76:
271:, which is an overgrowth of the femoral head and broadening of the femoral neck, accompanied by changes in the acetabulum, which may lead to subluxation of the femur. There was also some controversy about whether continuous high intra-articular pressure in transient synovitis could cause avascular necrosis of the femoral head (
288:. This is because if septic arthritis is missed in children, grave complications can occur. The exclusion of septic arthritis is mainly built upon the physician's clinical expertise and is supplemented by basic laboratory test and relevant imaging modalities. Additionally, beware to exclude the diagnosis of acute
139:
Transient synovitis usually affects children between three and ten years old (but it has been reported in a 3-month-old infant and in some adults). It is the most common cause of sudden hip pain and limp in young children. Boys are affected two to four times as often as girls. The exact cause is
183:
and limited weight-bearing. The condition usually clears by itself within seven to ten days, but a small group of patients will continue to have symptoms for several weeks. The recurrence rate is 4–17%, most of which is in the first six months.
1537:
1522:
255:. The log roll test involves gently rotating the entire lower limb inwards and outwards with the patient on his back, to check when muscle guarding occurs. The unaffected hip and the knees, ankles, feet and spine are found to be normal.
283:
There are no set standards for the diagnosis of suspected transient synovitis, so the amount of investigations will depend on the need to exclude other, more serious diseases. It is of great importance to exclude the diagnosis of
263:
In the past, there have been speculations about possible complications after transient synovitis. The current consensus however is that there is no proof of an increased risk of complications after transient synovitis.
40:
329:
shadow, diminution of soft tissue planes around the hip joint or slight demineralisation of the proximal femur. The main reason for radiographic examination is to exclude bony lesions such as occult fractures,
1432:
Kermond S, Fink M, Graham K, Carlin JB, Barnett P (Sep 2002). "A randomized clinical trial: should the child with transient synovitis of the hip be treated with nonsteroidal anti-inflammatory drugs?".
349:), although this is not always present in transient synovitis. However, it cannot reliably distinguish between septic arthritis and transient synovitis. If septic arthritis needs to be ruled out,
987:
Caird MS, Flynn JM, Leung YL, Millman JE, D'Italia JG, Dormans JP (Jun 2006). "Factors distinguishing septic arthritis from transient synovitis of the hip in children. A prospective study".
368:
More advanced imaging techniques can be used if the clinical picture is unclear; the exact role of different imaging modalities remains uncertain. Some studies have demonstrated findings on
404:
and severe symptoms (inability to bear weight, pronounced muscle guarding) all point to septic arthritis, but a high index of suspicion remains necessary even if these are not present.
1349:
Lee SK, Suh KJ, Kim YW, et al. (May 1999). "Septic arthritis versus transient synovitis at MR imaging: preliminary assessment with signal intensity alterations in bone marrow".
167:
of the hip joint. Nevertheless, children with transient synovitis of the hip can usually weight bear. This is an important clinical differentiating sign from
380:
can be entirely normal in transient synovitis, and scintigraphic findings do not distinguish transient synovitis from other joint conditions in children.
1616:
204:
on the affected side. However, children with transient synovitis of the hip can usually weight bear with varying degrees of limping. There may be a
353:
of the fluid can be performed under ultrasound guidance. In transient synovitis, the joint fluid will be clear. In septic arthritis, there will be
449:) typically occurs in children aged 4–8, and is also more common in boys. There may be an effusion on ultrasound, similar to transient synovitis.
132:). In everyday clinical practice however, irritable hip is commonly used as a synonym for transient synovitis. It should not be confused with
124:, joint stiffness, limp or non-weightbearing, indicative of an underlying condition such as transient synovitis or orthopedic infections (like
459:
is missed early in life, it can come to attention later in this way. Pain in the groin can also be caused by diseases of the organs in the
1035:"Validation of a clinical prediction rule for the differentiation between septic arthritis and transient synovitis of the hip in children"
136:, a condition describing hip and lower back pain much more common to adults than transient synovitis but with similar signs and symptoms.
1269:"Septic arthritis versus transient synovitis of the hip: gadolinium-enhanced MRI finding of decreased perfusion at the femoral epiphysis"
504:
180:
317:
imaging of the hip is most often unremarkable. Subtle radiographic signs include an accentuated pericapsular shadow, widening of the
1142:
Zamzam MM (Nov 2006). "The role of ultrasound in differentiating septic arthritis from transient synovitis of the hip in children".
149:
152:) or a trauma have been postulated as precipitating events, although these are reported only in 30% and 5% of cases, respectively.
159:. The diagnosis can be made in the typical setting of pain or limp in a young child who is not generally unwell and has no recent
33:
Transitory coxitis, Coxitis fugax, Acute transient epiphysitis, Coxitis serosa seu simplex, Phantom hip disease, Observation hip.
1224:
Skinner J, Glancy S, Beattie TF, Hendry GM (Mar 2002). "Transient synovitis: is there a need to aspirate hip joint effusions?".
788:"Acute osteoarticular infections in children are frequently forgotten multidiscipline emergencies: beyond the technical skills"
442:
331:
372:(MRI scan) that can differentiate between septic arthritis and transient synovitis (for example, signal intensity of adjacent
300:
1306:
Yang WJ, Im SA, Lim GY, et al. (Nov 2006). "MR imaging of transient synovitis: differentiation from septic arthritis".
476:
446:
272:
511:
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311:), but raised inflammatory markers are strong predictors of other more serious conditions such as septic arthritis.
369:
696:
1186:
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could shorten the disease course (from 4.5 to 2 days) and provide pain control with minimal side effects (mainly
326:
244:
93:
400:, because it can quickly cause irreversible damage to the hip joint. Fever, raised inflammatory markers on
1611:
397:
362:
308:
156:
1495:
An illustrated, free full-text review with emphasis on clinical examination of the acutely limping child.
861:"Seven year follow up of children presenting to the accident and emergency department with irritable hip"
456:
377:
220:). The condition is nearly always limited to one side. The pain and limp can range from mild to severe.
1385:
415:
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322:
232:
213:
567:
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338:). An anteroposterior and frog lateral (Lauenstein) view of the pelvis and both hips is advisable.
75:
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441:
injuries can be contracted during heavy physical activity —however, it is important not to miss a
235:, the child typically holds the hip slightly bent, turned outwards and away from the middle line (
1331:
1249:
1167:
1062:
1012:
630:
304:
605:
Quintos-Macasa AM, Serebro L, Menon Y (Feb 2006). "Transient synovitis of the hip in an adult".
268:
715:"Incidence and management of transient synovitis of the hip: a study in Dutch general practice"
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Pain in or around the hip and/or limp in children can be due to a large number of conditions.
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908:
Sharwood PF (Dec 1981). "The irritable hip syndrome in children. A long-term follow-up".
247:). Active and passive movements may be limited because of pain, especially abduction and
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703:". Family practice notebook. Revision of August 9, 2007. Retrieved December 22, 2007.
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joint space, lateral displacement of the femoral epiphyses with surface flattening (
1581:
961:
713:
Vijlbrief AS, Bruijnzeels MA, van der Wouden JC, van
Suijlekom-Smit LW (Oct 1992).
514:). If fever occurs or the symptoms persist, other diagnoses need to be considered.
480:
472:
452:
346:
97:
69:
531:
Do TT (Feb 2000). "Transient synovitis as a cause of painful limps in children".
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945:"Transient synovitis and Perthes' disease. Is there an aetiological connection?"
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500:
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Ultrasound is better than x-ray at detecting hip effusions in the limping child
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141:
52:
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275:), but further studies did not confirm any link between the two conditions.
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Inflammatory parameters in the blood may be slightly raised (these include
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117:
101:
1284:
1189:[Benefit of hip ultrasound in management of the limping child].
1187:"[Benefit of hip ultrasound in management of the limping child]"
422:), can also cause pain and limp, but are uncommon around the hip joint.
1033:
Kocher MS, Mandiga R, Zurakowski D, Barnewolt C, Kasser JR (Aug 2004).
693:
460:
430:
236:
228:
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Bienvenu-Perrard M, de
Suremain N, Wicart P, et al. (Mar 2007).
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16:
Inflammation of the inner lining (synovium) of the hip joint capsule
653:
Hart JJ (Oct 1996). "Transient synovitis of the hip in children".
419:
345:
of the hip can easily demonstrate fluid inside the joint capsule (
314:
224:
197:
193:
48:
859:
Mattick A, Turner A, Ferguson J, Beattie T, Sharp J (Sep 1999).
205:
201:
354:
39:
408:(infection of the bone tissue) can also cause pain and limp.
1267:
Kwack KS, Cho JH, Lee JH, Cho JH, Oh KK, Kim SY (Aug 2007).
396:(a bacterial infection of the joint) is the most important
223:
Some children may have a slightly raised temperature; high
763:. General Practice Notebook. Retrieved December 22, 2007.
568:"The limping child: epidemiology, assessment and outcome"
1386:"Assessing the limping child with skeletal scintigraphy"
216:
can be unexplained crying (for example, when changing a
212:
in infants) with or without pain. In small infants, the
1504:
1556:
1508:
63:
29:
24:
499:Treatment consists of rest, non-weightbearing and
267:One such previously suspected complication was
175:of the hip joint can show a fluid collection (
171:. Blood tests may show mild inflammation. An
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1132:. BestBETs.org . Retrieved December 22, 2007
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455:conditions can also present with a limp. If
231:point to other, more serious conditions. On
192:Transient synovitis causes pain in the hip,
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503:when needed. A small study showed that the
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943:Kallio P, Ryöppy S, Kunnamo I (Nov 1986).
445:. Avascular necrosis of the femoral head (
292:, because it not uncommonly cooccurs with
74:
38:
21:
1473:"Evaluation of the acutely limping child"
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960:
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730:
1082:"Investigating hip pain in a well child"
471:disease. Rarely, there is an underlying
719:The British Journal of General Practice
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648:
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1080:Gough-Palmer A, McHugh K (Jun 2007).
786:El-Sobky, T; Mahmoud, S (July 2021).
7:
357:in the joint, which can be sent for
181:nonsteroidal anti-inflammatory drugs
92:; see below for more synonyms) is a
47:The hip joint is formed between the
1384:Connolly LP, Treves ST (Jun 1998).
566:Fischer SU, Beattie TF (Nov 1999).
505:nonsteroidal anti-inflammatory drug
1363:10.1148/radiology.211.2.r99ma47459
1156:10.1097/01.bpb.0000228388.32184.7f
619:10.1097/01.smj.0000199746.29009.4c
457:developmental dysplasia of the hip
14:
150:upper respiratory tract infection
1617:Disorders of synovium and tendon
1238:10.1097/00063110-200203000-00005
1128:Nicola Wright, Vince Choudhery.
1051:10.2106/00004623-200408000-00005
545:10.1097/00008480-200002000-00010
1471:Leet AI, Skaggs DL (Feb 2000).
443:slipped upper femoral epiphysis
332:slipped upper femoral epiphysis
962:10.1302/0301-620X.68B5.3782251
301:erythrocyte sedimentation rate
1:
1203:10.1016/S0221-0363(07)89834-9
533:Current Opinion in Pediatrics
512:gastrointestinal disturbances
477:juvenile idiopathic arthritis
1434:Annals of Emergency Medicine
1098:10.1136/bmj.39188.515741.47
694:Transient hip tenosynovitis
584:10.1302/0301-620X.81B6.9607
251:. The hip can be tender to
86:Transient synovitis of hip
1638:
1416:Legg-Calve-Perthes Disease
804:10.1302/2058-5241.6.200155
447:Legg-Calvé-Perthes disease
370:magnetic resonance imaging
273:Legg-Calvé-Perthes disease
1320:10.1007/s00247-006-0289-9
922:10.3109/17453678108992159
384:does not appear helpful.
334:or bone tumours (such as
155:Transient synovitis is a
100:of the inner lining (the
46:
37:
418:(spiral fracture of the
296:of the hip in children.
1446:10.1067/mem.2002.126171
94:self-limiting condition
661:(5): 1587–91, 1595–6.
398:differential diagnosis
388:Differential diagnosis
363:antibiotic sensitivity
309:white blood cell count
157:diagnosis of exclusion
378:Skeletal scintigraphy
179:). Treatment is with
163:. There is a limited
96:in which there is an
1039:J Bone Joint Surg Am
1001:10.2106/JBJS.E.00216
989:J Bone Joint Surg Am
949:J Bone Joint Surg Br
877:10.1136/emj.16.5.345
572:J Bone Joint Surg Br
485:gonococcal arthritis
429:can be evident when
233:clinical examination
214:presenting complaint
1285:10.2214/AJR.07.2080
1273:AJR Am J Roentgenol
25:Transient synovitis
1622:Skeletal disorders
1557:External resources
1197:(3 Pt 1): 377–83.
1144:J Pediatr Orthop B
792:EFORT Open Reviews
699:2007-09-16 at the
692:Scott Moses, MD. "
416:toddler's fracture
305:C-reactive protein
188:Symptoms and signs
148:(most commonly an
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910:Acta Orthop Scand
865:J Accid Emerg Med
359:bacterial culture
351:needle aspiration
249:internal rotation
241:external rotation
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238:
234:
230:
226:
221:
219:
215:
211:
208:(or abnormal
207:
203:
199:
195:
187:
185:
182:
178:
174:
170:
166:
162:
158:
153:
151:
147:
143:
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135:
131:
130:osteomyelitis
127:
123:
119:
115:
114:irritable hip
111:
107:
103:
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91:
88:(also called
87:
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1433:
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451:
414:, such as a
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367:
347:Fabella sign
340:
313:
298:
282:
266:
262:
227:and general
222:
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98:inflammation
89:
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84:
70:Rheumatology
1566:MedlinePlus
1232:(1): 15–8.
607:South Med J
501:painkillers
489:bone tumour
475:condition (
463:(such as a
424:Soft tissue
402:blood tests
382:CT scanning
374:bone marrow
144:. A recent
112:. The term
30:Other names
1607:Pediatrics
1601:Categories
1390:J Nucl Med
518:References
487:, ...) or
469:testicular
269:coxa magna
53:acetabulum
1585:emerg/387
1577:eMedicine
1421:eMedicine
1351:Radiology
848:eMedicine
508:ibuprofen
495:Treatment
473:rheumatic
420:shin bone
365:testing.
327:obturator
279:Diagnosis
253:palpation
245:abduction
120:of acute
110:hip joint
104:) of the
65:Specialty
1582:ped/1676
1489:10706154
1454:12192353
1371:10228529
1336:23475331
1328:17019590
1293:17646472
1254:29742427
1246:11989490
1211:17457269
1191:J Radiol
1172:27006647
1164:17001248
1116:17556478
1067:13529642
1059:15292409
1017:29137759
1009:16757758
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843:ped/1676
822:34377550
697:Archived
635:26520520
627:16509560
592:10615981
553:10676774
467:) or by
439:ligament
427:injuries
210:crawling
177:effusion
134:sciatica
122:hip pain
118:syndrome
102:synovium
1402:9627343
1107:1892599
971:3782251
930:7331801
886:1347055
813:8335954
741:1466922
732:1372234
667:8857781
461:abdomen
431:bruises
237:flexion
229:malaise
142:unknown
108:of the
106:capsule
55:of the
1571:000981
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435:Muscle
319:medial
218:diaper
161:trauma
72:
57:pelvis
1532:M67.3
1332:S2CID
1250:S2CID
1168:S2CID
1063:S2CID
1013:S2CID
631:S2CID
315:X-ray
225:fever
198:groin
194:thigh
49:femur
1542:9-CM
1485:PMID
1450:PMID
1398:PMID
1367:PMID
1324:PMID
1289:PMID
1242:PMID
1207:PMID
1160:PMID
1112:PMID
1055:PMID
1043:86-A
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967:PMID
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891:PMID
818:PMID
737:PMID
663:PMID
623:PMID
588:PMID
549:PMID
361:and
307:and
243:and
206:limp
202:knee
51:and
1538:ICD
1523:ICD
1442:doi
1419:at
1359:doi
1355:211
1316:doi
1281:doi
1277:189
1234:doi
1199:doi
1152:doi
1102:PMC
1094:doi
1090:334
1086:BMJ
1047:doi
997:doi
957:doi
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881:PMC
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