Updated: 12/22/2021

Transient Synovitis of Hip

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  • Snapshot
    • A 7-year-old boy presents with 1 week of subjective low grade fevers and sudden onset right hip pain. His parents noticed a new limp in the past few days. They also report that the patient had a recent upper respiratory infection about 2 weeks ago. Physical exam reveals a crying but otherwise well-appearing child. He has a temperature of 100.0°F (37.8°C). There is limited range of motion of the right hip.
  • Introduction
    • Clinical definition
      • benign transient synovitis of the hip, often characterized by acute hip pain
  • Epidemiology
    • Demographics
      • male > female
      • children 3-8 years of age
        • this is the most common cause of acute hip pain in this age group
        • uncommon in adults
    • Risk factors
      • preceding viral infection
  • Etiology
    • Pathogenesis
      • sterile synovial inflammation and joint effusion
  • Presentation
    • Symptoms
      • acute-onset limp or refusal to bear weight
      • acute hip or groin pain
    • Physical exam
      • well-appearing child
      • limping on the affected side
      • may have limited range of motion of the hip due to effusion
      • may have tenderness to palpation
  • Imaging
    • Radiography
      • indication
        • only indicated if there is suspicion for other hip pathology, such as Legg-Calve-Perthes disease
      • recommend views
        • anteroposterior pelvis
        • lateral views of both hips
      • findings
        • normal findings or joint space widening
  • Studies
    • Making the diagnosis
      • most cases are clinically diagnosed
  • Differential
    • Septic arthritis
      • distinguishing factors
        • the child is typically ill-appearing and febrile
        • elevated white blood cell count
    • Legg-Calve-Perthes disease
      • distinguishing factors
        • physical exam often reveals atrophy in the thighs and leg asymmetry
        • radiography shows sclerosis in the femoral head
  • Treatment
    • Conservative
      • rest and observation
        • indication
          • for all patients
    • Medical
      • nonsteroidal anti-inflammatory drugs
        • indication
          • pain management
  • Complications
    • None
  • Prognosis
    • Typically resolves within 1 week
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(M2.OR.14.31) A 7-year-old boy presents with right hip pain for the past 2 days. He reports gradual onset of pain and states it hurts to walk. He had a recent cold last week but is otherwise healthy. His temperature is 98.2°F (36.8°C), blood pressure is 107/70 mm Hg, pulse is 90/min, respiratory rate is 19/min, and oxygen saturation is 98% on room air. Physical exam reveals no swelling or warmth surrounding the joint. The patient is sitting with the right hip flexed, abducted, and externally rotated. Passive range of motion of the hip causes discomfort. The patient is able to ambulate but states it hurts. An initial radiograph of the hip is unremarkable. The patient's CRP is 0.10 mg/L. Which of the following is the best next step in management of this patient?

QID: 105429

Arthrocentesis

2%

(1/44)

Ibuprofen

68%

(30/44)

MRI

7%

(3/44)

Prednisone

18%

(8/44)

Vancomycin and piperacillin-tazobactam

0%

(0/44)

M 7 E

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