MSK - Transient Synovitis

Question 1

Definition

Answer 1

Informally known as: irritable hip
Common self-limiting inflammatory condition affecting the synovial membrane of a joint = most commonly the hip

Question 2

Aetiology

Answer 2

Unknown
- Thought to be triggered by a viral infection or an immune-mediated response. This is due to the fact that many patients will have a preceding upper respiratory tract infection.

Question 3

Epidemiology

Answer 3

Transient synovitis is the most common cause of hip pain in children aged 3-10 years.
- Age: the disease typically presents at a mean age of 6 (3–8) years
- Male sex: 2:1 ratio
- Preceding upper respiratory tract infection
- Preceding trauma

Question 4

Signs

Answer 4

• Joint tenderness
• Limited range of motion in the hip
• Antalgic gait

Question 5

Symptoms

Answer 5

Hip pain
Knee pain: this is referred pain from the hip
Limping
Joint stiffness

Question 6

Diagnosis

Answer 6

Blood tests:
- ESR, CRP = rule out other causes of joint inflammation, such as septic arthritis or juvenile idiopathic arthritis.
X-ray: Assess joint effusion and rule out fractures, dislocations, or other bony abnormalities.
USS: to visualise joint effusion and assess for synovial thickening.
Joint aspiration: in cases with high suspicion of septic arthritis, to evaluate synovial fluid for cell count, gram stain, and culture.

Question 7

Treatment

Answer 7

• Rest and activity modification: to reduce pain and inflammation. It typically resolves on its own in 1-2 weeks.
• Analgesia: ibuprofen is typically used for pain relief and reduction of inflammation, with paracetamol as an adjunct.
• Physiotherapy : to maintain joint mobility and muscle strength once pain has subsided.

Question 8

Complications

Answer 8

• Recurrence of transient synovitis
• Progression to a more severe form of arthritis: this is very rare