Transient Synovitis Flashcards Preview

Pediatrics > Transient Synovitis > Flashcards

Flashcards in Transient Synovitis Deck (18):
1

Accidental vs Nonaccidental bruising

Bruises over bony prominences are normal in young kids
- bruises over well-padded areas are suspicious for possible abuse

2

History from child with limp

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

3

Developmental dysplasia of hip

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

4

Risk factors for DDH

Female, Breech presentation, family history

5

Screening for DDH

Barlow and Orlanti tests on PE

6

Lyme Disease

tick-borne illness from Borrelia-burgdorfi
- erythema migrans with fever, malaise, headache
- diagnosis made clinically
- arthritis

7

DDx for acute refusal to walk

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

8

Hip pain secondary to effusion

pain relieved with open (flexion and external rotation)
- osteomyelitis is not position dependent

9

Transient Synovitis

not associated with inflammation in other parts of body
- recent URI

10

Musculoskeletal exam in kid

begin slow and observe how kid moves
- approach slowly and leave bad limb for last

11

ROM

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

12

Septic arthritis indicators

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

13

Eval of painful hip

WBC, CRP, ESR (greater increases in these for septic arthritis than in transient synovitis)
- blood culture if really concerned
- Xray of hip

14

CRP vs ESR

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

15

Topical anesthetic creasm

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

16

Septic Arthritis of HIp

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

17

Transient Synovitis of Hip

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

18

Ibu in kids

10 mg/kg every 6-8 hrs
100 mg/5 mL (20 mg/1 mL)