transient synovitis of hip

[axis]

Think so this is useful. taken from NHS

Hip pain in children

Diagnostic calendar of childhood hip disorders
Age (years) Probable diagnoses
Birth Congenital dislocation
0 - 5 Perthe's disease, Late presentation of CDH, Irritable hip
5 - 10 Perthe's disease, Irritable hip
10 - 15 Slipped upper femoral epiphysis, Septic arthritis, Rheumatoid arthritis

===============================================

Irritable hip syndrome

an acute manifestation related to synovitis that may be associated with Legg Calvè Perthes disease. It is characterized by a limp and limitation of motion with pain in the hip in a child approximately 3 years old. This disorder has also been called transient synovitis of the hip. Usually the clinical symptoms resolve within a few days, but some patients may develop radiological sequelae.

===============================================

Transient synovitis of the hip

common self-limiting mild inflammatory arthritis that occurs in children most frequently in the 3–8 year age range. In the absence of trauma transient synovitis is the commonest cause of acute hip or knee pain in children less than 10 years of age. The aetiology of the condition is unknown but onset of the synovitis may be preceded by an upper respiratory tract infection. Transient synovitis typically presents as acute onset of hip pain, limp and restricted movement. In contrast to septic arthritis the child is usually apyrexial without systemic illness. Clinical examination typically shows limited medial rotation of the hip and laboratory investigations including white blood cell count, erythrocyte sedimentation rate, and C-reactive protein are usually normal.

Imaging

A pelvic radiograph would be normal but may be indicated to exclude other pathology if the presentation is atypical, particularly if there is any suggestion of infection and in children over the age of 8 years in whom slipped capital femoral epiphysis becomes an important differential diagnosis. Ultrasound is very sensitive for the detection of hip joint effusion and is very useful for supporting the diagnosis of transient synovitis and for follow up to ensure the effusion resolves. The child should be scanned supine with the legs held in neutral or external rotation and the transducer orientated longitudinally along the femoral neck. In this plane ultrasound will show a fluid collection anterior to the femoral neck with associated convex anterior bulging of the echogenic joint capsule, synovial thickening may be evident both anterior to the fluid and in the synovial reflection along the femoral neck.

These sonographic appearances are indistinguishable from septic arthritis and therefore if there is any clinical suggestion of infection aspiration of culture of the effusion is indicated. However, routine aspiration of transient synovitis is not considered therapeutic. Occasionally, Perthes' disease may follow transient synovitis, the exact mechanism is uncertain but may relate to increased capsular pressure. Rest and reduced weight-bearing usually ensure resolution of symptoms within 10 days, the joint effusion may persist slightly longer.

===============================================

http://www.nhsdirect.nhs.uk/en.asp?TopicID=271&AreaID=1685&LinkID=1288


Introduction

All the freely movable joints have a kind of lubricating lining called the synovial membrane. Irritable hip is a condition in which this membrane becomes inflamed. This causes pain. As a result of the inflammation the membrane produces more than its normal thin film of lubricating fluid. Irritable hip occurs in children (usually those aged between 3 and 10 years) and is more common in boys than in girls.

Causes

Irritable hip is known medically as a transient synovitis. That just means that the synovial membrane of the hip joint is inflamed for a short time.

The cause is unknown. It may be due to a virus, or perhaps a reaction to an infection somewhere else in the body.

Diagnosis

First of all, the doctor will look at the hip to assess the extent that it is affected.

Investigation in hospital will include X-ray and ultrasound scanning to eliminate more serious causes of hip pain. Blood tests may be done to see if this will help to find the cause.

Symptoms

Sometimes following a ’flu-like illness, the child will complain of pain in one hip on walking and this may occur without any obvious cause. The pain may be felt in the groin or in the thigh, even sometimes in the knee. The pain may clear up within a week, but often it will last longer.

Treatment

Children with irritable hip may find walking and standing painful. The child should be allowed to rest so that pain is avoided. It may help to lie still on their back with the knee bent outwards on the painful side, and their foot pointed away from the body. If the condition clears up quickly, ensure that the child avoids strenuous exertion for at least a week afterwards.

An anti-inflammatory medicine, such as ibuprofen (e.g. Nurofen for Children) may be recommended to ease the swelling of the synovial membrane. The doctor may ask to be notified if any high fever occurs, as this could indicate an underlying condition other than irritable hip.

A more severe case is best treated in hospital, where full investigation may be carried out. Irritable hip is commonly treated in hospital by traction.

In most cases, a full recovery is reached with no long-term effects. A further hip x-ray may be required in 6 months' time just to ensure that the condition has completely cleared.

===============================================

Transient idiopathic synovitis of the hip is a condition of unknown cause, which causes an irritable hip syndrome. The diagnosis is one of exclusion, as all tests and the X-Rays are normal. Osteoarthritis, is characterised by pain and joint limitation. Stiffness is usually of short duration and the discomfort is worse with weight bearing, activity and through the day, rather than on waking in the morning. X-Ray changes are usually on the upper aspect of the articulation, with superior migration of the femoral head. Osteophytes, sclerosis and cyst formation, of the femoral and acetabular surfaces are common.

[nidnav]

thanks a lot for the effort!