Transient synovitiss

Question 1

What is it also referred to as?

Answer 1

Irritable hip

Question 2

What is it caused by?

Answer 2

Temporary (transient) irritation and inflammation in the synovial membrane of the joints (synovitis). It’s the most common cause of hip pain in children aged 3-10 years.

Question 3

What is it often associated with?

Answer 3

A recent viral upper respiratory tract infection, usually preceded by this.

Question 4

What is the difference between this and septic arthritis?

Answer 4

Children with transient synovitis usually don’t have fever. Joint pain and fever need urgent management for septic arthritis.

Question 5

What is the presentation?

Answer 5

Symptoms often occur within a few weeks of a viral illness. Present with acute or more gradual onset of:
- Triad = hip pain, limp and recent infective illness
- Limp
- Refusal to weight bear
- Groin or hip pain
- Mild low grade temperature

Children will be otherwise well and should have normal paediatric observations with no signs of systemic illness. When other signs are present consider an alternative diagnosis.

Question 6

What is the management?

Answer 6

General management is symptomatic with simple analgesia to help ease discomfort. Exclude other diagnoses, especially septic arthritis. Children aged 3-9 with symptoms suggesting transient synovitis may be managed in primary care if the limp is present for less than 48 hours and are otherwise well, but safety netting advice to attend A&E immediately if symptoms worsen or they develop a fever. Follow up at 48 hours and 1 week to ensure symptoms are improving and then fully resolve.

Question 7

What is the prognosis?

Answer 7

Usually significant improvement in symptoms after 24-48 hours. They fully resolve within 1-2 weeks without any lasting problems. It can recur in some patients.