Transient synovitis

Question 1

What is transient synovitis?

Answer 1

Transient synovitis, also known as irritable hip, is the inflammation of the synovium, often secondary to a viral infection, usually affecting the hip joint

Question 2

Describe the aetiology of Transient synovitis

Answer 2

Transient synovitis commonly occurs shortly after a viral upper respiratory tract infection, however, in some cases, no cause is found

It typically occurs between the age of 2 and 10 and is the most common cause of hip pain in childhood

It more commonly affects boys than girls

Question 3

What are some common presentations of transient synovitis?

Answer 3

• History of viral illness
• Limp
• Hip/groin pain
• Referred pain to knee (Uncommon)
• Low grade fever
• Usually systemically well
• Hip lying flexed/externally rotated

Question 4

What is Kochers criteria for assessment of transient synovitis?

Answer 4

• WCC > 12
• Inability to weight bear
• Temperature > 38.5ºC
• ESR > 40 or raised CRP

Question 5

What investigations are required in transient synovitis?

Answer 5

Kocher’s criteria
Ultrasound
Aspiration of synovial fluid

Question 6

What are some other investigations in transient synovitis to rule out other conditions?

Answer 6

X-ray - To rule out Perthes disease
CRP - To rule out septic arthritis
MRI - To rule out osteomyelitis

Question 7

How is transient synovitis usually managed?

Answer 7

Transient synovitis is usually self-limiting, so management is purely conservative, with rest and NSAIDs usually being the guidance

Question 8

How long will pain usually last in transient synovitis?

Answer 8

Pain will generally resolve within a few weeks, however, if there is no resolution of pain, then another cause of the pain should be sought