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
8.
9.
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)
11.
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
