Materiały źródłowe

• #1 Transient synovitis (irritable hip)

  https://www.rch.org.au/kidsinfo/fact_sheets/Transient_synovitis/

  Transient synovitis (irritable hip) is the most common cause of limping in children. It is due to inflammation (swelling) of the lining of the hip joint. […] Irritable hip is most often seen in children aged between three and 10 years old. It is not serious, and will get better on its own with rest. […] Usually, no tests are required for irritable hip, and you can care for your child at home. […] Irritable hip is a mild condition that will get better on its own. Complete rest is usually all that is needed. It should start to improve in about three days and be better in two weeks. […] Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, are helpful for irritable hip as they relieve the pain as well as reducing inflammation. […] Transient synovitis (irritable hip) is the most common cause of limping in children. […] It is generally a mild condition that will get better on its own with rest, usually within two weeks. […] Non-steroidal anti-inflammatory drugs, e.g. ibuprofen, may help relieve the pain and reduce inflammation.

• #2 “Irritable Hip”: Diagnosis in the Emergency Department. A Descriptive Study Over One Year

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6314824/

  In this population, IH has: (i) an atypical age profile (age distribution shift to younger), (ii) no marked association with social deprivation (in contrast to other studies), and (iii) a 'spring preponderance’. We suggest that most cases can safely be managed in the ED without recourse to further investigations or speciality referral. […] The diagnosis of IH in the Glasgow ED is primarily a clinical one. All patients who presented to the ED had a history taken and underwent an examination. The majority of patients were diagnosed as having an irritable hip clinically (n = 254). […] The annual incidence of irritable hip in the GGC area (n = 319) was 177.7 per 100,000 children aged 014 years. The incidence of irritable hip was greater in boys, with a 1.9:1 boy:girl ratio (209 boys, 110 girls, p 0.001).

• #3 Irritable hip (transient synovitis): Symptoms, causes, and diagnosis

  https://www.medicalnewstoday.com/articles/166614

  Irritable hip results from hip joint inflammation. It is a common cause of hip pain and limping in children aged 10 years or younger. […] Doctors refer to irritable hip as acute transient synovitis or toxic synovitis. It is most common between the ages of 3 and 10 years and occurs more frequently in boys than girls. […] The symptoms may cause alarm and discomfort, but irritable hip is a mild condition that usually lasts up to 2 weeks. […] Irritable hip is a transient condition in children that causes pain and a limp. […] The pain ranges from mild to severe and tends to start suddenly. It usually occurs on one side of the hip, but it can affect the hip, groin, thigh, and knee on the affected side. […] The doctor, usually a primary care physician, will ask the child, parent, or caregiver about symptoms, then perform a physical examination.

• #4 Hip pain in children (irritable hip)

  https://www.nhs.uk/conditions/hip-pain-children-irritable-hip/

  Hip pain in children is most often caused by a condition called irritable hip, which usually gets better on its own. But it should always be checked because it could be a sign of something serious. […] A condition called irritable hip is the most common cause of hip pain in children. This is where the hip joint becomes sore and inflamed. […] Irritable hip can be painful, but it’s not usually serious and often gets better by itself. […] To find out what’s causing your child’s hip pain, a doctor or nurse may: look at and feel your child’s hip, leg or knee; try gently moving the leg in different directions; ask about any recent injuries or illnesses; arrange an X-ray. […] Sometimes a blood test or other scans may also be done to confirm it’s nothing serious. […] Irritable hip usually gets better in 1 or 2 weeks and does not cause lasting problems. […] If your child has irritable hip, you can usually look after them at home.

• #5 Irritable hip (transient synovitis): Symptoms, causes, and diagnosis

  https://www.medicalnewstoday.com/articles/166614

  Irritable hip results from hip joint inflammation. It is a common cause of hip pain and limping in children aged 10 years or younger. […] Doctors refer to irritable hip as acute transient synovitis or toxic synovitis. It is most common between the ages of 3 and 10 years and occurs more frequently in boys than girls. […] The symptoms may cause alarm and discomfort, but irritable hip is a mild condition that usually lasts up to 2 weeks. […] Irritable hip is a transient condition in children that causes pain and a limp. […] The pain ranges from mild to severe and tends to start suddenly. It usually occurs on one side of the hip, but it can affect the hip, groin, thigh, and knee on the affected side. […] The doctor, usually a primary care physician, will ask the child, parent, or caregiver about symptoms, then perform a physical examination.

• #6 Irritable Hip | UAMS Department of Radiology

  https://medicine.uams.edu/radiology/kb/irritable-hip/

  A very common sighting in any pediatric emergency department is the child who presents with refusal to bear weight, sudden limp or atypical irritability and crankiness. […] Elevated white count and inflammatory markers (ESR and CRP) and decreased range of motion at the hip (presumably due to inflammatory fluid in the joint space) may help point towards this diagnosis as well. […] Diagnostic evaluation frequently begins with hip joint radiographs which may be unrevealing or may show widening of the joint space, which is a nonspecific finding. […] Ultrasound is widely cited as the gold standard for the assessment of the presence and extent of joint effusion as the absence of joint effusions effectively eliminates septic arthritis. […] If there is an effusion on ultrasound, US guided aspiration is generally the next step to differentiate between the more critical septic arthritis and the more indolent transient synovitis. […] Determination of operative management is based on the WBC count (50k) and positive Gram stain and culture.

• #7 Transient Synovitis of the Hip | Doctor – PMM

  https://www.pmmonline.org/doctor/limping-child/key-conditions/hip-disorders/transient-synovitis-of-the-hip/

  Transient synovitis, also known as irritable hip, is a common cause of acute hip pain in young children. It is a self-limiting condition, but is a diagnosis of exclusion and especially to exclude septic arthritis. […] Patients tend to be systemically well, with normal or mildly elevated inflammatory markers. Limp is invariably present, often with pain. There may be reluctance to weight-bear with reduced movement of the hip. Investigations should include blood tests (full blood count and acute phase reactants) and assessment of body temperature. In typical cases, the body temperature is normal or slightly elevated (below 38C). Ultrasound of the hips will demonstrate increased fluid (effusion) in the affected hip. Often a pelvic radiograph including frog-leg view is advised in order to exclude other causes of hip pain, such as Perthes disease and malignancy.

• #8 Dr. Skand Kumar’s Ortho Clinic – Irritable hip

  https://www.orthohyd.com/joint-replacement-ortho-trauma-surgery/common-orthopaedic-problems-conditions/irritable-hip

  Transient synovitis of the hip is an acute inflammatory condition of the inner lining of the hip. […] In fact, it’s the most common cause of acute hip pain in young children between the ages of three and 10. […] The history and physical examination are probably the most important tools the physician uses to diagnose transient synovitis of the hip. […] X-rays are usually taken. […] A blood test will show mild inflammation. […] If needed, the physician may order an ultrasound of the hip. […] Drawing the fluid out with a needle called needle aspiration will show if there is pus in the joint from septic (bacterial) arthritis. The fluid is clear in transient synovitis.

• #9 Irritable Hip | Advanced Orthopaedics & Sports Medicine, Orthopaedic Specialists, Cypress, Houston, TX

  https://www.advancedosm.com/irritable-hip-orthopaedic-sports-medicine-specialist-cypress-houston-tx/

  Irritable hip, also known as acute transient synovitis, is a common disorder of childhood characterized by hip pain and limping. The diagnosis of an irritable hip is made based on your child’s symptoms and a physical examination. To rule out other possible causes of your child’s symptoms, the following diagnostic tests may be ordered: […] X-rays: Detect any problem with your child’s bone […] Blood tests: Determine a bone or joint infection […] Ultrasound scan: Creates an image of the affected hip joint and detects any fluid in the joint.

• #10

  https://www.orthobullets.com/pediatrics/4030/transient-synovitis-of-hip

  Transient Synovitis of Hip is inflammation of the synovium and a common cause of hip pain in pediatric patients that must be differentiated from septic arthritis of the hip. […] Diagnosis is one of exclusion and can be suspected in a patient with hip pain with low CRP and near normal synovial WBC count. […] most common cause of hip pain in the pediatric population. […] 3% of children between 3-10yo. […] male-to-female ratio is 2:1. […] hip presents in flexion, abduction, and external rotation (position with least amount of intracapsular pressure). […] mild to moderate restriction of hip internal rotation is the most sensitive range-of-motion restriction. […] a painless arc of motion is more likely synovitis rather than septic arthritis. […] CRP 20 mg/l is the most important factor to RULE OUT septic arthritis. […] if symptoms improve with NSAIDS, more likely to be transient synovitis. […] symptom resolution in under 1 week from the date of presentation.

• #11 Review for the generalist: evaluation of pediatric hip pain | Pediatric Rheumatology | Full Text

  https://ped-rheum.biomedcentral.com/articles/10.1186/1546-0096-7-10

  Hip pathology may cause groin pain, referred thigh or knee pain, refusal to bear weight or altered gait in the absence of pain. […] A young child with an irritable hip poses a diagnostic challenge. […] Transient synovitis, one of the most common causes of hip pain in children, must be differentiated from septic arthritis. […] Transient synovitis and septic arthritis have similar early symptoms with the spontaneous onset of progressive hip, groin, or thigh pain; limp or inability to bear weight; fever; and irritability. […] Untreated intra-articular infection can lead to a permanent loss of hip function making it extremely important to differentiate possible infection from benign cases of transient synovitis. […] A young child with an irritable hip poses a diagnostic challenge. […] Clinical prediction rules serves as guidelines but clinical judgment ultimately dictates patient management.

• #12 Transient Synovitis: Practice Essentials, Pathophysiology and Etiology, Epidemiology

  https://emedicine.medscape.com/article/1007186-overview

  Transient synovitis (TS) is the most common cause of acute hip pain in children aged 3-10 years. The disease causes arthralgia and arthritis secondary to a transient inflammation of the synovium of the hip. […] Unilateral hip or groin pain is the most common symptom reported; however, some patients with transient synovitis may report medial thigh or knee pain. […] Children with transient synovitis are usually afebrile or have a mildly elevated temperature; high fever is rare. […] The following studies may be indicated in transient synovitis: Complete blood cell (CBC) count, Erythrocyte sedimentation rate (ESR), C-reactive protein measurement, Urinalysis and culture. […] Radiographs exclude bony lesions unless the child had onset of symptoms within 3 days, has no fever, appears well, and has only mildly restricted abduction without guarding against movement in other planes.

• #13 Transient Synovitis of the Hip | Doctor – PMM

  https://www.pmmonline.org/doctor/limping-child/key-conditions/hip-disorders/transient-synovitis-of-the-hip/

  It is imperative to exclude infection of the bone or joint. Septic arthritis is more likely if the child is unwell, febrile (above 38) and there are raised inflammatory markers and white cell count. In such cases, the child must be fasted and immediately prepared for hip puncture and possibly joint lavage under general anaesthesia. […] Kocher’s rules can be helpful to differentiate septic arthritis at the hip joint from transient synovitis. It is noteworthy however that Kocher’s rules are not universally used (e.g., are not used in New Zealand) and are not useful to differentiate sepsis from acute rheumatic fever (ARF). In endemic areas for ARF, a monoarthritis is a common presentation and should be suspected with a raised ESR even if the white cell count is not elevated.

• #14 Hip Pain in Children (Causes, Symptoms, and Treatment)

  https://patient.info/doctor/painful-hips-in-children

  The clinical challenge in paediatric hip pain is to distinguish urgent conditions such as infection of the hip joint from the more common irritable hip. […] Transient synovitis is one of the most common causes in children over 3 years of age but it has similar early symptoms to septic arthritis. […] Transient synovitis (irritable hip) peaking at 3-8 years. […] This significant clinical overlap means that there are no absolute criteria for definitive diagnosis of either condition. […] Transient synovitis is the most common cause of hip pain in children between the ages of 3-10 years (peaking between 5 years and 6 years) and is more common in boys, often preceded by viral infection. […] Children with septic arthritis appear ill. […] A septic hip is a surgical emergency. […] Arrange urgent specialist assessment if the child has a fever and/or red flags, such as pain waking the child at night (possible malignancy). […] Is younger than 3 years of age (transient synovitis is rare in this age group, and septic arthritis is more common).

• #15 Irritable Hip | UAMS Department of Radiology

  https://medicine.uams.edu/radiology/kb/irritable-hip/

  A very common sighting in any pediatric emergency department is the child who presents with refusal to bear weight, sudden limp or atypical irritability and crankiness. […] Elevated white count and inflammatory markers (ESR and CRP) and decreased range of motion at the hip (presumably due to inflammatory fluid in the joint space) may help point towards this diagnosis as well. […] Diagnostic evaluation frequently begins with hip joint radiographs which may be unrevealing or may show widening of the joint space, which is a nonspecific finding. […] Ultrasound is widely cited as the gold standard for the assessment of the presence and extent of joint effusion as the absence of joint effusions effectively eliminates septic arthritis. […] If there is an effusion on ultrasound, US guided aspiration is generally the next step to differentiate between the more critical septic arthritis and the more indolent transient synovitis. […] Determination of operative management is based on the WBC count (50k) and positive Gram stain and culture.

• #16 Transient Synovitis: Practice Essentials, Pathophysiology and Etiology, Epidemiology

  https://emedicine.medscape.com/article/1007186-overview

  Transient synovitis (TS) is the most common cause of acute hip pain in children aged 3-10 years. The disease causes arthralgia and arthritis secondary to a transient inflammation of the synovium of the hip. […] Unilateral hip or groin pain is the most common symptom reported; however, some patients with transient synovitis may report medial thigh or knee pain. […] Children with transient synovitis are usually afebrile or have a mildly elevated temperature; high fever is rare. […] The following studies may be indicated in transient synovitis: Complete blood cell (CBC) count, Erythrocyte sedimentation rate (ESR), C-reactive protein measurement, Urinalysis and culture. […] Radiographs exclude bony lesions unless the child had onset of symptoms within 3 days, has no fever, appears well, and has only mildly restricted abduction without guarding against movement in other planes.

• #17

  https://www.orthobullets.com/pediatrics/4030/transient-synovitis-of-hip

  Transient Synovitis of Hip is inflammation of the synovium and a common cause of hip pain in pediatric patients that must be differentiated from septic arthritis of the hip. […] Diagnosis is one of exclusion and can be suspected in a patient with hip pain with low CRP and near normal synovial WBC count. […] most common cause of hip pain in the pediatric population. […] 3% of children between 3-10yo. […] male-to-female ratio is 2:1. […] hip presents in flexion, abduction, and external rotation (position with least amount of intracapsular pressure). […] mild to moderate restriction of hip internal rotation is the most sensitive range-of-motion restriction. […] a painless arc of motion is more likely synovitis rather than septic arthritis. […] CRP 20 mg/l is the most important factor to RULE OUT septic arthritis. […] if symptoms improve with NSAIDS, more likely to be transient synovitis. […] symptom resolution in under 1 week from the date of presentation.

• #18 Causes, symptoms and details of Irritable hip – Pulse Reference

  https://pulsereference.com/diagnoses/irritable-hip/

  Irritable hip, also known as transient synovitis, is a self-limiting condition characterised by inflammation of the synovium of the hip joint. It is predominantly a diagnosis of exclusion, made after ruling out other more serious conditions such as septic arthritis. The condition is typically marked by acute hip pain, limping and restricted range of movement in the hip joint. […] Irritable hip is most commonly observed in children between the ages of 3 and 10 years, with a higher incidence in boys than in girls. It is the most common cause of hip pain and limping in this age group, although it can occasionally be seen in adolescents and, rarely, in adults. […] The condition presents acutely with hip pain, which may be accompanied by limping or refusal to bear weight on the affected side.

• #19 Review for the generalist: evaluation of pediatric hip pain

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2686695/

  Children with septic arthritis appear ill and early management with surgical drainage and intravenous antibiotics is necessary to prevent bony destruction and preserve hip function. A septic hip is a surgical emergency. […] A variety of clinical, laboratory, and radiographic criteria are used to help differentiate septic arthritis from transient synovitis, but because of the substantial overlap between the two groups there are no absolute criteria for definitive diagnosis of either condition. […] The predicted probability of septic arthritis was determined for all sixteen combinations of these four predictors and is summarized (original cohort/prospective cohort) as less than 0.2 percent for zero predictors, 3.0/9.5 percent for one predictor, 40.0/35.0 percent for two predictors, 93.1/72.8 percent for three predictors, and 99.6/93.0 percent for four predictors. […] Clinical prediction rules serves as guidelines but clinical judgment ultimately dictates patient management.

• #20 Irritable Hip Dallas | Hip Pain Rockwall | Acute Transient Synovitis Rowlett

  https://www.aliashrafmd.com/irritable-hip-orthopaedic-sports-medicine-specialist-dallas-rockwall-rowlett/

  Irritable hip, also known as acute transient synovitis, is a common disorder of childhood characterized by hip pain and limping. […] The diagnosis of an irritable hip is made based on your child’s symptoms and a physical examination. To rule out other possible causes of your child’s symptoms, the following diagnostic tests may be ordered: […] X-rays: detect any problem with your child’s bone […] Blood tests: determine a bone or joint infection […] Ultrasound scan: creates an image of the affected hip joint and detects any fluid in the joint.

• #21 Irritable Hip Overland Park | Acute Transient Synovitis Kansas City, Lee’s Summit

  https://www.kcbj.com/irritable-hip-orthopedic-musculoskeletal-care-overland-park-kansas-city/

  Irritable hip, also known as acute transient synovitis, is a common disorder of childhood characterized by hip pain and limping. […] The diagnosis of an irritable hip is made based on your child’s symptoms and a physical examination. To rule out other possible causes of your child’s symptoms, the following diagnostic tests may be ordered: […] X-rays: Detect any problem with your child’s bone […] Blood tests: Determine a bone or joint infection […] Ultrasound scan: Creates an image of the affected hip joint and detects any fluid in the joint.

• #22 Hip Pain in Children Riverside, Moreno Valley, CA | Transient Synovitis Corona, CA

  https://www.kadriortho.com/irritable-hip-knee-reconstructive-surgeon-riverside-corona-ca/

  Irritable hip, also known as acute transient synovitis, is a common disorder of childhood characterized by hip pain and limping. […] A child with irritable hip will experience the following symptoms: Hip pain, Limping, Pain, which may spread to the groin, thigh and knee areas, Abnormal crawling, Abnormal crying, Slight fever. […] The diagnosis of an irritable hip is made based on your child’s symptoms and a physical examination. To rule out other possible causes of your child’s symptoms, the following diagnostic tests may be ordered: X-rays: Detect any problem with your child’s bone, Blood tests: Determine a bone or joint infection, Ultrasound scan: Creates an image of the affected hip joint and detects any fluid in the joint.

• #23 Physiotherapy in Kleinburg for Pediatric Pain – Transient Synovitis

  https://www.advantagephysiotherapy.com/Injuries-Conditions/Pediatric/Pediatric-Issues/Guide-for-Transient-Synovitis-of-the-Hip-in-Children/a~3061/article.html

  Transient synovitis of the hip is an acute inflammatory condition of the inner lining of the hip. Transient synovitis is also known as toxic synovitis or irritable hip. This condition affects young children (boys more than girls) most often. In fact, it’s the most common cause of acute hip pain in young children between the ages of three and 10. […] The history and physical examination are probably the most important tools used to diagnose transient synovitis of the hip. […] The majority of patients will be referred to a doctor for further diagnostic tests such as an X-ray, an ultrasound, and/or blood tests that can help to confirm or rule out the diagnosis. […] X-rays are usually taken. Though radiographs don’t show synovitis, they do help the physician rule out a fracture, tumor, or slipped capital femoral epiphysis (slippage of the growth plate). More advanced imaging such as MRI or bone scan may be needed if there is a need to rule out other more serious problems.

• #24 Irritable Hip | UAMS Department of Radiology

  https://medicine.uams.edu/radiology/kb/irritable-hip/

  A very common sighting in any pediatric emergency department is the child who presents with refusal to bear weight, sudden limp or atypical irritability and crankiness. […] Elevated white count and inflammatory markers (ESR and CRP) and decreased range of motion at the hip (presumably due to inflammatory fluid in the joint space) may help point towards this diagnosis as well. […] Diagnostic evaluation frequently begins with hip joint radiographs which may be unrevealing or may show widening of the joint space, which is a nonspecific finding. […] Ultrasound is widely cited as the gold standard for the assessment of the presence and extent of joint effusion as the absence of joint effusions effectively eliminates septic arthritis. […] If there is an effusion on ultrasound, US guided aspiration is generally the next step to differentiate between the more critical septic arthritis and the more indolent transient synovitis. […] Determination of operative management is based on the WBC count (50k) and positive Gram stain and culture.

• #25 Transient synovitis – Wikipedia

  https://en.wikipedia.org/wiki/Transient_synovitis

  Blood tests may show mild inflammation. An ultrasound scan of the hip joint can show a fluid collection (effusion). […] If septic arthritis needs to be ruled out, needle aspiration of the fluid can be performed under ultrasound guidance. In transient synovitis, the joint fluid will be clear. In septic arthritis, there will be pus in the joint, which can be sent for bacterial culture and antibiotic sensitivity testing.

• #26 Transient Synovitis: Practice Essentials, Pathophysiology and Etiology, Epidemiology

  https://emedicine.medscape.com/article/1007186-overview

  Although extremely accurate for detecting an intracapsular effusion, ultrasonography does not assist in determining the cause and is used best to guide hip aspiration. […] In settings in which routine aspiration of effusions is not performed, a magnetic resonance imaging (MRI) scan may help differentiate transient synovitis from septic arthritis. […] Apply heat and massage to patients with transient synovitis. If the diagnosis is equivocal or the patient is uncomfortable, hospitalize for observation and traction. […] Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen, may shorten the duration of symptoms. […] Advise parents and/or caregivers to initially check the temperature of the patient with transient synovitis regularly and inform the physician of any fever.

• #27 Irritable Hip | UAMS Department of Radiology

  https://medicine.uams.edu/radiology/kb/irritable-hip/

  A very common sighting in any pediatric emergency department is the child who presents with refusal to bear weight, sudden limp or atypical irritability and crankiness. […] Elevated white count and inflammatory markers (ESR and CRP) and decreased range of motion at the hip (presumably due to inflammatory fluid in the joint space) may help point towards this diagnosis as well. […] Diagnostic evaluation frequently begins with hip joint radiographs which may be unrevealing or may show widening of the joint space, which is a nonspecific finding. […] Ultrasound is widely cited as the gold standard for the assessment of the presence and extent of joint effusion as the absence of joint effusions effectively eliminates septic arthritis. […] If there is an effusion on ultrasound, US guided aspiration is generally the next step to differentiate between the more critical septic arthritis and the more indolent transient synovitis. […] Determination of operative management is based on the WBC count (50k) and positive Gram stain and culture.

• #28 Transient Synovitis: Practice Essentials, Pathophysiology and Etiology, Epidemiology

  https://emedicine.medscape.com/article/1007186-overview

  Although extremely accurate for detecting an intracapsular effusion, ultrasonography does not assist in determining the cause and is used best to guide hip aspiration. […] In settings in which routine aspiration of effusions is not performed, a magnetic resonance imaging (MRI) scan may help differentiate transient synovitis from septic arthritis. […] Apply heat and massage to patients with transient synovitis. If the diagnosis is equivocal or the patient is uncomfortable, hospitalize for observation and traction. […] Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen, may shorten the duration of symptoms. […] Advise parents and/or caregivers to initially check the temperature of the patient with transient synovitis regularly and inform the physician of any fever.

• #29 Transient synovitis of the hip – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/761

  Transient synovitis of the hip is a self-limiting inflammatory disorder of the hip that commonly affects young children between 2 and 12 years of age. […] The most important differential diagnosis to exclude is septic arthritis of the hip. […] Presents acutely with mild to moderate hip pain and limp. […] Key diagnostic factors include presence of risk factors, limited movement, pain, limp, and positive log roll. […] Other diagnostic factors include abducted and externally rotated hip and fever. […] 1st investigations to order include FBC, erythrocyte sedimentation rate, CRP, and x-ray. […] Investigations to consider include ultrasound and MRI with contrast.

• #30 Irritable Hip | UAMS Department of Radiology

  https://medicine.uams.edu/radiology/kb/irritable-hip/

  A very common sighting in any pediatric emergency department is the child who presents with refusal to bear weight, sudden limp or atypical irritability and crankiness. […] Elevated white count and inflammatory markers (ESR and CRP) and decreased range of motion at the hip (presumably due to inflammatory fluid in the joint space) may help point towards this diagnosis as well. […] Diagnostic evaluation frequently begins with hip joint radiographs which may be unrevealing or may show widening of the joint space, which is a nonspecific finding. […] Ultrasound is widely cited as the gold standard for the assessment of the presence and extent of joint effusion as the absence of joint effusions effectively eliminates septic arthritis. […] If there is an effusion on ultrasound, US guided aspiration is generally the next step to differentiate between the more critical septic arthritis and the more indolent transient synovitis. […] Determination of operative management is based on the WBC count (50k) and positive Gram stain and culture.

• #31 The Limping Child: A Systematic Approach to Diagnosis | AAFP

  https://www.aafp.org/pubs/afp/issues/2009/0201/p215.html

  Limping in a child can have a variety of etiologies. A detailed history and physical examination, in addition to appropriate laboratory tests and imaging, are essential for making a correct diagnosis. […] The presence of systemic symptoms such as fever, weight loss, night sweats, and anorexia is highly suspicious for infection, inflammation, or malignancy. […] When infection, inflammatory arthritis, or malignancy is suspected, a complete blood count with differential and measurement of ESR and CRP level should be obtained. […] The initial imaging modality for a limping child who has focal findings on physical examination is anteroposterior and lateral radiography of the involved site. […] Ultrasonography is recommended over plain-film radiography for detecting hip effusion. […] Hip aspiration is the gold standard for diagnosing septic arthritis and should be performed whenever septic arthritis is suspected, because the sequelae of a missed or late diagnosis can be severe.

• #32 Transient synovitis – Wikipedia

  https://en.wikipedia.org/wiki/Transient_synovitis

  Blood tests may show mild inflammation. An ultrasound scan of the hip joint can show a fluid collection (effusion). […] If septic arthritis needs to be ruled out, needle aspiration of the fluid can be performed under ultrasound guidance. In transient synovitis, the joint fluid will be clear. In septic arthritis, there will be pus in the joint, which can be sent for bacterial culture and antibiotic sensitivity testing.

• #33 Dr. Skand Kumar’s Ortho Clinic – Irritable hip

  https://www.orthohyd.com/joint-replacement-ortho-trauma-surgery/common-orthopaedic-problems-conditions/irritable-hip

  Transient synovitis of the hip is an acute inflammatory condition of the inner lining of the hip. […] In fact, it’s the most common cause of acute hip pain in young children between the ages of three and 10. […] The history and physical examination are probably the most important tools the physician uses to diagnose transient synovitis of the hip. […] X-rays are usually taken. […] A blood test will show mild inflammation. […] If needed, the physician may order an ultrasound of the hip. […] Drawing the fluid out with a needle called needle aspiration will show if there is pus in the joint from septic (bacterial) arthritis. The fluid is clear in transient synovitis.

• #34 Irritable Hip | UAMS Department of Radiology

  https://medicine.uams.edu/radiology/kb/irritable-hip/

  A very common sighting in any pediatric emergency department is the child who presents with refusal to bear weight, sudden limp or atypical irritability and crankiness. […] Elevated white count and inflammatory markers (ESR and CRP) and decreased range of motion at the hip (presumably due to inflammatory fluid in the joint space) may help point towards this diagnosis as well. […] Diagnostic evaluation frequently begins with hip joint radiographs which may be unrevealing or may show widening of the joint space, which is a nonspecific finding. […] Ultrasound is widely cited as the gold standard for the assessment of the presence and extent of joint effusion as the absence of joint effusions effectively eliminates septic arthritis. […] If there is an effusion on ultrasound, US guided aspiration is generally the next step to differentiate between the more critical septic arthritis and the more indolent transient synovitis. […] Determination of operative management is based on the WBC count (50k) and positive Gram stain and culture.

• #35 Review for the generalist: evaluation of pediatric hip pain

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2686695/

  Children with septic arthritis appear ill and early management with surgical drainage and intravenous antibiotics is necessary to prevent bony destruction and preserve hip function. A septic hip is a surgical emergency. […] A variety of clinical, laboratory, and radiographic criteria are used to help differentiate septic arthritis from transient synovitis, but because of the substantial overlap between the two groups there are no absolute criteria for definitive diagnosis of either condition. […] The predicted probability of septic arthritis was determined for all sixteen combinations of these four predictors and is summarized (original cohort/prospective cohort) as less than 0.2 percent for zero predictors, 3.0/9.5 percent for one predictor, 40.0/35.0 percent for two predictors, 93.1/72.8 percent for three predictors, and 99.6/93.0 percent for four predictors. […] Clinical prediction rules serves as guidelines but clinical judgment ultimately dictates patient management.

• #36 Hip Pain – Zero To Finals

  https://zerotofinals.com/paediatrics/ortho/hippain/

  Joint pain is a common paediatric presentation, particularly an acute limp. […] Hip pain will present differently depending on the developmental age of the child. They may present with: Limp, Refusal to use the affected leg, Refusal to weight bear, Inability to walk, Pain, Swollen or tender joint. […] It is helpful to remember the differential diagnosis in the context of the age of the child. There is some overlap in ages. […] Suspect serious pathology if there are red flags: Child under 3 years, Fever, Waking at night with pain, Weight loss, Anorexia, Night sweats, Fatigue, Persistent pain, Stiffness in the morning, Swollen or red joint. […] Management will focus on identifying the underlying cause. Investigations that can be useful include: Blood tests including inflammatory markers (CRP and ESR) for JIA and septic arthritis, Xrays are used to diagnose fractures, SUFE and other boney pathology, Ultrasound can establish an effusion (fluid) in the joint, Joint aspiration is used to diagnose or exclude septic arthritis, MRI is used to diagnose osteomyelitis.

• #37 Hip Pain in Children (Causes, Symptoms, and Treatment)

  https://patient.info/doctor/painful-hips-in-children

  The clinical challenge in paediatric hip pain is to distinguish urgent conditions such as infection of the hip joint from the more common irritable hip. […] Transient synovitis is one of the most common causes in children over 3 years of age but it has similar early symptoms to septic arthritis. […] Transient synovitis (irritable hip) peaking at 3-8 years. […] This significant clinical overlap means that there are no absolute criteria for definitive diagnosis of either condition. […] Transient synovitis is the most common cause of hip pain in children between the ages of 3-10 years (peaking between 5 years and 6 years) and is more common in boys, often preceded by viral infection. […] Children with septic arthritis appear ill. […] A septic hip is a surgical emergency. […] Arrange urgent specialist assessment if the child has a fever and/or red flags, such as pain waking the child at night (possible malignancy). […] Is younger than 3 years of age (transient synovitis is rare in this age group, and septic arthritis is more common).

• #38 Review for the generalist: evaluation of pediatric hip pain | Pediatric Rheumatology | Full Text

  https://ped-rheum.biomedcentral.com/articles/10.1186/1546-0096-7-10

  Hip pathology may cause groin pain, referred thigh or knee pain, refusal to bear weight or altered gait in the absence of pain. […] A young child with an irritable hip poses a diagnostic challenge. […] Transient synovitis, one of the most common causes of hip pain in children, must be differentiated from septic arthritis. […] Transient synovitis and septic arthritis have similar early symptoms with the spontaneous onset of progressive hip, groin, or thigh pain; limp or inability to bear weight; fever; and irritability. […] Untreated intra-articular infection can lead to a permanent loss of hip function making it extremely important to differentiate possible infection from benign cases of transient synovitis. […] A young child with an irritable hip poses a diagnostic challenge. […] Clinical prediction rules serves as guidelines but clinical judgment ultimately dictates patient management.

• #39 Medico-Legal Guidance: Differential diagnosis of childhood hip pain – Pedmore Medical

  https://pedmore-medical.com/medico-legal-guidance-differential-diagnosis-of-childhood-hip-pain/

  A common cause for hip pain in children is transient synovitis (irritable hip), a condition usually treated with nonsteroidal anti-inflammatory drugs and rest. The main challenge to a clinician treating a child complaining of hip pain is to determine whether the pain is actually caused by a more urgent and serious condition, such as septic arthritis (an infection of the hip joint), Perthes disease (a rare childhood condition that causes inadequate blood supply to the hip) or slipped upper femoral epiphysis (SUFE, a fracture of the growth plate). […] After the history has been obtained and the examination conducted, radiological investigation can usually rule out Perthes disease and SUFE. Once these two conditions have been ruled out, a clinician is left to differentiate between septic arthritis and transient synovitis, for which imaging may prove less useful.

• #40 Hip Pain in Children (Causes, Symptoms, and Treatment)

  https://patient.info/doctor/painful-hips-in-children

  The clinical challenge in paediatric hip pain is to distinguish urgent conditions such as infection of the hip joint from the more common irritable hip. […] Transient synovitis is one of the most common causes in children over 3 years of age but it has similar early symptoms to septic arthritis. […] Transient synovitis (irritable hip) peaking at 3-8 years. […] This significant clinical overlap means that there are no absolute criteria for definitive diagnosis of either condition. […] Transient synovitis is the most common cause of hip pain in children between the ages of 3-10 years (peaking between 5 years and 6 years) and is more common in boys, often preceded by viral infection. […] Children with septic arthritis appear ill. […] A septic hip is a surgical emergency. […] Arrange urgent specialist assessment if the child has a fever and/or red flags, such as pain waking the child at night (possible malignancy). […] Is younger than 3 years of age (transient synovitis is rare in this age group, and septic arthritis is more common).

• #41 Review for the generalist: evaluation of pediatric hip pain

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2686695/

  Children with septic arthritis appear ill and early management with surgical drainage and intravenous antibiotics is necessary to prevent bony destruction and preserve hip function. A septic hip is a surgical emergency. […] A variety of clinical, laboratory, and radiographic criteria are used to help differentiate septic arthritis from transient synovitis, but because of the substantial overlap between the two groups there are no absolute criteria for definitive diagnosis of either condition. […] The predicted probability of septic arthritis was determined for all sixteen combinations of these four predictors and is summarized (original cohort/prospective cohort) as less than 0.2 percent for zero predictors, 3.0/9.5 percent for one predictor, 40.0/35.0 percent for two predictors, 93.1/72.8 percent for three predictors, and 99.6/93.0 percent for four predictors. […] Clinical prediction rules serves as guidelines but clinical judgment ultimately dictates patient management.

• #42 Medico-Legal Guidance: Differential diagnosis of childhood hip pain – Pedmore Medical

  https://pedmore-medical.com/medico-legal-guidance-differential-diagnosis-of-childhood-hip-pain/

  Transient synovitis and septic arthritis can present very similar symptoms early on, such as with the spontaneous onset of progressive hip, groin, or thigh pain; limp or inability to bear weight; fever; and irritability. Oral temperature above 38.5C appears to be a good predictor for septic arthritis. Other indicators that could lead a clinician to suspect septic arthritis are refusal to bear weight, erythrocyte sedimentation rate more than 40 mm per hour or peripheral white blood cell count more than 12,000 per mm3 (12 109 per L).

• #43 Medico-Legal Guidance: Differential diagnosis of childhood hip pain – Pedmore Medical

  https://pedmore-medical.com/medico-legal-guidance-differential-diagnosis-of-childhood-hip-pain/

  A common cause for hip pain in children is transient synovitis (irritable hip), a condition usually treated with nonsteroidal anti-inflammatory drugs and rest. The main challenge to a clinician treating a child complaining of hip pain is to determine whether the pain is actually caused by a more urgent and serious condition, such as septic arthritis (an infection of the hip joint), Perthes disease (a rare childhood condition that causes inadequate blood supply to the hip) or slipped upper femoral epiphysis (SUFE, a fracture of the growth plate). […] After the history has been obtained and the examination conducted, radiological investigation can usually rule out Perthes disease and SUFE. Once these two conditions have been ruled out, a clinician is left to differentiate between septic arthritis and transient synovitis, for which imaging may prove less useful.

• #44 Medico-Legal Guidance: Differential diagnosis of childhood hip pain – Pedmore Medical

  https://pedmore-medical.com/medico-legal-guidance-differential-diagnosis-of-childhood-hip-pain/

  A common cause for hip pain in children is transient synovitis (irritable hip), a condition usually treated with nonsteroidal anti-inflammatory drugs and rest. The main challenge to a clinician treating a child complaining of hip pain is to determine whether the pain is actually caused by a more urgent and serious condition, such as septic arthritis (an infection of the hip joint), Perthes disease (a rare childhood condition that causes inadequate blood supply to the hip) or slipped upper femoral epiphysis (SUFE, a fracture of the growth plate). […] After the history has been obtained and the examination conducted, radiological investigation can usually rule out Perthes disease and SUFE. Once these two conditions have been ruled out, a clinician is left to differentiate between septic arthritis and transient synovitis, for which imaging may prove less useful.

• #45 Transient synovitis of the hip: which investigations are truly useful?

  https://smw.ch/index.php/smw/article/download/2068/3015?inline=1

  In the absence of hip effusion, children may be considered to have a so-called irritable hip. […] This study confirms that a vast majority of children with acute hip pain or limp suffer from TSH, a benign and self-limiting condition. […] Children with suspicion of TSH may therefore be treated on an outpatient basis, provided that severe hip disorders, such as septic arthritis of the hip or acute SCFE, have been ruled out. […] In the absence of a definite diagnosis, we suggest hip ultrasonography should be performed. […] In the presence of hip effusion without suspicion of septic arthritis, patients could be considered to have a probable transient synovitis of the hip. […] However, other diagnoses, such as osteomyelitis, should be kept in mind and excluded in the case of persistence of symptoms.

• #46 Physiotherapy in Kleinburg for Pediatric Pain – Transient Synovitis

  https://www.advantagephysiotherapy.com/Injuries-Conditions/Pediatric/Pediatric-Issues/Guide-for-Transient-Synovitis-of-the-Hip-in-Children/a~3061/article.html

  Transient synovitis of the hip is an acute inflammatory condition of the inner lining of the hip. Transient synovitis is also known as toxic synovitis or irritable hip. This condition affects young children (boys more than girls) most often. In fact, it’s the most common cause of acute hip pain in young children between the ages of three and 10. […] The history and physical examination are probably the most important tools used to diagnose transient synovitis of the hip. […] The majority of patients will be referred to a doctor for further diagnostic tests such as an X-ray, an ultrasound, and/or blood tests that can help to confirm or rule out the diagnosis. […] X-rays are usually taken. Though radiographs don’t show synovitis, they do help the physician rule out a fracture, tumor, or slipped capital femoral epiphysis (slippage of the growth plate). More advanced imaging such as MRI or bone scan may be needed if there is a need to rule out other more serious problems.

• #47 Hip Pain in Children (Causes, Symptoms, and Treatment)

  https://patient.info/doctor/painful-hips-in-children

  The clinical challenge in paediatric hip pain is to distinguish urgent conditions such as infection of the hip joint from the more common irritable hip. […] Transient synovitis is one of the most common causes in children over 3 years of age but it has similar early symptoms to septic arthritis. […] Transient synovitis (irritable hip) peaking at 3-8 years. […] This significant clinical overlap means that there are no absolute criteria for definitive diagnosis of either condition. […] Transient synovitis is the most common cause of hip pain in children between the ages of 3-10 years (peaking between 5 years and 6 years) and is more common in boys, often preceded by viral infection. […] Children with septic arthritis appear ill. […] A septic hip is a surgical emergency. […] Arrange urgent specialist assessment if the child has a fever and/or red flags, such as pain waking the child at night (possible malignancy). […] Is younger than 3 years of age (transient synovitis is rare in this age group, and septic arthritis is more common).

• #48 Hip Pain in the Young Child

  https://www.hss.edu/conditions_hip-pain-young-child.asp

  Pediatric rheumatologists often care for patients with complaints of hip pain. […] When hip pain presents in young children, the first priority lies in excluding infection which, if untreated, may damage the hip joint permanently. […] Work-up for recurrent hip pain must be pursued vigilantly, as Legg-Calv Perthes disease, tumor, occult trauma, slipped capital femoral epiphysis, congenital hip dislocation, and arthritic conditions may present with recurrent hip pain. […] However, in children with juvenile spondyloarthropathies, the hip joint is involved commonly and hip pain may be the presenting complaint. […] Spondyloarthropathies commonly present with morning pain or stiffness in the hips, heels, or lower back, and are most common in children over the age of 10 years. […] While patients with spondyloarthropathy may be HLA-B27 positive, many will be negative, and HLA-B27 negativity does not exclude this diagnosis.

• #49 Transient synovitis of the hip: which investigations are truly useful?

  https://smw.ch/index.php/smw/article/download/2068/3015?inline=1

  Children presenting with acute nontraumatic hip pathology can display a wide variety of nonspecific symptoms, such as a limp or abnormal gait, pain, refusal to bear weight or decreased movement of the involved joint. […] The most common cause of hip pain and limp in children is transient synovitis of the hip (TSH). […] Symptom resolution without any specific treatment in a matter of days is an essential feature of diagnosis. […] However, the symptoms of TSH are nonspecific and may be present in many other potentially serious hip conditions. […] In cases where no definite diagnosis is made during initial management, it is not clear whether further investigations, such as a rheumatological panel, to exclude all other possible diagnoses are necessary. […] Patients were diagnosed with TSH if an ultrasound-confirmed hip effusion was present, complete resolution of symptoms occurred without any specific treatment, and no other pathology of the hip was identified during follow-up.

• #50 Transient Synovitis In Kids | Children’s Hospital Colorado

  https://www.childrenscolorado.org/conditions-and-advice/conditions-and-symptoms/conditions/transient-synovitis/

  Transient synovitis is an inflammation in the hip joint that causes pain, limp and sometimes refusal to bear weight. This occurs in pre-pubescent children and is the most common cause of hip pain. […] Transient synovitis is a diagnosis of exclusion, meaning the diagnosis is made once other more dangerous causes of acute hip pain are ruled out. The following tests will be done to rule out other more dangerous causes of hip pain. […] A diagnosis for transient synovitis is a diagnosis of exclusion. By working with radiology, infectious disease and rheumatology, our experts can rule out all other causes of hip pain. Ruling out other causes can lead to a proper diagnosis.

• #51 Irritable hip – Know Your Doctor

  https://www.knowyourdoctor.com.cy/medical/irritable-hip-2/

  Bed rest is recommended until the symptoms of pain resolve, which usually takes between seven and 10 days. […] Your child may be admitted to hospital if the diagnosis is uncertain or painkillers and bed rest haven’t eased the pain. […] Recovery It usually takes a couple of weeks to recover from irritable hip, although your GP may recommend that your child does not play sport or take part in any strenuous activities for at least another two weeks following treatment. […] A follow-up appointment may be needed up to six months later.

• #52 Irritable hip (transient synovitis): Symptoms, causes, and diagnosis

  https://www.medicalnewstoday.com/articles/166614

  They may also order an imaging scan, such as an X-ray, or a blood test to detect infection. […] A child with irritable hip usually does not need to spend time in the hospital. […] If the condition does not resolve, or if the pain persists or gets worse, seek medical attention. Ongoing or increasing pain may indicate a different underlying condition.

• #53 “Irritable Hip”: Diagnosis in the Emergency Department. A Descriptive Study Over One Year

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6314824/

  A limping child commonly presents to the emergency department (ED), often without a history of trauma. It is important that serious underlying pathology is ruled out before a diagnosis of benign irritable hip (IH). The aim of this study was to determine the basic epidemiology of IH in the Glasgow Population. […] A total of 354 patients were diagnosed with IH, of which 319 and 189 were in the Greater Glasgow and Clyde and City of Glasgow catchment areas, respectively. The majority of these patients (n = 254) were diagnosed clinically. The incidence of IH was 177.7 per 100,000 children with a boy:girl ratio of 1.9:1 (209:110). The mean age of presentation was 3.5 years and the recurrence rate was 5.9% (n = 18). There was an increased incidence in spring (n = 111), especially in March (n = 42) and April (n = 40).

• #54 “Irritable Hip”: Diagnosis in the Emergency Department. A Descriptive Study Over One Year

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6314824/

  In this population, IH has: (i) an atypical age profile (age distribution shift to younger), (ii) no marked association with social deprivation (in contrast to other studies), and (iii) a 'spring preponderance’. We suggest that most cases can safely be managed in the ED without recourse to further investigations or speciality referral. […] The diagnosis of IH in the Glasgow ED is primarily a clinical one. All patients who presented to the ED had a history taken and underwent an examination. The majority of patients were diagnosed as having an irritable hip clinically (n = 254). […] The annual incidence of irritable hip in the GGC area (n = 319) was 177.7 per 100,000 children aged 014 years. The incidence of irritable hip was greater in boys, with a 1.9:1 boy:girl ratio (209 boys, 110 girls, p 0.001).

• #55 “Irritable Hip”: Diagnosis in the Emergency Department. A Descriptive Study Over One Year

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6314824/

  In this population, IH has: (i) an atypical age profile (age distribution shift to younger), (ii) no marked association with social deprivation (in contrast to other studies), and (iii) a 'spring preponderance’. We suggest that most cases can safely be managed in the ED without recourse to further investigations or speciality referral. […] The diagnosis of IH in the Glasgow ED is primarily a clinical one. All patients who presented to the ED had a history taken and underwent an examination. The majority of patients were diagnosed as having an irritable hip clinically (n = 254). […] The annual incidence of irritable hip in the GGC area (n = 319) was 177.7 per 100,000 children aged 014 years. The incidence of irritable hip was greater in boys, with a 1.9:1 boy:girl ratio (209 boys, 110 girls, p 0.001).

• #56 “Irritable Hip”: Diagnosis in the Emergency Department. A Descriptive Study Over One Year

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6314824/

  In this population, IH has: (i) an atypical age profile (age distribution shift to younger), (ii) no marked association with social deprivation (in contrast to other studies), and (iii) a 'spring preponderance’. We suggest that most cases can safely be managed in the ED without recourse to further investigations or speciality referral. […] The diagnosis of IH in the Glasgow ED is primarily a clinical one. All patients who presented to the ED had a history taken and underwent an examination. The majority of patients were diagnosed as having an irritable hip clinically (n = 254). […] The annual incidence of irritable hip in the GGC area (n = 319) was 177.7 per 100,000 children aged 014 years. The incidence of irritable hip was greater in boys, with a 1.9:1 boy:girl ratio (209 boys, 110 girls, p 0.001).

• #57 “Irritable Hip”: Diagnosis in the Emergency Department. A Descriptive Study Over One Year

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6314824/

  There was an increased incidence of irritable hip in spring (n = 111) when compared to the other seasons. When divided into months, this was represented with an increased incidence in March (n = 42) and April (n = 40). […] The most common cause of IH is TS. In the literature, the incidence of benign IH can be categorised as ultrasound-positive TS or ultrasound-negative IH. […] In our population, there was a preponderance of irritable hips presenting in March and April. […] IH is classically a diagnosis of exclusion and it is imperative that serious underlying causes are not missed. Of the 408 cases initially coded as TS/IH, 44 (10.8%) did not have a final diagnosis of IH. […] The final diagnosis for nine of these patients was benign and would not require speciality referral.

• #58 Hip Pain in Children (Causes, Symptoms, and Treatment)

  https://patient.info/doctor/painful-hips-in-children

  The clinical challenge in paediatric hip pain is to distinguish urgent conditions such as infection of the hip joint from the more common irritable hip. […] Transient synovitis is one of the most common causes in children over 3 years of age but it has similar early symptoms to septic arthritis. […] Transient synovitis (irritable hip) peaking at 3-8 years. […] This significant clinical overlap means that there are no absolute criteria for definitive diagnosis of either condition. […] Transient synovitis is the most common cause of hip pain in children between the ages of 3-10 years (peaking between 5 years and 6 years) and is more common in boys, often preceded by viral infection. […] Children with septic arthritis appear ill. […] A septic hip is a surgical emergency. […] Arrange urgent specialist assessment if the child has a fever and/or red flags, such as pain waking the child at night (possible malignancy). […] Is younger than 3 years of age (transient synovitis is rare in this age group, and septic arthritis is more common).

• #59 Transient Synovitis In Kids | Children’s Hospital Colorado

  https://www.childrenscolorado.org/conditions-and-advice/conditions-and-symptoms/conditions/transient-synovitis/

  Transient synovitis is an inflammation in the hip joint that causes pain, limp and sometimes refusal to bear weight. This occurs in pre-pubescent children and is the most common cause of hip pain. […] Transient synovitis is a diagnosis of exclusion, meaning the diagnosis is made once other more dangerous causes of acute hip pain are ruled out. The following tests will be done to rule out other more dangerous causes of hip pain. […] A diagnosis for transient synovitis is a diagnosis of exclusion. By working with radiology, infectious disease and rheumatology, our experts can rule out all other causes of hip pain. Ruling out other causes can lead to a proper diagnosis.

• #60 Transient synovitis (irritable hip)

  https://www.rch.org.au/kidsinfo/fact_sheets/Transient_synovitis/

  Transient synovitis (irritable hip) is the most common cause of limping in children. It is due to inflammation (swelling) of the lining of the hip joint. […] Irritable hip is most often seen in children aged between three and 10 years old. It is not serious, and will get better on its own with rest. […] Usually, no tests are required for irritable hip, and you can care for your child at home. […] Irritable hip is a mild condition that will get better on its own. Complete rest is usually all that is needed. It should start to improve in about three days and be better in two weeks. […] Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, are helpful for irritable hip as they relieve the pain as well as reducing inflammation. […] Transient synovitis (irritable hip) is the most common cause of limping in children. […] It is generally a mild condition that will get better on its own with rest, usually within two weeks. […] Non-steroidal anti-inflammatory drugs, e.g. ibuprofen, may help relieve the pain and reduce inflammation.

• #61 Irritable Hip | UAMS Department of Radiology

  https://medicine.uams.edu/radiology/kb/irritable-hip/

  A very common sighting in any pediatric emergency department is the child who presents with refusal to bear weight, sudden limp or atypical irritability and crankiness. […] Elevated white count and inflammatory markers (ESR and CRP) and decreased range of motion at the hip (presumably due to inflammatory fluid in the joint space) may help point towards this diagnosis as well. […] Diagnostic evaluation frequently begins with hip joint radiographs which may be unrevealing or may show widening of the joint space, which is a nonspecific finding. […] Ultrasound is widely cited as the gold standard for the assessment of the presence and extent of joint effusion as the absence of joint effusions effectively eliminates septic arthritis. […] If there is an effusion on ultrasound, US guided aspiration is generally the next step to differentiate between the more critical septic arthritis and the more indolent transient synovitis. […] Determination of operative management is based on the WBC count (50k) and positive Gram stain and culture.

• #62 Review for the generalist: evaluation of pediatric hip pain

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2686695/

  Hip pathology may cause groin pain, referred thigh or knee pain, refusal to bear weight or altered gait in the absence of pain. A young child with an irritable hip poses a diagnostic challenge. Transient synovitis, one of the most common causes of hip pain in children, must be differentiated from septic arthritis. […] Transient synovitis and septic arthritis have similar early symptoms with the spontaneous onset of progressive hip, groin, or thigh pain; limp or inability to bear weight; fever; and irritability. […] A young child with an irritable hip poses a diagnostic challenge. Transient synovitis typically has an acute onset, and spontaneous recovery with no radiological abnormality or systemic upset. It occurs between the ages of 2 and 10 years (peaking between 5 and 6 years) and is more common in boys, often preceded by viral infection.

• #63 Review for the generalist: evaluation of pediatric hip pain

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2686695/

  Children with septic arthritis appear ill and early management with surgical drainage and intravenous antibiotics is necessary to prevent bony destruction and preserve hip function. A septic hip is a surgical emergency. […] A variety of clinical, laboratory, and radiographic criteria are used to help differentiate septic arthritis from transient synovitis, but because of the substantial overlap between the two groups there are no absolute criteria for definitive diagnosis of either condition. […] The predicted probability of septic arthritis was determined for all sixteen combinations of these four predictors and is summarized (original cohort/prospective cohort) as less than 0.2 percent for zero predictors, 3.0/9.5 percent for one predictor, 40.0/35.0 percent for two predictors, 93.1/72.8 percent for three predictors, and 99.6/93.0 percent for four predictors. […] Clinical prediction rules serves as guidelines but clinical judgment ultimately dictates patient management.

• #64 Irritable hip (transient synovitis): Symptoms, causes, and diagnosis

  https://www.medicalnewstoday.com/articles/166614

  They may also order an imaging scan, such as an X-ray, or a blood test to detect infection. […] A child with irritable hip usually does not need to spend time in the hospital. […] If the condition does not resolve, or if the pain persists or gets worse, seek medical attention. Ongoing or increasing pain may indicate a different underlying condition.

• #65 Transient synovitis (irritable hip)

  https://www.rch.org.au/kidsinfo/fact_sheets/Transient_synovitis/

  Transient synovitis (irritable hip) is the most common cause of limping in children. It is due to inflammation (swelling) of the lining of the hip joint. […] Irritable hip is most often seen in children aged between three and 10 years old. It is not serious, and will get better on its own with rest. […] Usually, no tests are required for irritable hip, and you can care for your child at home. […] Irritable hip is a mild condition that will get better on its own. Complete rest is usually all that is needed. It should start to improve in about three days and be better in two weeks. […] Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, are helpful for irritable hip as they relieve the pain as well as reducing inflammation. […] Transient synovitis (irritable hip) is the most common cause of limping in children. […] It is generally a mild condition that will get better on its own with rest, usually within two weeks. […] Non-steroidal anti-inflammatory drugs, e.g. ibuprofen, may help relieve the pain and reduce inflammation.

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