- 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.