Transient Synovitis of the Hip

Question 1

pathology

Answer 1

Self-limiting inflammation of the synovium joint
Most commonly of the hip
Shortly after an upper respiratory tract infection (usually viral)

Question 2

who gets it?

Answer 2

2-10 years

boys> girls

Question 3

what is it?

Answer 3

Transient hip synovitis is the commonest cause of hip pain in childhood

Other differentials: 
Septic arthritis
Perthes disease
Juvenile Idiopathic Arthritis
Rheumatoid Arthritis

Question 4

how does it present?

Answer 4

Limp
Reluctance to weight bear on affected side
ROM may be restricted
Not as much pain or loss of motion as septic arthritis
Low grade fever
Not systemically unwell or septic

Question 5

how is it investigated?

Answer 5

Radiographs – exclude Perthes
CRP normal/near normal & clinical picture suggestive of TSOFTH – exclude septic arthritis
If doubt: aspiration of the hip (anaesthetic/ open surgical drainage to limit cartilage damage)
MRI – may be helpful in equivocal cases – osteomyelitis of proximal femur is possible

Question 6

how is it managed?

Answer 6

NSAID and rest

Resolves within a few weeks – if not: other causes sought (JIA, early Perthes)