Transient Synovitis (Irritable Hip)

Presented By Siti Nur Rifhan Kamaruddin

OVERVIEW

Definition: A self-limiting condition in which there is

inflammation and swelling of the tissue around the

hip joint.

• Most common cause of acute hip pain in children 3-8 years old.

• Boys affected twice > girls

• The exact cause is unknown.

ETIOLOGY

• No definitive cause is known.

• The following have been suggested :

- History of trauma, which may be a cause or

predisposing factor.

- A Study found increased viral antibody titers

in 67-80 patients with Transient Synovitis

- Post vaccination or drug-mediated reactions

- Allergic disposition

CLINICAL FEATURES

• Most common symptom: Unilateral hip or groin pain

• Limping

• Duration: Symptoms last for 1 or 2 weeks then subside spontaneously

• The child may experience > one episode , with an interval of months between pain attacks

• Very young children may have no symptoms other than crying at night.

On Examination:

• Hip kept in flexion with slight abduction and external rotation

• Some may have mild restriction of abduction & internal rotation

• The hip may be painful with passive movement and tender on palpation

DIAGNOSIS

• Diagnosis of exclusion once trauma and infection are excluded.

• Diagnosis is made primarily based on clinical features

- Lab investigations are normal

- X-ray show nothing more than slight

widening of medial joint space

DIFFERENTIAL DIAGNOSIS• Perthes Disease

- Acute symptoms > 2 weeks- X-rays features are prominent

• Slipped Epiphysis- If age and general built are suggestive of SUFEor Sx persist – x-ray should be repeated.

• Septic Arthritis - Suspect if blood tests are abnormal and x-ray aresuggestive.

• Juvenile Chronic Arthritis & Ankylosing Spondylitis- Look for systemic features and raised (ESR).

Synovial biopsy to confirm

INVESTIGATIONS

Tests are done to rule our other diagnoses

• WBC, ESR and CRP level are elevated in Septic

Arthritis

• X-Rays: Can exclude bony lesions

• Ultrasound guided aspiration of the effusion

MANAGEMENT

• Most children recover within a few days and any deterioration in signs and symptoms requires urgent reassessment.

• Treatment involves

- Best rest

- Reduced activity

- Observation (At home or hospital)

• Ultrasonography is repeated at intervals

• Weight bearing is allowed only when disappear and the effusion resolves

PROGNOSIS

• Usually marked improvement within 24-48 hours

• Two-thirds to three-fourths of patients have complete resolution within 2 weeks.

• Recurrence rate is 4-17%

REFERENCES

• Apley and Solomon’s Concise System of Orthopedics and Trauma 4th Edition. CRC Press

Thank you..