | |||
**ESR >40 | |||
**WBC >12,000 | |||
**CRP >2 | |||
**severe pain with ROM | |||
{{Kocher criteria}} | |||
== | ==Management== | ||
* | *Return to full activity as tolerated | ||
*[[NSAIDs]] | |||
*NSAIDs | |||
==Disposition== | ==Disposition== | ||
*If | *If diagnosis is certain, follow up with primary care provider within 1 week as needed | ||
==See Also== | ==See Also== | ||
[[Hip | *[[Hip pain (peds)]] | ||
[[Category: | ==References== | ||
[[Category: | <references/> | ||
[[Category:Pediatrics]] | |||
[[Category:Orthopedics]] | |||
Latest revision as of 19:09, 8 August 2019
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 hip pain
- 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
Evaluation
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:
- Temperature <38.5
- ESR <20
- WBC <12,000
- CRP <2
- Septic arthritis favored by:
- Temperature >38.5
- ESR >40
- WBC >12,000
- CRP >2
- severe pain with ROM
Kocher Criteria for septic arthritis of the hip
- ESR > 40 mm/hr
- WBC > 12,000/microliter
- Refusal or inability to weight bear on affected joint
- Fever 38.5° C or greater
| Number of Kocher Criteria | Chance of Septic Joint |
| 1 | 3% |
| 2 | 40% |
| 3 | 93% |
| 4 | 99% |
Management
- Return to full activity as tolerated
- NSAIDs
Disposition
- If diagnosis is certain, follow up with primary care provider within 1 week as needed