Transient Synovitis

Question 1

What

Answer 1

is sometimes referred to as irritable hip. It is caused by temporary (transient) irritation and inflammation in the synovial membrane of the joint (synovitis). It is the most common cause of hip pain in children aged 3 – 10 years. It is often associated with a recent viral upper respiratory tract infection.

Children with transient synovitis typically do not have a fever. Children with joint pain and a fever need urgent management for septic arthritis.

Question 2

Present

Answer 2

Symptoms of transient synovitis often occur within a few weeks of a viral illness. They present with acute or more gradual onset of:

Limp
Refusal to weight bear
Groin or hip pain
Mild low grade temperature
Children with transient synovitis should be otherwise well. They should have normal paediatric observations and no signs of systemic illness. When other signs are present, consider alternative diagnoses.

Question 3

Treatment

Answer 3

General management of transient synovitis is symptomatic, with simple analgesia to help ease the discomfort. The challenge is to establish the correct diagnosis and exclude other significant pathology, particularly septic arthritis.

NICE clinical knowledge summaries provide guidance on managing transient synovitis: Children aged 3 – 9 years with symptoms suggestive of transient synovitis may be managed in primary care if the limp is present for less than 48 hours and they are otherwise well, however they need clear safety net advice to attend A&E immediately if the symptoms worsen or they develop a fever. They should also be followed up at 48 hours and 1 week to ensure symptoms are improving and then fully resolve.

Prognosis
Typically there is a significant improvement in symptoms after 24 – 48 hours. Symptoms fully resolve within 1 – 2 weeks without any lasting problems. Transient synovitis may recur in around 20% of patients.