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Transient (toxic) synovitis
From WikEM
(Redirected from Transient (Toxic) Synovitis (Hip))
Contents
Background
- Self-limiting inflammatory process of the hip
- Most common cause of acute hip pain in children <10yr
- Peak incidence 3-8yrs, with a mean of 6 yrs
- Male:Female is 2:1
- Usually unilateral
- 32-50% present after recent viral URI
- Possible posttraumatic or allergic pathologies
Clinical Features
- Abrupt onset of unilateral hip pain, limp, and restricted hip motion
- Nontoxic appearance
- May have a low grade fever
Differential Diagnosis
Pediatric hip pain
- Septic arthritis of the hip (peds)
- Slipped capital femoral epiphysis
- Legg-Calve-Perthes disease
- Transient (toxic) synovitis
- Acute rheumatic fever
- Juvenile idiopathic arthritis
- Developmental dysplasia of hip
- Femur fracture
Evaluation
Work-up
- X-ray if suspicious for fracture
- Plain films or ultrasound can show effusion
- If effusion found consider arthrocentesis
- Presence of effusion does not rule in or out transient synovitis as bilateral effusions can occur in 25% of children
Evaluation
Must distinguish from septic arthritis
- Transient Synovitis favored by:
- Temperature <38.5
- ESR <20
- WBC <12,000
- CRP <2
- Septic arthritis favored by:
- Temperature >38.5
- ESR >40
- WBC >12,000
- CRP >2
- Severe pain with ROM
Management
- Return to full activity as tolerated
- NSAIDs
Disposition
- If diagnosis is certain, follow up with primary care provider within 1 week as needed
