Transient Synovitis of the Hip

Question 1

What is the MC cause if hip pain in the pediatric patient?

Answer 1

transient synovitis of the hip

MC in kids 4-8yo

Question 2

What causes transient synovitis of the hip?

Answer 2

Unknown; possibly viral or post-bacterial infection

Is a non-specific inflammation and hypertrophy of the synovial lining/membrane
usually benign; marked improvements usually in 24-48 hours; complete resolution of symptoms will usually occur in

Question 3

How does transient synovitis of the hip present?

Answer 3

Unable to bear weight, sudden onset pain, able to limp later in the day;
mild to moderate restriction of hip abduction is the most sensitive range-of-motion restriction

Question 4

In a child with hip pain what are the two most important things to r/o septic hip?

Answer 4

1) can bear weight on leg

2) CRP

Question 5

What are the Kocher criteria for septic arthritis in pediatric hip?

Answer 5

Kocher criteria for septic arthritis (3 out of 4 = 93% chance of septic arthritis)

1) fever > 38.5 C
2) WBC > 12,000 mm3
3) non-weightbearing on affected side
4) ESR > 40mm/h

CRP >20 not part of criteria but is the most important independent risk factor for septic arthritis

Question 6

How are kids with transient synovitis treated?

Answer 6

1) NSAIDs and observation; Kocher 2 or concurrent infxn

3) Urgent I&D; Kocher 4 and systemic infxn