Transient hip synovitis

Question 1

Describe THS

Answer 1

UNILATERAL inflammation of synovium of hip joint

Self limiting 1-2 weeks

Question 2

Treatment for THS

Answer 2

Bed rest

Analgesia - NSAIDs

Question 3

Diagnosis of THS

Answer 3

Diagnosis of exclusion!

Question 4

Differentials for THS and how they can be ruled out

Answer 4

Perthes disease - >2 weeks, X-ray shows increased joint space as loss of femoral head
Tuberculous synovitis - abnormal blood results
Juvenile RA - >6 weeks, stiffness improves during day
Septic arthritis - acutely unwell, raised inflammatory markers, very restricted ROM
SUFE - shown on X-ray

Question 5

Presentation of THS

Answer 5

Ipsilateral pain in groin and hip
Antalgic gait
Hip in flexed and externally rotated position as minimum stretch on joint capsule

Question 6

Causes of chronic limp in children

Answer 6

THS
Perthes
SUFE

Question 7

Investigation results in THS

Answer 7

Normal bloods
Normal X ray
US may show small joint effusion