Transient synovitis - Revision history

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2025-04-12T18:08:05Z

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← Older revision		Revision as of 19:49, 8 April 2025
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			{{SI}}
			{{Infobox medical condition
			\| name = Transient synovitis
			\| image = [[File:Hip.jpg\|left\|thumb\|Illustration of the hip joint]]
			\| caption = Illustration of the hip joint
			\| field = [[Orthopedics]]
			\| synonyms = Toxic synovitis
			\| symptoms = [[Hip pain]], [[limping]], [[fever]]
			\| complications = [[Avascular necrosis]] (rare)
			\| onset = Typically between ages 3 and 8
			\| duration = 1 to 2 weeks
			\| causes = Unknown, possibly [[viral infection]]
			\| risks = Recent [[upper respiratory infection]]
			\| diagnosis = [[Clinical examination]], [[ultrasound]], [[X-ray]]
			\| differential = [[Septic arthritis]], [[Legg-Calvé-Perthes disease]], [[Juvenile idiopathic arthritis]]
			\| treatment = [[Rest]], [[nonsteroidal anti-inflammatory drug\|NSAIDs]]
			\| prognosis = Excellent, self-limiting
			\| frequency = Common in children
			}}
	== '''Alternate Names''' ==		== '''Alternate Names''' ==

	* Irritable hip		* Irritable hip
	* Transient coxitis		* Transient coxitis
	* Coxitis fugax		* Coxitis fugax

	<youtube>		<youtube>
	title='''{{PAGENAME}}'''		title='''{{PAGENAME}}'''
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	height=600		height=600
	</youtube>		</youtube>

	== '''Definition''' ==		== '''Definition''' ==

	* Transient synovitis (TS) is an acute, non-specific, self-limited inflammatory process affecting the joint [[synovium]]. Transient synovitis of the hip is a common cause of hip pain in the pediatric patient population.		* Transient synovitis (TS) is an acute, non-specific, self-limited inflammatory process affecting the joint [[synovium]]. Transient synovitis of the hip is a common cause of hip pain in the pediatric patient population.

	== '''Etiology''' ==		== '''Etiology''' ==

	* The exact etiology of TS is unknown. Proposed risk factors include:		* The exact etiology of TS is unknown. Proposed risk factors include:
	*# Preceding upper respiratory tract infection		*# Preceding upper respiratory tract infection
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	*# Preceding bacterial infection		*# Preceding bacterial infection
	*# Post-streptococcal toxic synovitis		*# Post-streptococcal toxic synovitis
			[[File:Hip joint with acute inflammation of the synovial membrane Wellcome L0061419.jpg\|left\|thumb\|Inflamed hip joint]]
	[[File:Hip joint with acute inflammation of the synovial membrane Wellcome L0061419.jpg\|thumb\|Inflamed hip joint]]

	== '''Epidemiology''' ==		== '''Epidemiology''' ==

	* TS of the hip most frequently occurs in children ages 3 to 10 years old. The average annual incidence of TS and the total lifetime risk are estimated to be at 0.2% and 3%, respectively.		* TS of the hip most frequently occurs in children ages 3 to 10 years old. The average annual incidence of TS and the total lifetime risk are estimated to be at 0.2% and 3%, respectively.
	* The incidence rate in males is twice that of females, and about 1% to 4% of the time a patient may demonstrate bilateral involvement.		* The incidence rate in males is twice that of females, and about 1% to 4% of the time a patient may demonstrate bilateral involvement.

	== '''Signs and symptoms''' ==		== '''Signs and symptoms''' ==

	* Acute unilateral limb disuse ranging from nonspecific hip pain or subtle limp to a refusal to bear weight.		* Acute unilateral limb disuse ranging from nonspecific hip pain or subtle limp to a refusal to bear weight.
	* Child or infant becoming increasingly agitated or crying more often than at baseline.		* Child or infant becoming increasingly agitated or crying more often than at baseline.
	* The patient may present with the hip in the flexed, abducted, and externally rotated position as this relaxes the hip joint capsule to decrease [[intra-articular pressure]].		* The patient may present with the hip in the flexed, abducted, and externally rotated position as this relaxes the hip joint capsule to decrease [[intra-articular pressure]].
	* May be febrile at presentation.		* May be febrile at presentation.

	== '''Diagnosis''' ==		== '''Diagnosis''' ==

	* TS remains a diagnosis of exclusion.		* TS remains a diagnosis of exclusion.
	* Synovial WBC counts: (5,644 - 15,388) in Transient synovitis while (105,432 - 260,214) in Septic arthritis.		* Synovial WBC counts: (5,644 - 15,388) in Transient synovitis while (105,432 - 260,214) in Septic arthritis.
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	*# ESR greater than or equal to 20 mm/hr		*# ESR greater than or equal to 20 mm/hr
	*# Severe hip pain and spasm with movement		*# Severe hip pain and spasm with movement
	* The Kocher criteria remain a helpful set of clinical risk factors differentiating SA(septic arthritis) and TS in pediatric patients presenting with hip pain. The criteria include the increasing diagnostic probability in favor of the former, yielding a 99.6% probability favoring SA as a diagnosis when all four criteria are met:		* The Kocher criteria remain a helpful set of clinical risk factors differentiating SA(septic arthritis) and TS in pediatric patients presenting with hip pain.¬† The criteria include the increasing diagnostic probability in favor of the former, yielding a 99.6% probability favoring SA as a diagnosis when all four criteria are met:
	*# WBC > 12,000 cells per microliter of serum		*# WBC > 12,000 cells per microliter of serum
	*# Inability or refusal to bear weight		*# Inability or refusal to bear weight
	*# Febrile (> 101.3 degrees Fahrenheit or 38.5 degrees celsius)		*# Febrile (> 101.3 degrees Fahrenheit or 38.5 degrees celsius)
	*# ESR > 40 mm/hr When none of the above risk factors are present upon presentation, the probability of the patient having SA of the hip drops below 0.2%.		*# ESR > 40 mm/hr When none of the above risk factors are present upon presentation, the probability of the patient having SA of the hip drops below 0.2%. ¬†

	== '''Management''' ==		== '''Management''' ==
			* It involves supportive care and rest from activity.¬†[[NSAIDS]] can be used for pain control.¬†Other modalities include the application of heat and/or massage modalities.
	* It involves supportive care and rest from activity. [[NSAIDS]] can be used for pain control. ~~Other~~ modalities include the application of heat and/or massage modalities.		* Symptoms generally improve after 24 to 48 hours.¬†Complete resolution of symptoms often takes up to 1 to 2 weeks in up to 75% of patients.¬†The remainder may have less severe symptoms for several weeks.
	* Symptoms generally improve after 24 to 48 hours. ~~Complete~~ resolution of symptoms often takes up to 1 to 2 weeks in up to 75% of patients. ~~The~~ remainder may have less severe symptoms for several weeks.
	* If significant symptoms persist for seven to 10 days after the initial presentation, consider other diagnoses. Patients with symptoms for more than a month have been found to have a different pathology.		* If significant symptoms persist for seven to 10 days after the initial presentation, consider other diagnoses. Patients with symptoms for more than a month have been found to have a different pathology.

	== '''Differential diagnosis''' ==		== '''Differential diagnosis''' ==

	* [[Osteomyelitis]]		* [[Osteomyelitis]]
	* [[Septic arthritis]]		* [[Septic arthritis]]
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	* [[Legg–Calvé–Perthes disease]] (LCPD)		* [[Legg–Calvé–Perthes disease]] (LCPD)
	* [[Slipped capital femoral epiphysis]] (SCFE)		* [[Slipped capital femoral epiphysis]] (SCFE)

	== '''Prognosis''' ==		== '''Prognosis''' ==
			* In total, TS of the hip recurs in up to 20% to 25% of patients.¬†The patient should be educated regarding the increased risk of recurrence in the setting of a previously documented diagnosis of TS.
	* In total, TS of the hip recurs in up to 20% to 25% of patients. ~~The~~ patient should be educated regarding the increased risk of recurrence in the setting of a previously documented diagnosis of TS.

	== '''Complications''' ==		== '''Complications''' ==

	* The major complication associated with TS is a recurrence of symptoms.		* The major complication associated with TS is a recurrence of symptoms.

	== '''References''' ==		== '''References''' ==

	* Christine C. Whitelaw; Matthew Varacallo. Transient synovitis [Updated June 29,2021]. In StatPearls[Internet]. Available at: https://www.ncbi.nlm.nih.gov/books/NBK459181/		* Christine C. Whitelaw; Matthew Varacallo. Transient synovitis [Updated June 29,2021]. In StatPearls[Internet]. Available at: https://www.ncbi.nlm.nih.gov/books/NBK459181/

	[[Category:Pediatrics]]		[[Category:Pediatrics]]
	[[Category:Inflammations]]		[[Category:Inflammations]]

Ajnimmagadda at 14:57, 10 August 2021

2021-08-10T14:57:51Z

New page

== '''Alternate Names''' ==

* Irritable hip
* Transient coxitis
* Coxitis fugax

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== '''Definition''' ==

* Transient synovitis (TS) is an acute, non-specific, self-limited inflammatory process affecting the joint [[synovium]]. Transient synovitis of the hip is a common cause of hip pain in the pediatric patient population.

== '''Etiology''' ==

* The exact etiology of TS is unknown. Proposed risk factors include:
*# Preceding upper respiratory tract infection
*# Preceding trauma
*# Preceding bacterial infection
*# Post-streptococcal toxic synovitis

[[File:Hip joint with acute inflammation of the synovial membrane Wellcome L0061419.jpg|thumb|Inflamed hip joint]]

== '''Epidemiology''' ==

* TS of the hip most frequently occurs in children ages 3 to 10 years old. The average annual incidence of TS and the total lifetime risk are estimated to be at 0.2% and 3%, respectively.
* The incidence rate in males is twice that of females, and about 1% to 4% of the time a patient may demonstrate bilateral involvement.

== '''Signs and symptoms''' ==

* Acute unilateral limb disuse ranging from nonspecific hip pain or subtle limp to a refusal to bear weight.
* Child or infant becoming increasingly agitated or crying more often than at baseline.
* The patient may present with the hip in the flexed, abducted, and externally rotated position as this relaxes the hip joint capsule to decrease [[intra-articular pressure]].
* May be febrile at presentation.

== '''Diagnosis''' ==

* TS remains a diagnosis of exclusion.
* Synovial WBC counts: (5,644 - 15,388) in Transient synovitis while (105,432 - 260,214) in Septic arthritis.
* Inflammatory markers slightly raised in TS.
*# ESR range for SA patients was 44 - 64 mm/hr
*# ESR range for TS patients was 21 - 33 mm/hr
* If the aspirate has a positive gram stain, more than 90% polymorphonuclear cells, or a glucose less than 40 mg/dL or markedly different from the serum glucose, the patient is more likely to have septic arthritis and not transient synovitis.
* Although plain films may be normal for months after the onset of symptoms, the medial joint space is typically slightly wider in the affected hip indicating the presence of fluid. One-half to two-thirds of patients with transient synovitis may have an accentuated pericapsular shadow.
* [[Ultrasound]] is extremely accurate for detecting an intracapsular effusion. Ultrasound-guided hip aspiration not only relieves pain and limitation of movement but often provides a rapid distinction from septic arthritis. Ultrasound-guided hip aspiration should be done in all individuals in whom ultrasonography has exhibited evidence of an effusion, and any of the following predictive criteria are present:
*# Temperature greater than 99.5 F
*# ESR greater than or equal to 20 mm/hr
*# Severe hip pain and spasm with movement
* The Kocher criteria remain a helpful set of clinical risk factors differentiating SA(septic arthritis) and TS in pediatric patients presenting with hip pain. The criteria include the increasing diagnostic probability in favor of the former, yielding a 99.6% probability favoring SA as a diagnosis when all four criteria are met:
*# WBC > 12,000 cells per microliter of serum
*# Inability or refusal to bear weight
*# Febrile (> 101.3 degrees Fahrenheit or 38.5 degrees celsius)
*# ESR > 40 mm/hr When none of the above risk factors are present upon presentation, the probability of the patient having SA of the hip drops below 0.2%.

== '''Management''' ==

* It involves supportive care and rest from activity. [[NSAIDS]] can be used for pain control. Other modalities include the application of heat and/or massage modalities.
* Symptoms generally improve after 24 to 48 hours. Complete resolution of symptoms often takes up to 1 to 2 weeks in up to 75% of patients. The remainder may have less severe symptoms for several weeks.
* If significant symptoms persist for seven to 10 days after the initial presentation, consider other diagnoses. Patients with symptoms for more than a month have been found to have a different pathology.

== '''Differential diagnosis''' ==

* [[Osteomyelitis]]
* [[Septic arthritis]]
* Primary or metastatic lesions
* [[Legg–Calvé–Perthes disease]] (LCPD)
* [[Slipped capital femoral epiphysis]] (SCFE)

== '''Prognosis''' ==

* In total, TS of the hip recurs in up to 20% to 25% of patients. The patient should be educated regarding the increased risk of recurrence in the setting of a previously documented diagnosis of TS.

== '''Complications''' ==

* The major complication associated with TS is a recurrence of symptoms.

== '''References''' ==

* Christine C. Whitelaw; Matthew Varacallo. Transient synovitis [Updated June 29,2021]. In StatPearls[Internet]. Available at: https://www.ncbi.nlm.nih.gov/books/NBK459181/

[[Category:Pediatrics]]
[[Category:Inflammations]]
[[Category:Disorders of synovium and tendon]]
[[Category:Skeletal disorders]]
{{stub}}

← Older revision		Revision as of 18:08, 12 April 2025
Line 59:		Line 59:
	*# ESR greater than or equal to 20 mm/hr		*# ESR greater than or equal to 20 mm/hr
	*# Severe hip pain and spasm with movement		*# Severe hip pain and spasm with movement
	* The Kocher criteria remain a helpful set of clinical risk factors differentiating SA(septic arthritis) and TS in pediatric patients presenting with hip pain.¬† The criteria include the increasing diagnostic probability in favor of the former, yielding a 99.6% probability favoring SA as a diagnosis when all four criteria are met:		* The Kocher criteria remain a helpful set of clinical risk factors differentiating SA(septic arthritis) and TS in pediatric patients presenting with hip pain. The criteria include the increasing diagnostic probability in favor of the former, yielding a 99.6% probability favoring SA as a diagnosis when all four criteria are met:
	*# WBC > 12,000 cells per microliter of serum		*# WBC > 12,000 cells per microliter of serum
	*# Inability or refusal to bear weight		*# Inability or refusal to bear weight
	*# Febrile (> 101.3 degrees Fahrenheit or 38.5 degrees celsius)		*# Febrile (> 101.3 degrees Fahrenheit or 38.5 degrees celsius)
	*# ESR > 40 mm/hr When none of the above risk factors are present upon presentation, the probability of the patient having SA of the hip drops below 0.2%. ¬†		*# ESR > 40 mm/hr When none of the above risk factors are present upon presentation, the probability of the patient having SA of the hip drops below 0.2%.
	== '''Management''' ==		== '''Management''' ==
	* It involves supportive care and rest from activity.¬†[[NSAIDS]] can be used for pain control.~~¬†Other~~ modalities include the application of heat and/or massage modalities.		* It involves supportive care and rest from activity. [[NSAIDS]] can be used for pain control. Other modalities include the application of heat and/or massage modalities.
	* Symptoms generally improve after 24 to 48 hours.~~¬†Complete~~ resolution of symptoms often takes up to 1 to 2 weeks in up to 75% of patients.~~¬†The~~ remainder may have less severe symptoms for several weeks.		* Symptoms generally improve after 24 to 48 hours. Complete resolution of symptoms often takes up to 1 to 2 weeks in up to 75% of patients. The remainder may have less severe symptoms for several weeks.
	* If significant symptoms persist for seven to 10 days after the initial presentation, consider other diagnoses. Patients with symptoms for more than a month have been found to have a different pathology.		* If significant symptoms persist for seven to 10 days after the initial presentation, consider other diagnoses. Patients with symptoms for more than a month have been found to have a different pathology.
	== '''Differential diagnosis''' ==		== '''Differential diagnosis''' ==
Line 75:		Line 75:
	* [[Slipped capital femoral epiphysis]] (SCFE)		* [[Slipped capital femoral epiphysis]] (SCFE)
	== '''Prognosis''' ==		== '''Prognosis''' ==
	* In total, TS of the hip recurs in up to 20% to 25% of patients.~~¬†The~~ patient should be educated regarding the increased risk of recurrence in the setting of a previously documented diagnosis of TS.		* In total, TS of the hip recurs in up to 20% to 25% of patients. The patient should be educated regarding the increased risk of recurrence in the setting of a previously documented diagnosis of TS.
	== '''Complications''' ==		== '''Complications''' ==
	* The major complication associated with TS is a recurrence of symptoms.		* The major complication associated with TS is a recurrence of symptoms.