Daily Bolus of LR: Transient Synovitis of the Hip

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April 29, 2011 by dailybolusoflr

Transient synovitis of the Hip

 

A bit under two years ago, my 3 1/2 year old daughter woke up in the morning and refused to get out of bed.  She told me her right thigh hurt and kept grabbing it.  I felt around her thigh, squeezed it etc … nothing. I felt around her hip and knee. . still nothing.  So I tried to get her to sit up to get out of bed and as soon as I bent her at the waist, she started crying and saying her leg hurt.  Then I tried to bend her knee, but as soon as it flexed her hip, she again started crying.  We went to the ED… where she was afebrile with a normal x-ray and normal blood work.  She was diagnosed with transient synovitis and had the ultrasound shown below (effusion of the right hip).

 

·         Transient synovitis is the most common cause of hip pain and limping in children between the ages of 4 and 10

·         It is characterized as a self-limited inflammatory condition of the hip which usually presents with pain in the hip, decreased ROM or limping/refusal to walk

·         The etiology is not clear, but is thought to be a post viral condition, most frequently after a URI or GI infection

·         The differential includes: Legg-Calfe-Perthes disease, SCFE and septic joint        

o   Legg-Calfe-Perthes disease is an idiopathic avascular necrosis of the hip which presents in the same age group, but has a 5x higher incidence in boys

o   SCFE or Slipped Capital Femoral Epiphysis is an inferior and posterior slipping of the femoral head in the growth plate. It is typically seen between the ages of 10 and 15 and is 3x

more frequent in boys and in children who are overweight

·         Reassuring factors to exclude the above diseases include:

o   Afebrile

o   Normal X-ray

o   No evidence of redness/warmth overlying the joint

·         Ultrasound typically shows and effusion which will reabsorb over the next 7-10 days

·         If symptoms persist after 2 weeks, a repeat x-ray to exclude Legg-Calfe-Perthes disease should be performed

·         Patients should rest and be given anti-inflammatory medication and/or pain medication based on the degree of their pain

 

 

AC hip with effusion.jpg AC hip without effusion.jpg

 

 

 

Eur J Pediatr (2010) 169:143148

 

 

Linda Regan, MD FACEP

Program Director, Emergency Medicine Residency

Johns Hopkins Medical Institutions

 

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