Materiały źródłowe

• #1 “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. […] 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 incidence of IH was 177.7 per 100,000 children with a boy:girl ratio of 1.9:1 (209:110). […] There was an increased incidence in spring (n = 111), especially in March (n = 42) and April (n = 40). […] 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’. […] The annual incidence of irritable hip in the GGC area (n = 319) was 177.7 per 100,000 children aged 0-14 years. […] There was an increased incidence of irritable hip in spring (n = 111) when compared to the other seasons. […] The mean age of presentation was 3.5 years and the recurrence rate was 5.9% (n = 18).

• #2 Transient Synovitis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK459181/

  Transient synovitis is an acute, nonspecific, inflammatory process affecting the joint synovium, particularly in the pediatric patient population, where it frequently manifests as hip pain. […] Transient synovitis of the hip most frequently occurs in children ages 3 to 10 years old. The average annual incidence of transient synovitis and the total lifetime risk are estimated to be 0.2% and 3%, respectively. […] The incidence rate in males is twice that of females, and about 1% to 4% of the time, a patient may demonstrate bilateral involvement.

• #2

  https://link.springer.com/article/10.1007/s11832-016-0733-9

  Hip pain with limping is a common presentation in childhood. The most common diagnosis in young children is transient synovitis of the hip (TSH), a benign and self-limiting condition. […] In our clinical practice, we observed eosinophilia in children presenting with irritable hip more commonly than would otherwise be expected. […] Epidemiological data on the incidence of TSH are generally lacking. One study from the Netherlands revealed an incidence of 76.2 cases per 100,000 person-years, while a recent English study found an annual incidence of 25.1 cases per 100,000 children aged 14 years or less. […] To the authors knowledge, this is the first study to explore the relationship between TSH and eosinophilia. We found a sizeable minority (15.6 %) of children with TSH to have eosinophilia.

• #3

  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. […] most common cause of hip pain in the pediatric population. […] 3% of children between 3-10yo. […] recurrence rate is as high as 20%. […] most common in children aged 4-8 years old. […] male-to-female ratio is 2:1. […] can affect any major joint but most commonly affects the hip joint. […] the exact cause of transient synovitis is largely unknown, however, may be related to viral infection (upper respiratory). […] bacterial infection (poststreptococcal toxic synovitis). […] trauma. […] higher interferon concentration. […] allergic reaction.

• #3

  https://link.springer.com/article/10.1007/s11832-016-0733-9

  Hip pain with limping is a common presentation in childhood. The most common diagnosis in young children is transient synovitis of the hip (TSH), a benign and self-limiting condition. […] In our clinical practice, we observed eosinophilia in children presenting with irritable hip more commonly than would otherwise be expected. […] Epidemiological data on the incidence of TSH are generally lacking. One study from the Netherlands revealed an incidence of 76.2 cases per 100,000 person-years, while a recent English study found an annual incidence of 25.1 cases per 100,000 children aged 14 years or less. […] To the authors knowledge, this is the first study to explore the relationship between TSH and eosinophilia. We found a sizeable minority (15.6 %) of children with TSH to have eosinophilia.

• #4 Transient Synovitis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK459181/

  Transient synovitis is an acute, nonspecific, inflammatory process affecting the joint synovium, particularly in the pediatric patient population, where it frequently manifests as hip pain. […] Transient synovitis of the hip most frequently occurs in children ages 3 to 10 years old. The average annual incidence of transient synovitis and the total lifetime risk are estimated to be 0.2% and 3%, respectively. […] The incidence rate in males is twice that of females, and about 1% to 4% of the time, a patient may demonstrate bilateral involvement.

• #5

  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. […] most common cause of hip pain in the pediatric population. […] 3% of children between 3-10yo. […] recurrence rate is as high as 20%. […] most common in children aged 4-8 years old. […] male-to-female ratio is 2:1. […] can affect any major joint but most commonly affects the hip joint. […] the exact cause of transient synovitis is largely unknown, however, may be related to viral infection (upper respiratory). […] bacterial infection (poststreptococcal toxic synovitis). […] trauma. […] higher interferon concentration. […] allergic reaction.

• #6

  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. […] most common cause of hip pain in the pediatric population. […] 3% of children between 3-10yo. […] recurrence rate is as high as 20%. […] most common in children aged 4-8 years old. […] male-to-female ratio is 2:1. […] can affect any major joint but most commonly affects the hip joint. […] the exact cause of transient synovitis is largely unknown, however, may be related to viral infection (upper respiratory). […] bacterial infection (poststreptococcal toxic synovitis). […] trauma. […] higher interferon concentration. […] allergic reaction.

• #7 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. […] Little data are available regarding the frequency of this illness. However, excluding infections and trauma, transient synovitis is one of the most common causes of joint pain in the pediatric age group. In 80-85% of children who present with a limp in the absence of trauma, transient synovitis of the hip is the cause. […] Transient synovitis affects boys twice as often as girls. Transient synovitis most frequently occurs in children aged 4-10 years; however, transient synovitis has been reported in a 3-month-old infant and in adults.

• #8 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. […] 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. […] We estimate the recurrence rate is about 10 per cent. This means that one in 10 children will experience another episode of irritable hip.

• #9 “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. […] 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 incidence of IH was 177.7 per 100,000 children with a boy:girl ratio of 1.9:1 (209:110). […] There was an increased incidence in spring (n = 111), especially in March (n = 42) and April (n = 40). […] 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’. […] The annual incidence of irritable hip in the GGC area (n = 319) was 177.7 per 100,000 children aged 0-14 years. […] There was an increased incidence of irritable hip in spring (n = 111) when compared to the other seasons. […] The mean age of presentation was 3.5 years and the recurrence rate was 5.9% (n = 18).

• #10 The Limping Child – RCEMLearning

  https://www.rcemlearning.co.uk/foamed/the-limping-child/

  Irritable Hip […] Transient synovitis or irritable hip is a possibility. Irritable hip is a common cause of limp in children and again is more common in boys than girls. There is no reliable way of differentiating irritable hip from septic arthritis. Clinical suspicion, supplemented with blood test results, is important and this formulates the kocher criteria. […] Commonly, not much is known about transient synovitis (TS), and for many ED clinicians, it is a diagnosis of exclusion, as when a patient presenting with hip pain typical of TS will be suspected to have septic arthritis, until proven otherwise. That is of course, the safe approach. But what exactly is TS? […] TS is a self-limiting synovial inflammation of the hip that occurs in childhood (there are only about three reported cases in adulthood in the literature). It is relatively common, with an average annual incidence of 0.2% of the general population. There is a male-to-female ratio of slightly more than 2:1. The disease typically presents at a mean age of 6 years. The truth is we dont really know what actually causes TS.

• #11 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. […] Little data are available regarding the frequency of this illness. However, excluding infections and trauma, transient synovitis is one of the most common causes of joint pain in the pediatric age group. In 80-85% of children who present with a limp in the absence of trauma, transient synovitis of the hip is the cause. […] Transient synovitis affects boys twice as often as girls. Transient synovitis most frequently occurs in children aged 4-10 years; however, transient synovitis has been reported in a 3-month-old infant and in adults.

• #12 Transient synovitis – Wikipedia

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

  Transient synovitis usually affects children between three and ten years old (but it has been reported in a 3-month-old infant and in some adults). […] It is the most common cause of sudden hip pain and limp in young children. […] Boys are affected two to four times as often as girls. […] The term irritable hip refers to the syndrome of acute hip pain, joint stiffness, limp or non-weightbearing, indicative of an underlying condition such as transient synovitis or orthopedic infections (like septic arthritis or osteomyelitis). […] In everyday clinical practice however, irritable hip is commonly used as a synonym for transient synovitis. […] The diagnosis can be made in the typical setting of pain or limp in a young child who is not generally unwell and has no recent trauma. […] Transient synovitis is a diagnosis of exclusion. […] The condition usually clears by itself within seven to ten days, but a small group of patients will continue to have symptoms for several weeks. […] The recurrence rate is 417%, most of which is in the first six months.

• #13 “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. […] 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 incidence of IH was 177.7 per 100,000 children with a boy:girl ratio of 1.9:1 (209:110). […] There was an increased incidence in spring (n = 111), especially in March (n = 42) and April (n = 40). […] 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’. […] The annual incidence of irritable hip in the GGC area (n = 319) was 177.7 per 100,000 children aged 0-14 years. […] There was an increased incidence of irritable hip in spring (n = 111) when compared to the other seasons. […] The mean age of presentation was 3.5 years and the recurrence rate was 5.9% (n = 18).

• #14 Transient Synovitis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK459181/

  Transient synovitis is an acute, nonspecific, inflammatory process affecting the joint synovium, particularly in the pediatric patient population, where it frequently manifests as hip pain. […] Transient synovitis of the hip most frequently occurs in children ages 3 to 10 years old. The average annual incidence of transient synovitis and the total lifetime risk are estimated to be 0.2% and 3%, respectively. […] The incidence rate in males is twice that of females, and about 1% to 4% of the time, a patient may demonstrate bilateral involvement.

• #15

  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. […] most common cause of hip pain in the pediatric population. […] 3% of children between 3-10yo. […] recurrence rate is as high as 20%. […] most common in children aged 4-8 years old. […] male-to-female ratio is 2:1. […] can affect any major joint but most commonly affects the hip joint. […] the exact cause of transient synovitis is largely unknown, however, may be related to viral infection (upper respiratory). […] bacterial infection (poststreptococcal toxic synovitis). […] trauma. […] higher interferon concentration. […] allergic reaction.

• #16 Transient synovitis of the hip | Radiology Case | Radiopaedia.org

  https://radiopaedia.org/cases/transient-synovitis-of-the-hip-6?lang=us

  Left hip pain and limping for two days without a fever. Hemogram and ESR levels normal. […] It affects children under 10 years of age, with an incidence peak of 3-5 years, presenting a higher prevalence in boys than in girls in a 3:1 ratio. The right hip is mostly affected, and in 5% of cases, it is bilateral.

• #17 “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. […] 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 incidence of IH was 177.7 per 100,000 children with a boy:girl ratio of 1.9:1 (209:110). […] There was an increased incidence in spring (n = 111), especially in March (n = 42) and April (n = 40). […] 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’. […] The annual incidence of irritable hip in the GGC area (n = 319) was 177.7 per 100,000 children aged 0-14 years. […] There was an increased incidence of irritable hip in spring (n = 111) when compared to the other seasons. […] The mean age of presentation was 3.5 years and the recurrence rate was 5.9% (n = 18).

• #18 The Limping Child – RCEMLearning

  https://www.rcemlearning.co.uk/foamed/the-limping-child/

  There are theories of an autoimmune or post-traumatic process, but there is little proof behind them. Five main research papers support a link with viral infection two studies measured immunological parameters and three investigated clinical evidence of a preceding viral illness. However, there is much doubt on this hypothesis, and I will tell you why. First lets talk about the studies supporting this: Early work by Leibowitz, et al., and later by Tolat, et al. found that patients with TS have a higher serum interferon concentration and are more likely to be in an antiviral state compared with controls. […] A few years later Landin et al. further supported this hypothesis when they noted a seasonal variation in the incidence of TS, with more cases presenting in October and fewer cases in February. Kastrissianakis and Beattie, raised the suspicion further when they found that TS patients are more likely to have preceding viral symptoms. In another paper, Fisher and Beattie found a preceding illness in 40% of patients with TS. However, studies attempting to single out viral pathogens, which would not only help diagnosis, but also prevention, have not been successful. If youre a bit of a sceptic, this fact alone will already begin to raise an eyebrow. However, one can argue that although the viral culprit hasnt been found, that doesnt mean they didnt do it. So, others have taken on the debate from different angles. For example, Harrison, et al. argue that the finding of raised interferon levels is not universal, nor specific to a virus, and is not made in comparison with a well-formed control group.

• #19 The Limping Child – RCEMLearning

  https://www.rcemlearning.co.uk/foamed/the-limping-child/

  Clinical questions of viral illness are flawed by recall bias, they say, and the strongest evidence to support the viral association is the ecological evidence of an association between TS and seasonality. Harrisons well-powered study, which looked at the epidemiology of TS in my hometown- Liverpool, found no seasonal association. Interestingly though, these authors found a link with deprivation in Merseyside, however, this may be due to referral bias and further attempts to replicate this in other settings are needed. Ok FINE. So, we dont know what causes it. But how do we differentiate it from other hip pathology? As outlined already, the diagnosis is mainly one of exclusion. Several evidence-based algorithms have been presented for the limping child, mainly to ensure that emergencies or more serious diseases (like osteomyelitis, septic arthritis, orthopaedic oncological lesions, Perthes disease and SUFE) are not over-looked.

• #20 “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. […] 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 incidence of IH was 177.7 per 100,000 children with a boy:girl ratio of 1.9:1 (209:110). […] There was an increased incidence in spring (n = 111), especially in March (n = 42) and April (n = 40). […] 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’. […] The annual incidence of irritable hip in the GGC area (n = 319) was 177.7 per 100,000 children aged 0-14 years. […] There was an increased incidence of irritable hip in spring (n = 111) when compared to the other seasons. […] The mean age of presentation was 3.5 years and the recurrence rate was 5.9% (n = 18).

• #21

  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. […] most common cause of hip pain in the pediatric population. […] 3% of children between 3-10yo. […] recurrence rate is as high as 20%. […] most common in children aged 4-8 years old. […] male-to-female ratio is 2:1. […] can affect any major joint but most commonly affects the hip joint. […] the exact cause of transient synovitis is largely unknown, however, may be related to viral infection (upper respiratory). […] bacterial infection (poststreptococcal toxic synovitis). […] trauma. […] higher interferon concentration. […] allergic reaction.

• #22 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 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. […] Transient synovitis typically has an acute onset, and spontaneous recovery with no radiological abnormality or systemic upset. […] Transient synovitis recurs in up to 15% of children, and may affect the same or opposite hip. […] 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.

• #23 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. […] 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. […] We estimate the recurrence rate is about 10 per cent. This means that one in 10 children will experience another episode of irritable hip.

• #24 Transient Synovitis In Children Overview | OrthoFixar 2025

  https://orthofixar.com/pediatric/transient-synovitis-of-hip/

  Transient Synovitis is also known as toxic synovitis, irritable hip, and observation hip. […] This condition is seen most often in children between 3 and 8 years of age and manifests with the rapid onset of hip pain, limited joint range of motion, and limping (or an inability to walk, if the condition is severe). […] The irritability of the hip is usually several grades less severe than in a child with septic arthritis. […] Transient synovitis resolves spontaneously: […] Transient synovitis of the hip recurs in up to 20% to 25% of patients. Patients should be educated regarding the increased risk of recurrence in the setting of a previously documented diagnosis of transient synovitis. One study reported the subsequent recurrence rates in patients with a previously documented diagnosis of transient synovitis were 69%, 13%, and 18% at 1-year, 2-year, and long-term follow-up, respectively.

• #25 Transient Synovitis In Children Overview | OrthoFixar 2025

  https://orthofixar.com/pediatric/transient-synovitis-of-hip/

  Transient Synovitis is also known as toxic synovitis, irritable hip, and observation hip. […] This condition is seen most often in children between 3 and 8 years of age and manifests with the rapid onset of hip pain, limited joint range of motion, and limping (or an inability to walk, if the condition is severe). […] The irritability of the hip is usually several grades less severe than in a child with septic arthritis. […] Transient synovitis resolves spontaneously: […] Transient synovitis of the hip recurs in up to 20% to 25% of patients. Patients should be educated regarding the increased risk of recurrence in the setting of a previously documented diagnosis of transient synovitis. One study reported the subsequent recurrence rates in patients with a previously documented diagnosis of transient synovitis were 69%, 13%, and 18% at 1-year, 2-year, and long-term follow-up, respectively.

• #26 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 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. […] Transient synovitis typically has an acute onset, and spontaneous recovery with no radiological abnormality or systemic upset. […] Transient synovitis recurs in up to 15% of children, and may affect the same or opposite hip. […] 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.

• #27 Transient Synovitis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK459181/

  Transient synovitis is an acute, nonspecific, inflammatory process affecting the joint synovium, particularly in the pediatric patient population, where it frequently manifests as hip pain. […] Transient synovitis of the hip most frequently occurs in children ages 3 to 10 years old. The average annual incidence of transient synovitis and the total lifetime risk are estimated to be 0.2% and 3%, respectively. […] The incidence rate in males is twice that of females, and about 1% to 4% of the time, a patient may demonstrate bilateral involvement.

• #28 Transient Hip Tenosynovitis

  https://mobile.fpnotebook.com/Ortho/Peds/TrnsntHpTnsynvts.htm

  Incidence: Common (8x more common than septic hip in children) […] Most common cause of limp with Hip Pain under age 10 […] Peaks ages 3 to 6 years […] Boys more commonly affected than girls by a 2:1 to 4:1 ratio […] Unilateral involvement in 95% of cases.

• #29 Transient synovitis of the hip | Radiology Case | Radiopaedia.org

  https://radiopaedia.org/cases/transient-synovitis-of-the-hip-6?lang=us

  Left hip pain and limping for two days without a fever. Hemogram and ESR levels normal. […] It affects children under 10 years of age, with an incidence peak of 3-5 years, presenting a higher prevalence in boys than in girls in a 3:1 ratio. The right hip is mostly affected, and in 5% of cases, it is bilateral.

• #30 Transient Synovitis of the Hip | Pediatric Orthopaedic Society of North America (POSNA)

  https://posna.org/physician-education/study-guide/transient-synovitis-of-the-hip

  Common cause of hip pain in the pediatric population […] 3% children between ages 3-10 years old […] Predominance boys ~2:1 […] Right side is more commonly affected.

• #31 Transient synovitis of the hip | Radiology Case | Radiopaedia.org

  https://radiopaedia.org/cases/transient-synovitis-of-the-hip-6?lang=us

  Left hip pain and limping for two days without a fever. Hemogram and ESR levels normal. […] It affects children under 10 years of age, with an incidence peak of 3-5 years, presenting a higher prevalence in boys than in girls in a 3:1 ratio. The right hip is mostly affected, and in 5% of cases, it is bilateral.

• #32

  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. […] most common cause of hip pain in the pediatric population. […] 3% of children between 3-10yo. […] recurrence rate is as high as 20%. […] most common in children aged 4-8 years old. […] male-to-female ratio is 2:1. […] can affect any major joint but most commonly affects the hip joint. […] the exact cause of transient synovitis is largely unknown, however, may be related to viral infection (upper respiratory). […] bacterial infection (poststreptococcal toxic synovitis). […] trauma. […] higher interferon concentration. […] allergic reaction.

• #33 Hip Transient Synovitis – Singapore Sports And Orthopaedic Clinic

  https://www.orthopaedicclinic.com.sg/dictionary/hip-transient-synovitis/

  Transient synovitis is the most common cause of hip pain in children. […] The risk of a child having at least 1 episode of transient synovitis of the hip is 1-3%. […] Male:Female ratio is 2:1. […] Transient synovitis accounts for 0.5% of annual pediatric orthopaedic admissions. […] The incidence is much lower among African Americans. […] Transient synovitis of the hip is a diagnosis of exclusion. […] Transient hip synovitis is a self-limiting process without major consequences. […] Some authorities have suggested an increased incidence of later Legg-Calve-Perthes disease in such patients, but this finding has not been proven conclusively.

• #34 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 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. […] Transient synovitis typically has an acute onset, and spontaneous recovery with no radiological abnormality or systemic upset. […] Transient synovitis recurs in up to 15% of children, and may affect the same or opposite hip. […] 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.

• #35 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. […] Septic arthritis, a surgical emergency, is always to be suspected when a child of any age presents with hip pain, fever, irritability and toxic appearance without a history of trauma. […] Toxic synovitis is the diagnosis with the highest incidence rate but remains a diagnosis of exclusion. […] Most cases of septic arthritis occur from direct extension of bacterial infection (Staphylococcus aureus is frequently the causative organism) from the adjacent metaphysis. […] 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.

• #36 Transient synovitis – Wikipedia

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

  Transient synovitis usually affects children between three and ten years old (but it has been reported in a 3-month-old infant and in some adults). […] It is the most common cause of sudden hip pain and limp in young children. […] Boys are affected two to four times as often as girls. […] The term irritable hip refers to the syndrome of acute hip pain, joint stiffness, limp or non-weightbearing, indicative of an underlying condition such as transient synovitis or orthopedic infections (like septic arthritis or osteomyelitis). […] In everyday clinical practice however, irritable hip is commonly used as a synonym for transient synovitis. […] The diagnosis can be made in the typical setting of pain or limp in a young child who is not generally unwell and has no recent trauma. […] Transient synovitis is a diagnosis of exclusion. […] The condition usually clears by itself within seven to ten days, but a small group of patients will continue to have symptoms for several weeks. […] The recurrence rate is 417%, most of which is in the first six months.

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

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

  The diagnosis of TSH in children with acute nontraumatic hip pain or limp is often challenging. […] Results of the current study show that children presenting with acute, nontraumatic hip pain or limp at the emergency room without a clear diagnosis at time of presentation were subsequently found to have TSH in the great majority of cases (92%) at the end of diagnostic work-up. […] 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. […] Specific investigations are probably not fundamental, especially if symptoms have been present for less than a few days.

• #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 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. […] Transient synovitis typically has an acute onset, and spontaneous recovery with no radiological abnormality or systemic upset. […] Transient synovitis recurs in up to 15% of children, and may affect the same or opposite hip. […] 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.

• #39 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 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. […] Transient synovitis typically has an acute onset, and spontaneous recovery with no radiological abnormality or systemic upset. […] Transient synovitis recurs in up to 15% of children, and may affect the same or opposite hip. […] 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.

• #40 Transient Synovitis or Septic Arthritis? Evaluating the Kocher Criteria — Taming the SRU

  https://www.tamingthesru.com/blog/intern-diagnostics/kocher-criteria

  When a child presents with atraumatic hip pain, the differential includes septic arthritis, transient synovitis, osteomyelitis, slipped capital femoral epiphysis, Legg- Calve-Perthes disease, juvenile idiopathic arthritis, acute rheumatic fever, post strep reactive arthritis, gonococcal arthritis, Henoch-Schoenlein purpura, sickle cell crisis, lyme arthritis, etc. The list is extensive. Fortunately, many of these complaints can be ruled out using a good history, physical exam, and basic laboratory/imaging tests. Two diagnoses, however, are notoriously hard to differentiate without an invasive procedure: septic arthritis and transient synovitis. Both present with an atraumatic, acutely irritable hip sometimes with associated limp, fever, refusal to bear weight, limited ROM, and/or joint effusion on x-ray and ultrasound. It is imperative to differentiate the two as the treatment and course of the two diseases are very different. […]

• #41 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 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. […] Transient synovitis typically has an acute onset, and spontaneous recovery with no radiological abnormality or systemic upset. […] Transient synovitis recurs in up to 15% of children, and may affect the same or opposite hip. […] 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.

• #42 The Limping Child – RCEMLearning

  https://www.rcemlearning.co.uk/foamed/the-limping-child/

  Pain is the most common presenting symptom of septic arthritis followed by joint swelling, fevers, sweats and rigors. Clinical suspicion is the most important diagnostic tool in diagnosis in these cases as even apyrexial patients with a normal white cell count can have septic arthritis. […] Kochers Criteria for diagnosing Septic Arthritis is well validated, and NEWT is a useful mnemonic for remembering it. […] Many places now use CRP instead of ESR. A high CRP has a strong association with septic arthritis, and a high CRP in a non-weight-bearing child gives a 74% probability of the diagnosis. […] X-rays may show an effusion, if the effusion is big enough. Ultrasound normally identifies the presence of an effusion, and some sonographers can tell you whether it is thick fluid (pus) or not. Fluid may be present in both transient synovitis and septic arthritis.

• #43 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. […] Septic arthritis, a surgical emergency, is always to be suspected when a child of any age presents with hip pain, fever, irritability and toxic appearance without a history of trauma. […] Toxic synovitis is the diagnosis with the highest incidence rate but remains a diagnosis of exclusion. […] Most cases of septic arthritis occur from direct extension of bacterial infection (Staphylococcus aureus is frequently the causative organism) from the adjacent metaphysis. […] 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.

• #44 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. […] Septic arthritis, a surgical emergency, is always to be suspected when a child of any age presents with hip pain, fever, irritability and toxic appearance without a history of trauma. […] Toxic synovitis is the diagnosis with the highest incidence rate but remains a diagnosis of exclusion. […] Most cases of septic arthritis occur from direct extension of bacterial infection (Staphylococcus aureus is frequently the causative organism) from the adjacent metaphysis. […] 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.

• #45 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 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. […] Transient synovitis typically has an acute onset, and spontaneous recovery with no radiological abnormality or systemic upset. […] Transient synovitis recurs in up to 15% of children, and may affect the same or opposite hip. […] 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.

• #46 Transient Synovitis or Septic Arthritis? Evaluating the Kocher Criteria — Taming the SRU

  https://www.tamingthesru.com/blog/intern-diagnostics/kocher-criteria

  Transient Synovitis on the other hand is the most common cause of acute hip pain in children less than 10 years old. The cause is not always clear; however, it is often attributed to a viral illness. The joint pain occurs when the synovial membrane becomes inflamed and hypertrophies. […] […] A detailed history and physical exam are critical in the assessment of pediatric hip pain. Subsequent investigations including laboratory and imaging studies should be guided by your pre-test probability of septic arthritis. The Kocher criteria, especially when used in conjunction with CRP, can help guide the need for arthrocentesis and consultation of orthopedic surgery however the positive predictive value of the criteria is variable. […] […] Ultimately, a patient with 0 of 4 Kocher criteria, a negative CRP, and a low pre-test probability of septic arthritis can reasonably be managed as an outpatient with NSAIDS and strict return precautions for worsening hip pain and/or fever. Increasing uncertainty, either by history and/or the presence of Kocher criteria, mandates the need for further investigation with arthrocentesis and/or consultation with orthopedics as misdiagnosis of septic arthritis can have dire consequences.

• #47 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 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. […] Transient synovitis typically has an acute onset, and spontaneous recovery with no radiological abnormality or systemic upset. […] Transient synovitis recurs in up to 15% of children, and may affect the same or opposite hip. […] 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.

• #48 Hip pain in children (irritable hip) | nidirect

  https://www.nidirect.gov.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. […] They probably just have irritable hip (inflammation of the hip joint). This isn’t serious and gets better by itself. […] Irritable hip normally gets better in one or two weeks and doesn’t cause lasting problems. […] Take your child back to the GP or hospital if: their pain is getting worse; they get a high temperature or feel hot and shivery; their pain hasn’t started to improve after a week; they’re still in pain after 2 weeks; their pain went away but has come back. This might mean they have a more serious problem.

• #49 Transient synovitis (irritable hip) — Chelsea and Westminster Hospital NHS Foundation Trust

  https://www.chelwest.nhs.uk/your-visit/patient-leaflets/paediatrics/transient-synovitis-irritable-hip

  Irritable hip occurs in children (usually aged between 3 and 10 years) and is more common in boys than girls. […] The inflammation in the joint sometimes happens after a flu-like illness. […] One of the most important of these is a bacterial infection in the hip, which needs to be diagnosed and treated relatively quickly to prevent any damage occurring to the hip joint. […] Children with irritable hip may find walking and standing painful. […] You should return to AE if: Your child is not better after 7 days of rest.

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

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

  The diagnosis of TSH in children with acute nontraumatic hip pain or limp is often challenging. […] Results of the current study show that children presenting with acute, nontraumatic hip pain or limp at the emergency room without a clear diagnosis at time of presentation were subsequently found to have TSH in the great majority of cases (92%) at the end of diagnostic work-up. […] 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. […] Specific investigations are probably not fundamental, especially if symptoms have been present for less than a few days.

• #51 Hip Pain in Preschool-Age Children | AAFP

  https://www.aafp.org/pubs/afp/issues/2009/0815/p385.html

  Evidence is lacking on the most common causes of hip pain in children because most data come from cohort studies and include referred patients. Based on these studies, transient synovitis is the most common cause of hip pain in preschool-age children, accounting for more than 80 percent of cases. […] Transient synovitis was diagnosed in 471 patients (94 percent). […] Overall, 426 patients (84 percent) were diagnosed with irritable hip (transient synovitis); […] Transient synovitis is a self-limited and benign condition. Most patients are neither referred nor hospitalized. The previously mentioned studies likely underestimated the true prevalence of transient synovitis in an outpatient setting, strengthening the conclusion that transient synovitis is the most common cause of hip pain in young children.

• #52 Hip Pain in Preschool-Age Children | AAFP

  https://www.aafp.org/pubs/afp/issues/2009/0815/p385.html

  Evidence is lacking on the most common causes of hip pain in children because most data come from cohort studies and include referred patients. Based on these studies, transient synovitis is the most common cause of hip pain in preschool-age children, accounting for more than 80 percent of cases. […] Transient synovitis was diagnosed in 471 patients (94 percent). […] Overall, 426 patients (84 percent) were diagnosed with irritable hip (transient synovitis); […] Transient synovitis is a self-limited and benign condition. Most patients are neither referred nor hospitalized. The previously mentioned studies likely underestimated the true prevalence of transient synovitis in an outpatient setting, strengthening the conclusion that transient synovitis is the most common cause of hip pain in young children.

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

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

  The diagnosis of TSH in children with acute nontraumatic hip pain or limp is often challenging. […] Results of the current study show that children presenting with acute, nontraumatic hip pain or limp at the emergency room without a clear diagnosis at time of presentation were subsequently found to have TSH in the great majority of cases (92%) at the end of diagnostic work-up. […] 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. […] Specific investigations are probably not fundamental, especially if symptoms have been present for less than a few days.

• #54 Hip Pain in Preschool-Age Children | AAFP

  https://www.aafp.org/pubs/afp/issues/2009/0815/p385.html

  Evidence is lacking on the most common causes of hip pain in children because most data come from cohort studies and include referred patients. Based on these studies, transient synovitis is the most common cause of hip pain in preschool-age children, accounting for more than 80 percent of cases. […] Transient synovitis was diagnosed in 471 patients (94 percent). […] Overall, 426 patients (84 percent) were diagnosed with irritable hip (transient synovitis); […] Transient synovitis is a self-limited and benign condition. Most patients are neither referred nor hospitalized. The previously mentioned studies likely underestimated the true prevalence of transient synovitis in an outpatient setting, strengthening the conclusion that transient synovitis is the most common cause of hip pain in young children.

• #55

  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. […] most common cause of hip pain in the pediatric population. […] 3% of children between 3-10yo. […] recurrence rate is as high as 20%. […] most common in children aged 4-8 years old. […] male-to-female ratio is 2:1. […] can affect any major joint but most commonly affects the hip joint. […] the exact cause of transient synovitis is largely unknown, however, may be related to viral infection (upper respiratory). […] bacterial infection (poststreptococcal toxic synovitis). […] trauma. […] higher interferon concentration. […] allergic reaction.

• #56 The Limping Child – RCEMLearning

  https://www.rcemlearning.co.uk/foamed/the-limping-child/

  There are theories of an autoimmune or post-traumatic process, but there is little proof behind them. Five main research papers support a link with viral infection two studies measured immunological parameters and three investigated clinical evidence of a preceding viral illness. However, there is much doubt on this hypothesis, and I will tell you why. First lets talk about the studies supporting this: Early work by Leibowitz, et al., and later by Tolat, et al. found that patients with TS have a higher serum interferon concentration and are more likely to be in an antiviral state compared with controls. […] A few years later Landin et al. further supported this hypothesis when they noted a seasonal variation in the incidence of TS, with more cases presenting in October and fewer cases in February. Kastrissianakis and Beattie, raised the suspicion further when they found that TS patients are more likely to have preceding viral symptoms. In another paper, Fisher and Beattie found a preceding illness in 40% of patients with TS. However, studies attempting to single out viral pathogens, which would not only help diagnosis, but also prevention, have not been successful. If youre a bit of a sceptic, this fact alone will already begin to raise an eyebrow. However, one can argue that although the viral culprit hasnt been found, that doesnt mean they didnt do it. So, others have taken on the debate from different angles. For example, Harrison, et al. argue that the finding of raised interferon levels is not universal, nor specific to a virus, and is not made in comparison with a well-formed control group.

• #57 “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. […] 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 incidence of IH was 177.7 per 100,000 children with a boy:girl ratio of 1.9:1 (209:110). […] There was an increased incidence in spring (n = 111), especially in March (n = 42) and April (n = 40). […] 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’. […] The annual incidence of irritable hip in the GGC area (n = 319) was 177.7 per 100,000 children aged 0-14 years. […] There was an increased incidence of irritable hip in spring (n = 111) when compared to the other seasons. […] The mean age of presentation was 3.5 years and the recurrence rate was 5.9% (n = 18).

• #58 The Limping Child – RCEMLearning

  https://www.rcemlearning.co.uk/foamed/the-limping-child/

  Clinical questions of viral illness are flawed by recall bias, they say, and the strongest evidence to support the viral association is the ecological evidence of an association between TS and seasonality. Harrisons well-powered study, which looked at the epidemiology of TS in my hometown- Liverpool, found no seasonal association. Interestingly though, these authors found a link with deprivation in Merseyside, however, this may be due to referral bias and further attempts to replicate this in other settings are needed. Ok FINE. So, we dont know what causes it. But how do we differentiate it from other hip pathology? As outlined already, the diagnosis is mainly one of exclusion. Several evidence-based algorithms have been presented for the limping child, mainly to ensure that emergencies or more serious diseases (like osteomyelitis, septic arthritis, orthopaedic oncological lesions, Perthes disease and SUFE) are not over-looked.

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