Transient Synovitis in Children

Transient Synovitis:
Introduction
Aetiology
Clinical Features
Differential Diagnosis
Investigations
Management

1. Presented by: ANISH DHAKAL (ARYAN) 26 th March, 2019

2. Outline Introduction Aetiology Clinical Features Differential Diagnosis Investigations Management

3. 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

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

5. 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

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

7. 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)

8. 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

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

10. Thank You