From the Guidelines
Transient synovitis in a 2-year-old typically presents as acute hip pain with limping or refusal to bear weight, often following a viral illness, and management includes rest, non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, and close monitoring. The presentation of transient synovitis can be similar to that of septic arthritis, but the Kocher criteria, which include fever, erythrocyte sedimentation rate, white blood cell count, and inability to bear weight, can help distinguish between the two conditions 1. In children under 2 years old, septic arthritis is more common than osteomyelitis, making it essential to rule out this condition through clinical evaluation and laboratory tests 1.
Key Features of Transient Synovitis
- Acute hip pain with limping or refusal to bear weight
- Often follows a viral illness
- Child may appear irritable, hold the affected hip in slight flexion and external rotation, and have limited range of motion
- Systemic symptoms are usually mild or absent
- Fever, if present, is typically low-grade
Management and Monitoring
- Rest and non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen at 5-10 mg/kg every 6-8 hours for 3-5 days
- Close monitoring for worsening symptoms
- Parents should maintain the child's hydration, administer prescribed pain medication, and observe for worsening symptoms
- Follow-up within 24-48 hours is recommended to ensure improvement
- If symptoms worsen, fever increases above 38.5°C, or pain persists beyond 10 days, immediate reassessment is necessary to exclude other diagnoses 1.
Diagnosis and Differential Diagnosis
- Diagnosis requires ruling out more serious conditions like septic arthritis through clinical evaluation, laboratory tests (CBC, ESR, CRP), and ultrasound imaging
- The Kocher criteria can help distinguish between transient synovitis and septic arthritis 1
- Elevated C-reactive protein >2.0 mg/dL has been described as an accurate predictor of septic arthritis 1.
Prognosis and Outcome
- Most cases of transient synovitis resolve spontaneously within 7-10 days without long-term complications
- Transient synovitis is believed to be an inflammatory response, often triggered by a preceding viral infection, causing temporary joint effusion and pain that resolves without specific intervention beyond symptomatic treatment.
From the Research
Presentation of Transient Synovitis in a 2-year-old
- Transient synovitis typically presents as an acute onset of thigh pain with a limp or an unwillingness to bear weight 2, 3.
- The condition is characterized by the absence of fever, as well as unremarkable bloodwork (WBC, CRP, ESR), radiographs, and hip aspiration 2.
- Children with transient synovitis usually present with hip pain for one to three days, accompanied by limping or the refusal to bear weight 3.
Management of Transient Synovitis in a 2-year-old
- Conservative treatment and observation are the mainstay of management 2, 4.
- Treatment consists of rest, anti-inflammatory agents, and a tincture of time 4.
- Nonsteroidal anti-inflammatory drugs (NSAIDs) may be used to accelerate the resolution of symptoms, which generally occurs by 1 week 2.
- Regular temperature checks are necessary to exclude the onset of fever, and significant pain and limping persisting seven to 10 days after the initial presentation require reevaluation 3.
Diagnostic Considerations
- Transient synovitis is a diagnosis of exclusion, and more serious conditions such as septic arthritis, osteomyelitis, and pyomyositis must be ruled out 2, 3, 5.
- Serum laboratory testing and hip ultrasound may be performed to distinguish transient synovitis from more serious diseases, although the optimal combination of tests remains unclear 5.