Transient Synovitis

Question 1

Accidental vs Nonaccidental bruising

Answer 1

Bruises over bony prominences are normal in young kids

- bruises over well-padded areas are suspicious for possible abuse

Question 2

History from child with limp

Answer 2

Associated bruising?
Ever happened before?
Sick recently?
Other symptoms?

Question 3

Developmental dysplasia of hip

Answer 3

femoral head not properly aligned with the acetabulum –> can become dysplastic, dislocate, sublux

Question 4

Risk factors for DDH

Answer 4

Female, Breech presentation, family history

Question 5

Screening for DDH

Answer 5

Barlow and Orlanti tests on PE

Question 6

Lyme Disease

Answer 6

tick-borne illness from Borrelia-burgdorfi

• erythema migrans with fever, malaise, headache
• diagnosis made clinically
• arthritis

Question 7

DDx for acute refusal to walk

Answer 7

Leukemia - replacement of marrow by leukemic cells (fever, weight loss)
Osteomyelitis - infection of bone (staph, Hib)
Reactive arthritis - inflammatory process outside the joint (urethritis and conjunctivitis)
Septic arthritis - needs to be excluded
Transient synovitis - acute hip pain with no other explanation following URI
Trauma

Question 8

Hip pain secondary to effusion

Answer 8

pain relieved with open (flexion and external rotation)

- osteomyelitis is not position dependent

Question 9

Transient Synovitis

Answer 9

not associated with inflammation in other parts of body

- recent URI

Question 10

Musculoskeletal exam in kid

Answer 10

begin slow and observe how kid moves

- approach slowly and leave bad limb for last

Question 11

ROM

Answer 11

flexion - bend joint
extend - straighten joint
abduction - away from body
adduction - toward body
internal rotation - rotation toward midline
external rotation - rotation away from midline

Question 12

Septic arthritis indicators

Answer 12

Fever (best predictor)
Non-weight bearing
ESR > 40 mm/hr
WBC >12

Question 13

Eval of painful hip

Answer 13

WBC, CRP, ESR (greater increases in these for septic arthritis than in transient synovitis)

• blood culture if really concerned
• Xray of hip

Question 14

CRP vs ESR

Answer 14

CRP - rises quickly, direct quantification of acute phase reactant, more specific, more sensitive
ESR - rises slowly, indirect quantification of fibrinogen, not specific, not sensitive

Question 15

Topical anesthetic creasm

Answer 15

ELA-max = contain lidocaine and can be used for kiddos with blood draws (need 30 min to work)

Question 16

Septic Arthritis of HIp

Answer 16

Staph aureus, streptococcus, Hib, Neisseria

• US used to see if effusion present or guiding needle for aspiration (turbid fluid with low glucose and increased WBC)
• empiric IV antibiotics should be used until culture grown

Question 17

Transient Synovitis of Hip

Answer 17

inflammation and swelling of tissues around hip

• unknown etiology in kids following URI
• Tx = rest and Ibu
• resolves in 3-10 days
• small chance of recurrence - no sequelae

Question 18

Ibu in kids

Answer 18

10 mg/kg every 6-8 hrs

100 mg/5 mL (20 mg/1 mL)