Transient synovitis

• Transient synovitis:

  • Transient irritation and inflammation in the synovial membrane of the hip = synovitis
  • Most common cause of hip pain in children aged 3-10
  • Often associated with recent viral upper respiratory tract infection
• Children with transient synovitis typically do not have a fever. Children with joint pain and a fever need urgent management for septic arthritis.
• Clinical features:

  • Hip presents in flexion, abduction and external rotation
  • Limited ROM - most commonly hip abduction and internal rotation
  • Limp
  • Pain
  • Muscle spasms
• Symptoms of transient synovitis often occur within a few weeks of a viral illness. They present with acute or more gradual onset of:

  • Limp
  • Refusal to weight bear
  • Groin or hip pain
  • Mild low grade temperature
• Investigations:

  • FBC and CRP - infection/inflammatory markers raised
  • X-ray to rule out other paediatric hip disorders
  • Ultrasound can be performed if there is suspicion of septic arthritis - Kocher's criteria
• Kocher criteria to differentiate septic arthritis from transient synovitis:

  • Each positive finding is 1 point - score of 1 = 3% probability, score of 4 = 93% probability of septic arthritis
  • Temp >38.5
  • ESR >40
  • WBC >12
• Management:

  • Transient synovitis is a self-limited disorder that typically lasts 7-10 days therefore management is focused on relieving the patients symptoms
  • Bed rest (short period)
  • Activity restriction
  • Analgesia - paracetamol and NSAIDs