[84] Transient Synovitis

Question 1

What is transient synovitis?

Answer 1

A self-limiting condition where there is inflammation of the synovium of the capsule of the hip joint

Question 2

Is transient synovitis common?

Answer 2

Yes, it is the most common cause of acute hip pain in children

Question 3

What age does transient synovitis present?

Answer 3

2-12 years old

Question 4

What is transient synovitis associated with?

Answer 4

It often follows, or is accompanied by, a viral infection

Question 5

What is the underlying mechanism of transient synovitis?

Answer 5

There is non-specific inflammation and hypertrophy of the synovial membrane

Question 6

What gender is transient synovitis more common in?

Answer 6

Males

Question 7

How does transient synovitis present?

Answer 7

• Sudden onset of pain in hip, or limp
• Decreased range of movement, particularly internal rotation
• Referred pain to knee

Question 8

Is there pain at rest in transient synovitis?

Answer 8

No

Question 9

How does the child appear systemically in transient synovitis?

Answer 9

They are afebrile or have a mild fever, and do not appear ill

Question 10

What is it important to differentiate from transient synovitis?

Answer 10

Early septic arthritis of the hip joint

Question 11

What should be done if there is any suspicion of septic arthritis of the hip joint?

Answer 11

• Joint aspiration

- Blood cultures

Question 12

What is the difference between transient synovitis and septic arthritis of the hip joint, in terms of fever?

Answer 12

Fever is mild/absent in transient synovitis, but moderate/high in septic arthritis

Question 13

What is the difference between transient synovitis and septic arthritis of the hip joint, in terms of the child’s appearance?

Answer 13

The child often looks well in transient synovitis, but looks ill in septic arthritis

Question 14

What is the difference between transient synovitis and septic arthritis of the hip joint, in terms of examination of the hip?

Answer 14

In transient synovitis, the hip is comfortable at rest, with limited internal rotation and pain on movement.
In septic arthritis, the hip is held flexed, with severe pain at rest which is worse on any attempt to move the joint

Question 15

What is the difference between transient synovitis and septic arthritis of the hip joint, in terms of WCC?

Answer 15

WCC is normal in transient synovitis, may be raised in septic arthritis

Question 16

What is the difference between transient synovitis and septic arthritis of the hip joint, in terms of CRP/ESR?

Answer 16

Normal or slightly raised in transient synovitis, raised in septic arthritis

Question 17

What kind of diagnosis is transient synovitis?

Answer 17

Diagnosis of exclusion

Question 18

When can a diagnosis of transient synovitis be made?

Answer 18

In the typical setting of pain or limp in a young child who is not generally unwell and has had no recent trauma

Question 19

What are the differential diagnoses of transient synovitis?

Answer 19

• Septic arthritis
• Trauma
• Perthes disease
• Slipped capital femoral epiphysis

Question 20

How is transient synovitis managed?

Answer 20

Rest and analgesia with NSAIDs

Rarely, skin traction will be used

Question 21

What is a potential complication of transient synovitis?

Answer 21

Perthes disease

Question 22

What % of children with transient synovitis will get Perthes disease?

Answer 22

Approx 3%