transient synovitis
TRANSCRIPT
Transient Synovitis (Irritable Hip)
Presented By Siti Nur Rifhan Kamaruddin
OVERVIEW
Definition: A self-limiting condition in which there is
inflammation and swelling of the tissue around the
hip joint.
• Most common cause of acute hip pain in children 3-8 years old.
• Boys affected twice > girls
• The exact cause is unknown.
ETIOLOGY
• No definitive cause is known.
• The following have been suggested :
- History of trauma, which may be a cause or
predisposing factor.
- A Study found increased viral antibody titers
in 67-80 patients with Transient Synovitis
- Post vaccination or drug-mediated reactions
- Allergic disposition
CLINICAL FEATURES
• Most common symptom: Unilateral hip or groin pain
• Limping
• Duration: Symptoms last for 1 or 2 weeks then subside spontaneously
• The child may experience > one episode , with an interval of months between pain attacks
• Very young children may have no symptoms other than crying at night.
On Examination:
• Hip kept in flexion with slight abduction and external rotation
• Some may have mild restriction of abduction & internal rotation
• The hip may be painful with passive movement and tender on palpation
DIAGNOSIS
• Diagnosis of exclusion once trauma and infection are excluded.
• Diagnosis is made primarily based on clinical features
- Lab investigations are normal
- X-ray show nothing more than slight
widening of medial joint space
DIFFERENTIAL DIAGNOSIS• Perthes Disease
- Acute symptoms > 2 weeks- X-rays features are prominent
• Slipped Epiphysis- If age and general built are suggestive of SUFEor Sx persist – x-ray should be repeated.
• Septic Arthritis - Suspect if blood tests are abnormal and x-ray aresuggestive.
• Juvenile Chronic Arthritis & Ankylosing Spondylitis- Look for systemic features and raised (ESR).
Synovial biopsy to confirm
INVESTIGATIONS
Tests are done to rule our other diagnoses
• WBC, ESR and CRP level are elevated in Septic
Arthritis
• X-Rays: Can exclude bony lesions
• Ultrasound guided aspiration of the effusion
MANAGEMENT
• Most children recover within a few days and any deterioration in signs and symptoms requires urgent reassessment.
• Treatment involves
- Best rest
- Reduced activity
- Observation (At home or hospital)
• Ultrasonography is repeated at intervals
• Weight bearing is allowed only when disappear and the effusion resolves
PROGNOSIS
• Usually marked improvement within 24-48 hours
• Two-thirds to three-fourths of patients have complete resolution within 2 weeks.
• Recurrence rate is 4-17%
REFERENCES
• Apley and Solomon’s Concise System of Orthopedics and Trauma 4th Edition. CRC Press
Thank you..