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Transient Synovitis

- Discussion:
    - relatively short lived acute inflammatory process;
    - usually seen in boys aged 2 to 10 years;
    - frequently follows an upper respiratory tract infection;
    - most common cause of painful hips in childhood;
    - is a diagnosis of exclusion;
    - diff dx: (see diff dx of childhood arthritis)
          - septic arthritis;
                 - in the report by Kocher MS, et al., the authors sought to distinguish transient synovitis vs sepsis on the basis of lab data
                       and patient history;
                       - independent clinical predictors between septic arthritis and transient synovitis included history of fever, non-wt-
                                 bearing, ESR of at least forty mm/hr, and serum WBC of more than 12,000;
                       - the predicted probability for septic arthritis were 93% if three of these variables were present and were over 99% if all
                                4 predictors were present;
                       - authors recommend careful observation without aspiration if none of the four independent predictors are present;
                 - reference:
                       - Differentiating between septic arthritis and transient synovitis of the hip in children: an evidence-based clinical prediction algorithm.
          - JRA
          - Perthes disease;
                 - if initial radiographs are normal and there is strong suspicion of Perthes disease, bone scanning and MRI  may be helpful;
                 - likelihood of transient synovitis leading to Perthes disease is small, certainly less than 3%;

- Clinical Findings:
    - findings include hip pain, muscle spasm, restriction of motion, refusal to walk, and low grade fever;
    - onset can be acute or insidious;

- Management:  
    - aspiration of the hip joint is usually needed to rule out septic arthritis;
           - consider this to be a dx of exclusion;
    - symptoms of toxic synovitis should show improvement after 24 hrs of traction

Coxa magna following transient synovitis of the hip.

Significance of laboratory and radiologic findings for differentiating between septic arthritis and transient synovitis of the hip.

Factors Distinguishing Septic Arthritis from Transient Synovitis of the Hip in Children. A Prospective Study.