| Introduction |
- Transient synovitis is the most common cause of pain during childhood
- more common in children age 2 to 5 years but may affect children up to 12 years
- Cause is unknown but may be related to
- viral infection (poststreptococcal toxic synovitis)
- allergic reaction
- trauma
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| Presentation |
- Symptoms
- mild or absent fever
- acute or insidious onset of hip pain, muscle spasms, and refusal to bear weight
- pain is typically worse on awakening and usually improves during day (child can walk with a limp later in the day)
- recent history of upper respiratory infection
- Physical exam
- mild to moderate restriction of hip abduction is the most sensitive range-of-motion restriction
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| Imaging |
- Lab values
- ESR usually less than 20 mm/h
- Radiographs
- are usually normal in early stages
- Ultrasonography
- shows increased fluid in the hip joint in both transient synovitis and septic arthritis
- MRI
- can differentiate transient synovitis from septic arthritis
- however requires general anesthesia and is not recommended in most patients
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| Labs |
- Lab values
- ESR usually less than 20 mm/h
|
| Differential |
- Transient synovitis is a diagnosis of exclusion.
 Table - Differential diagnosis of Hip Pain in Children
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| Treatment |
- Nonoperative
- observation with NSAIDS for 1 week followed by physical therapy
- indications
- patient is afebrile for the past 24 hours with mild symptoms
- some recommend observation with Buck's traction for 24-48 hours
- Operative
- full evaluation for infectious process, joint aspiration, initiation of IV antibiotics
- indications
- significant fever
- leukocytosis
- significantly elevated ESR
- concurrent infectious process (otitis media, URI)
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