Transient Synovitis / Irritable Hip

Transient synovitis is the most common cause of hip pain in children.

A limp in a child may be due to a minor cause, but the serious differentials has to be exclude to arrive at a proper diagnosis.

Differential diagnosis of a limping child includes….

Incidence

  • 3% of all children at 3 – 8 years of age 
  • M : F ratio is 2 : 1
 

Has a very good prognosis 


Aetiology And Pathogenesis Of Transient Synovitis 

Exact cause is unknown.
It is not considered as a true arthopathy as it does not damage the joint

 
Following upper respiratory tract infection / trauma

                  
Inflammation of the synovium
                  
Leading to the development of tender, warm, swollen joints with reduced range of motion 


Clinical Presentation Of Transient Synovitis

  • Acute onset unilateral pain the in hip thigh or knee 
  • Limping gait
  • Low grade fever / Afebrile 
  • Previous history of URTI
  • Reduced range of motion of the affected joint
  • Painful passive movements
  • Tender joint
  • Swollen joint – Suggestive of effusion
 
 
Investigations Of Transient Synovitis
 
Even though this is the commonest cause of hip pain in children, other causes has to excluded to arrive at a proper diagnosis.
Septic arthritis, JIA, perthe’s disease and SUFE has to be excluded in such presentation.
  • Haematological 
    • Complete blood count – WBC is slightly elevated
    • ESR – Raised
    • CRP – Raised
    • RA factor, HLA B27 – Negative
    • Urine analysis – Normal
  • X-Ray of involved joint – Normal 
  • Ultrasonography – Shows effusion
 
 

Treatment Of Transient Synovitis

  • Best rest for 7 – 10 days (Till the joint heals completely)
  • Analgesics – Ibuprofen
  • Only a few patients require hospitalization ; Done only if they present with severe pain 
 
 
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