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Updated: Dec 22 2021

Transient Synovitis of Hip

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Images
https://upload.medbullets.com/topic/120521/images/transient synovitis us.jpg
  • 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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