Transient Synovitis: Introduction Aetiology Clinical Features Differential Diagnosis Investigations Management

1. PRESENTED BY:
ANISH DHAKAL (ARYAN)
26TH MARCH, 2019

2. Outline
Introduction
Aetiology
Clinical Features
Differential Diagnosis
Investigations
Management

4. Introduction
The Irritable Hip
A non-specific, short lived synovitis
Transient – last for 1-2 weeks then subside
Results in effusion of hip joint
Most common cause of acute limping or hip pain

5. Aetiology
Exact cause not known
Viral infections, trauma and allergy
Leads to synovial effusion  Increased intra-articular pressure

6. Clinical Features
Pain – groin region, front of thigh, sometimes up to knee
Limping, crying
Symptoms occur – intermittently or after activity
History of sore throat, cough, ear infection prior to limp pain
O/E:
◦ Slight wasting may appear
◦ Restriction of all movements mostly at the extremes of the movement
◦ Tenderness at the joint

7. How to diagnose?
Mostly based on clinical features
Investigations – mostly done to rule out serious conditions
1. CBC, ESR, CRP : usually normal or may be raised
2. X-ray : increased joint space as compared to
unaffected side
3. USG : effusion (capsular distention) and subluxation
of femoral head may appear

10. Ultrasonography
Figure 1
Patient with transient synovitis: sagittal
US image. The anterior (A) and
posterior (P) layers of the joint capsule
are separated by anechoic effusion.
Figure 2
A healthy child. US image of the anterior joint
shows the femoral neck, the iliopsoas muscle
and both layers of the anterior joint
capsule(arrow)

12. Management
Symptomatic
◦ Bed Rest
◦ Decrease activity of the joint
◦ Traction – might increase intra-articular pressure
◦ Joint Aspiration – symptoms relieve but is short-lived
Mostly symptoms resolves within few days
Weight bearing only after effusion disappears
Good prognosis but repeated episodes may occur

14. References
Solomon, Warwick, Nayagam; Appley’s System of Orthopedics and
Fractures, 9th Ed
Essential Orthopedics. 5th Edition