Hip joint dysfunction (sacroiliac, transient synovitis)

Question 1

What is the aetiology of sacroiliac joint syndrome?

Answer 1

1. Abnormal motion i.e. hyper- or hypo-mobile
2. OR Malalignment of the sacroiliac joint

Question 2

What are the main causes of sacroiliac joint dysfunction?

Answer 2

• 80% - repetitive microtrauma or acute trauma
• 20% -pregnancy-related
• Or idiopathic

Question 3

Who is most affected by SI joint dysfunction?

Answer 3

Adults who lead a sedentary lifestyle - it makes up about 10-25% of back pain

Question 4

What are the clinical features of SI joint dysfunction?

Answer 4

• Pain over buttock
• Sharp, stabbing +/- shooting pain extending down posterior thigh not past the knee - mimics radicular pain
• Difficulty sitting in one place for too long, pain on lying on ipsilateral side or on climbing stairs
• Local tenderness near PSIS
• Pain on bending forward
• Aberrant SI movement

Question 5

What is the management of SI joint dysfunction?

Answer 5

• Simple analgesia
• Home exercises
• Orthoses e.g. belts, braces

Question 6

Which muscles may be affected in SI joint dysfunction?

Answer 6

Piriformis - SIJD often linked to piriformis syndrome

Hamstrings, quadriceps, iliotibial tract

etc

Question 7

A 3-year-old boy is seen in the accident and emergency department at 2 a.m. because he is crying. He is otherwise healthy. Earlier in the day he was playing, but his mother noted that he may have had a limp. He has no fever and otherwise feels well. On physical examination, slight movement of his hip is tolerated but excess motion causes him to cry. His full blood count and erythrocyte sedimentation rate are normal.

Diagnosis?

Answer 7

Transient synovitis

Question 8

Define irritable hip.

Answer 8

Transient synovitis is a self-limiting inflammatory disorder of the hip that commonly affects young children 2-12yo.

Question 9

What is the aetiology of transient synovitis?

Answer 9

• Viral URTI
• Allergic
• Trauma
• Growth abnormalities

Question 10

What are the clinical features of transient synovitis?

Answer 10

• Mild to moderate hip pain
• History of URTI
• Ambulating but with limp
• Resting hip in abduction and external rotation
• Positive log roll test

Question 11

What investigations should be done for transient synovitis?

Answer 11

• Obs - fever should be <38.5oC
• FBC - WCC <12
• CRP and ESR - may be slightly elevated, <40

Other:

• XR - normal
• USS - effusion common

Question 12

What 4 investigation findings would make transient synovitis more likely than septic arthritis?

Answer 12

• Fever <38.5
• Able to weight bear despite limp
• ESR <40 mm/hr
• WCC <12

= probability of septic arthritis <0.2%, if one above higher then 3%

Question 13

What is the management of transient synovitis?

Answer 13

• Activity restriction +/- bed rest
• Gentle skin traction
• NSAIDs

Question 14

What is the prognosis with transient synovitis?

Answer 14

Should resolve within 7-10 days. If persists –> further investigate.