Transient synovitis of the hip Flashcards
Hx
4 yr old male, fluctuating R hip pain for 24 hrs, refuses to bear weight, pain came yesterday morning, eased during day until he walked with a limo, v bad this morning, no recent infections
look/inspect
child in buggy, refusing to stand, hip flexed, abducted, laterally rotated [position of least intracapsular pressure]
active movement
child unwilling to move hip and bear weight
passive movement
moderate restriction of hip abduction, full pain free active ROM of lumbar spine and ipsilateral knee
other exam results
apyrexial
DDx
transient synovitis of hip
septic arthritis
perthes disease
SUFE
why is transient synovitis likely?
hx: sudden onset, fluctuating symptoms which ease as day goes on
exam: well, apyrexial, mild restriction of hip abduction on passive ROM
Why is septic arthritis unlikely?
child would be unwell and pyrexial
do bloods FBC/ESR/CRP
Why is Perthes unlikely?
pain unlikely to ease during the day
Why is SUFE unlikely?
older and more overweight
hx of several months of pain prior to presentation
investigations?
bloods
xray
U/S
MRI
Bloods
FBC - haem malignancy
ESR
CRP
Kocher criteria
Xrays
AP Pelvis and frog leg views
normal appearance
may show joint space widening medially
U/S
If suspected infection
detects intra-capsular fluid/ synovial thickening
difficult ddx transient synovitis vs septic arthritis
MRI
ddx transient synovitis vs septic arthritis
may need GA, not 1st line investigation!
