From the Guidelines
Transient synovitis of the hip is a diagnosis of exclusion, and management consists of rest, non-weight bearing or limited weight bearing as tolerated, and NSAIDs such as ibuprofen for pain and inflammation, with most cases resolving spontaneously within 7-10 days without long-term sequelae.
Presentation and Diagnosis
Transient synovitis of the hip typically presents as acute hip pain and limping in children, most commonly between ages 3-8 years, with the child often refusing to bear weight on the affected side and holding the hip in a position of flexion, abduction, and external rotation to minimize pain 1.
- Key features of the presentation include:
- Acute hip pain and limping
- Refusal to bear weight on the affected side
- Limited and painful hip range of motion, particularly internal rotation and abduction
- Low-grade fever (less than 38.5°C) may be present, but high fevers are uncommon and suggest alternative diagnoses
- Laboratory findings typically show normal or mildly elevated inflammatory markers (ESR, CRP), and normal or slightly elevated white blood cell count, with ultrasound often revealing a hip effusion, while radiographs are usually normal but help exclude other conditions 1.
Differential Diagnosis
Septic arthritis must always be ruled out, particularly when fever is higher or inflammatory markers are significantly elevated, using criteria such as the Kocher criteria, which include fever >101.3 F, erythrocyte sedimentation rate of at least 40 mm/hour, white blood cell (WBC) count of at least 12,000 cells/mm3, and an inability to bear weight on the affected side 1.
- Other conditions to consider in the differential diagnosis include:
- Osteomyelitis
- Trauma
- Inflammatory arthritis
Management
Management of transient synovitis of the hip consists of rest, non-weight bearing or limited weight bearing as tolerated, and NSAIDs such as ibuprofen (10mg/kg/dose three times daily) for pain and inflammation, with most cases resolving spontaneously within 7-10 days without long-term sequelae 1.
- Key components of management include:
- Rest and non-weight bearing or limited weight bearing as tolerated
- NSAIDs such as ibuprofen for pain and inflammation
- Monitoring for signs of complications or alternative diagnoses, such as septic arthritis.
From the Research
Presentation of Transient Synovitis of the Hip
- Transient synovitis is a benign, self-limiting condition that is diagnosed after the exclusion of more serious causes of acute hip pain in children 2.
- It typically presents as an acute onset of thigh pain with a limp or an unwillingness to bear weight 2.
- The condition is often triggered by an immune response to a viral infection, leading to acute inflammatory arthritis 3.
- Clinical indicators of transient synovitis include the absence of fever, as well as unremarkable bloodwork (WBC, CRP, ESR), radiographs, and hip aspiration 2.
Diagnostic Evaluation
- Diagnosis involves a combination of patient history, physical examinations, imaging techniques, and laboratory tests 3.
- The optimal combination of bloodwork and radiographic testing, especially ultrasound, to distinguish transient synovitis from more serious disease remains unclear 4.
- Most investigations performed during the initial work-up in patients suspected of transient synovitis of the hip are unnecessary and should routinely include only white blood cell count, C-reactive protein, erythrocyte sedimentation rate, and hip radiography and ultrasonography 5.
Differential Diagnosis
- Transient synovitis must be distinguished from more serious entities such as septic arthritis, osteomyelitis, and pyomyositis 4.
- Missed bacterial musculoskeletal infection in children diagnosed with transient synovitis is rare but more common in younger children 4.
- Septic arthritis is a rheumatological emergency requiring immediate assessment and specific treatment 6.
Treatment and Management
- Conservative treatment and observation are the mainstay of management for transient synovitis 2.
- Treatment primarily consists of symptom management through rest, analgesics, and nonsteroidal anti-inflammatory drugs 3.
- Resolution of symptoms generally occurs by 1 week and may be accelerated by NSAIDs 2.