Przemijające zapalenie błony maziowej stawu biodrowego – Rokowania, prognozy i postęp choroby

Przemijające zapalenie błony maziowej stawu biodrowego
Rokowania, prognozy i postęp choroby

Przemijające zapalenie błony maziowej stawu biodrowego (irritable hip) jest najczęstszą przyczyną bólu biodra i utykania u dzieci w wieku 3-10 lat. Charakteryzuje się samoograniczającym przebiegiem z poprawą kliniczną w ciągu 24-48 godzin i całkowitym ustąpieniem objawów u 66-75% pacjentów w ciągu 2 tygodni. Leczenie opiera się na odpoczynku oraz stosowaniu niesteroidowych leków przeciwzapalnych, takich jak ibuprofen, w celu złagodzenia bólu i stanu zapalnego. Nawrót choroby występuje u około 10% dzieci, zwykle w ciągu 6 miesięcy od pierwszego epizodu, i może dotyczyć tego samego lub przeciwległego stawu biodrowego. Mimo łagodnego przebiegu, konieczne jest różnicowanie z poważniejszymi schorzeniami, takimi jak septyczne zapalenie stawu biodrowego, choroba Legga-Calvé-Perthesa (LCP) oraz złuszczenie głowy kości udowej (SCFE), które wymagają odmiennych strategii terapeutycznych i mają inne rokowanie.

Przemijające zapalenie błony maziowej stawu biodrowego – Prognoza (rokowanie)

Czas trwania objawów i ustępowanie dolegliwości
Ryzyko nawrotów
Długoterminowe rokowanie i powikłania
Czynniki wpływające na rokowanie i różnicowanie z innymi schorzeniami
Podejście interdyscyplinarne i edukacja pacjentów
Kolejne rozdziały

Przemijające zapalenie błony maziowej stawu biodrowego – Prognoza (rokowanie)

Przemijające zapalenie błony maziowej stawu biodrowego (irritable hip) stanowi najczęstszą przyczynę bólu biodra i utykania u dzieci, szczególnie w wieku od 3 do 10 lat. Jest to schorzenie, które wymaga dokładnej diagnostyki ze względu na konieczność wykluczenia poważniejszych przyczyn dolegliwości biodrowych, jednak jego rokowanie jest zazwyczaj bardzo dobre.¹²³

Czas trwania objawów i ustępowanie dolegliwości

Przemijające zapalenie błony maziowej stawu biodrowego charakteryzuje się samoograniczającym przebiegiem i generalnie dobrym rokowaniem:⁴⁵

U większości pacjentów obserwuje się znaczną poprawę już w ciągu 24-48 godzin od wystąpienia pierwszych objawów⁶
Od 2/3 do 3/4 chorych dzieci doświadcza całkowitego ustąpienia objawów w ciągu 2 tygodni⁷
U pozostałych pacjentów łagodniejsze objawy mogą utrzymywać się przez kilka tygodni⁸
Zazwyczaj dzieci wracają do pełnej sprawności przed upływem 2 tygodni⁹

Schorzenie to ustępuje samoistnie po odpowiednim odpoczynku, a w celu złagodzenia bólu i zmniejszenia stanu zapalnego mogą być stosowane niesteroidowe leki przeciwzapalne, np. ibuprofen.¹⁰

Ryzyko nawrotów

Istotnym elementem rokowania w przemijającym zapaleniu błony maziowej stawu biodrowego jest możliwość wystąpienia nawrotów choroby:¹¹¹²

Szacowany wskaźnik nawrotów wynosi około 4-17%, przy czym większość źródeł podaje wartość około 10% (czyli 1 na 10 dzieci doświadczy kolejnego epizodu)¹³¹⁴
W niektórych badaniach odnotowano wyższy odsetek nawrotów sięgający 20-25%¹⁵
Większość nawrotów rozwija się w ciągu 6 miesięcy od pierwszego epizodu¹⁶
Nawroty mogą dotyczyć tego samego lub przeciwległego stawu biodrowego¹⁷

Jedno z badań wykazało, że częstość nawrotów u pacjentów z wcześniej udokumentowanym rozpoznaniem przemijającego zapalenia błony maziowej stawu biodrowego wynosiła odpowiednio: 69% w ciągu 1 roku, 13% w ciągu 2 lat i 18% w długoterminowej obserwacji.¹⁸

Długoterminowe rokowanie i powikłania

Przemijające zapalenie błony maziowej stawu biodrowego jest generalnie uznawane za łagodny stan bez poważnych długoterminowych następstw:¹⁹²⁰

Nie stwierdzono zwiększonego ryzyka rozwoju młodzieńczego przewlekłego zapalenia stawów u dzieci, które przebyły przemijające zapalenie błony maziowej²¹
Niektóre doniesienia sugerują nieznacznie zwiększone ryzyko późniejszego rozwoju choroby zwyrodnieniowej stawów²²
Kontrowersyjny pozostaje potencjalny związek etiologiczny między przemijającym zapaleniem błony maziowej a chorobą Legga-Calvé-Perthesa (LCP)²³
Około 1,5% pacjentów z przemijającym zapaleniem błony maziowej rozwija później chorobę Legga-Calvé-Perthesa, coxę magnę lub chorobę zwyrodnieniową stawów²⁴

Warto podkreślić, że większość dzieci, które przebyły przemijające zapalenie błony maziowej stawu biodrowego, nie rozwija długoterminowych problemów ze stawami biodrowymi.²⁵

Czynniki wpływające na rokowanie i różnicowanie z innymi schorzeniami

W kontekście różnicowania przemijającego zapalenia błony maziowej z innymi schorzeniami biodra u dzieci, warto zwrócić uwagę na czynniki prognostyczne w tych jednostkach chorobowych:²⁶²⁷

W przypadku choroby Legga-Calvé-Perthesa, która wymaga różnicowania z przemijającym zapaleniem błony maziowej:

Rokowanie zależy głównie od stopnia zajęcia głowy kości udowej, przy czym zajęcie przekraczające 50% powierzchni głowy jest najsilniejszym predyktorem złego wyniku leczenia²⁸²⁹
Wiek powyżej 6 lat w momencie zachorowania wiąże się z gorszym rokowaniem niż u młodszych dzieci³⁰³¹
Klasyfikacja Herringa (lateral pillar) silnie koreluje z ostatecznym wynikiem leczenia³²

W przypadku złuszczenia głowy kości udowej (SCFE), które również należy różnicować z przemijającym zapaleniem błony maziowej:

Stan ten może zaburzać ukrwienie głowy kości udowej i prowadzić do jej jałowej martwicy³³
Niestabilne złuszczenie głowy kości udowej wiąże się ze znacznie większym ryzykiem martwicy jałowej³⁴

W praktyce klinicznej szczególnie istotne jest różnicowanie przemijającego zapalenia błony maziowej od septycznego zapalenia stawu biodrowego, które stanowi stan nagły wymagający pilnej interwencji chirurgicznej i antybiotykoterapii dożylnej, aby zapobiec destrukcji kostnej i zachować funkcję stawu.³⁵³⁶

Należy pamiętać, że chociaż istnieją reguły predykcji klinicznej, które mogą pomóc w różnicowaniu, ostateczne postępowanie z pacjentem zależy od osądu klinicznego.³⁷³⁸

Podejście interdyscyplinarne i edukacja pacjentów

Ze względu na brak specyficznych testów diagnostycznych, przemijające zapalenie błony maziowej stawu biodrowego wymaga podejścia interdyscyplinarnego z udziałem ortopedy, radiologa, lekarza podstawowej opieki zdrowotnej, pielęgniarki, fizjoterapeuty i lekarza medycyny sportowej.³⁹

Edukacja pacjentów i ich rodzin jest istotnym elementem postępowania:

Należy poinformować o łagodnym charakterze schorzenia i spodziewanym ustąpieniu objawów w ciągu 7-14 dni⁴⁰
Ważne jest uświadomienie o zwiększonym ryzyku nawrotu w przypadku wcześniejszego epizodu przemijającego zapalenia błony maziowej⁴¹
Jeśli ból biodra nie reaguje na typowe leczenie przeciwbólowe, wskazane jest skierowanie do ortopedy⁴²

Pomimo odpowiedniego leczenia ryzyko nawrotu pozostaje stosunkowo wysokie, co powinno być uwzględnione w długoterminowej opiece nad pacjentem.⁴³

Kolejne rozdziały

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Wybierz kolejny rozdział z menu poniżej, aby otworzyć nową podstronę kompedium wiedzy i uzyskać szczegółowe informację o leku, substancji lub chorobie.

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 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. […] We estimate the recurrence rate is about 10 per cent. This means that one in 10 children will experience another episode of irritable hip.
#2 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. […] Hip pain may also be referred from low back or pelvic pathology. […] Transient synovitis typically has an acute onset, and spontaneous recovery with no radiological abnormality or systemic upset. […] It is a self-limited condition with no recognized long-term sequelae and can be managed with oral analgesics and observation. […] 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.
#3 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. […] Patients with transient synovitis usually experience marked improvement within 24-48 hours. Two thirds to three fourths of patients with transient synovitis have complete resolution within 2 weeks. The remainder may have less severe symptoms for several weeks. The recurrence rate is 4-17%; most recurrences develop within 6 months. No increased risk of juvenile chronic arthritis is known; however, a slightly increased risk for later development of osteoarthritis may be noted. […] The possible etiologic relationship between transient synovitis and Legg-Calv-Perthes disease (LCP) is controversial. […] Approximately 1.5% of patients with transient synovitis develop LCP, Coxa magna, osteoarthritis, or recurrences.
#4 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 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. […] We estimate the recurrence rate is about 10 per cent. This means that one in 10 children will experience another episode of irritable hip.
#5 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 usually gets better in 1 or 2 weeks and does not cause lasting problems.
#6 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. […] Patients with transient synovitis usually experience marked improvement within 24-48 hours. Two thirds to three fourths of patients with transient synovitis have complete resolution within 2 weeks. The remainder may have less severe symptoms for several weeks. The recurrence rate is 4-17%; most recurrences develop within 6 months. No increased risk of juvenile chronic arthritis is known; however, a slightly increased risk for later development of osteoarthritis may be noted. […] The possible etiologic relationship between transient synovitis and Legg-Calv-Perthes disease (LCP) is controversial. […] Approximately 1.5% of patients with transient synovitis develop LCP, Coxa magna, osteoarthritis, or recurrences.
#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. […] Patients with transient synovitis usually experience marked improvement within 24-48 hours. Two thirds to three fourths of patients with transient synovitis have complete resolution within 2 weeks. The remainder may have less severe symptoms for several weeks. The recurrence rate is 4-17%; most recurrences develop within 6 months. No increased risk of juvenile chronic arthritis is known; however, a slightly increased risk for later development of osteoarthritis may be noted. […] The possible etiologic relationship between transient synovitis and Legg-Calv-Perthes disease (LCP) is controversial. […] Approximately 1.5% of patients with transient synovitis develop LCP, Coxa magna, osteoarthritis, or recurrences.
#8 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. […] Patients with transient synovitis usually experience marked improvement within 24-48 hours. Two thirds to three fourths of patients with transient synovitis have complete resolution within 2 weeks. The remainder may have less severe symptoms for several weeks. The recurrence rate is 4-17%; most recurrences develop within 6 months. No increased risk of juvenile chronic arthritis is known; however, a slightly increased risk for later development of osteoarthritis may be noted. […] The possible etiologic relationship between transient synovitis and Legg-Calv-Perthes disease (LCP) is controversial. […] Approximately 1.5% of patients with transient synovitis develop LCP, Coxa magna, osteoarthritis, or recurrences.
#9 Irritable Hip In Children | KidsHealth New Zealand’s Trusted Voice On Children’s Health
https://www.kidshealth.org.nz/irritable-hip-in-children
Irritable hip is one of the most common causes of limping in tamariki (children). […] Irritable hip is not serious and your child will get better with rest and time. […] It usually takes 2 weeks until tamariki fully recover. […] Most tamariki are back to normal before 2 weeks. […] No. Tamariki who have had irritable hip do not develop long-term problems in their hips.
#10 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 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. […] We estimate the recurrence rate is about 10 per cent. This means that one in 10 children will experience another episode of irritable hip.
#11 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 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. […] We estimate the recurrence rate is about 10 per cent. This means that one in 10 children will experience another episode of irritable hip.
#12 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. […] Hip pain may also be referred from low back or pelvic pathology. […] Transient synovitis typically has an acute onset, and spontaneous recovery with no radiological abnormality or systemic upset. […] It is a self-limited condition with no recognized long-term sequelae and can be managed with oral analgesics and observation. […] 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.
#13 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 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. […] We estimate the recurrence rate is about 10 per cent. This means that one in 10 children will experience another episode of irritable hip.
#14 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. […] Patients with transient synovitis usually experience marked improvement within 24-48 hours. Two thirds to three fourths of patients with transient synovitis have complete resolution within 2 weeks. The remainder may have less severe symptoms for several weeks. The recurrence rate is 4-17%; most recurrences develop within 6 months. No increased risk of juvenile chronic arthritis is known; however, a slightly increased risk for later development of osteoarthritis may be noted. […] The possible etiologic relationship between transient synovitis and Legg-Calv-Perthes disease (LCP) is controversial. […] Approximately 1.5% of patients with transient synovitis develop LCP, Coxa magna, osteoarthritis, or recurrences.
#15 Transient Synovitis – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK459181/
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. […] The major complication associated with transient synovitis is a recurrence of symptoms. […] The diagnosis of transient synovitis is difficult because there are no specific tests. Thus, the disorder is best managed by an interprofessional team that includes an orthopedic surgeon, radiologist, primary care provider, nurse practitioner, physical therapist, and sports physician. When patients present with hip pain and do not respond to the usual pain medication, referral to an orthopedic surgeon is recommended. Patients should be educated that the disorder is benign and will resolve within 7 to 14 days. However, the symptoms may recur. Despite adequate treatment, the risk of recurrence is high.
#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. […] Patients with transient synovitis usually experience marked improvement within 24-48 hours. Two thirds to three fourths of patients with transient synovitis have complete resolution within 2 weeks. The remainder may have less severe symptoms for several weeks. The recurrence rate is 4-17%; most recurrences develop within 6 months. No increased risk of juvenile chronic arthritis is known; however, a slightly increased risk for later development of osteoarthritis may be noted. […] The possible etiologic relationship between transient synovitis and Legg-Calv-Perthes disease (LCP) is controversial. […] Approximately 1.5% of patients with transient synovitis develop LCP, Coxa magna, osteoarthritis, or recurrences.
#17 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. […] Hip pain may also be referred from low back or pelvic pathology. […] Transient synovitis typically has an acute onset, and spontaneous recovery with no radiological abnormality or systemic upset. […] It is a self-limited condition with no recognized long-term sequelae and can be managed with oral analgesics and observation. […] 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.
#18 Transient Synovitis – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK459181/
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. […] The major complication associated with transient synovitis is a recurrence of symptoms. […] The diagnosis of transient synovitis is difficult because there are no specific tests. Thus, the disorder is best managed by an interprofessional team that includes an orthopedic surgeon, radiologist, primary care provider, nurse practitioner, physical therapist, and sports physician. When patients present with hip pain and do not respond to the usual pain medication, referral to an orthopedic surgeon is recommended. Patients should be educated that the disorder is benign and will resolve within 7 to 14 days. However, the symptoms may recur. Despite adequate treatment, the risk of recurrence is high.
#19 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. […] Hip pain may also be referred from low back or pelvic pathology. […] Transient synovitis typically has an acute onset, and spontaneous recovery with no radiological abnormality or systemic upset. […] It is a self-limited condition with no recognized long-term sequelae and can be managed with oral analgesics and observation. […] 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.
#20 Irritable Hip In Children | KidsHealth New Zealand’s Trusted Voice On Children’s Health
https://www.kidshealth.org.nz/irritable-hip-in-children
Irritable hip is one of the most common causes of limping in tamariki (children). […] Irritable hip is not serious and your child will get better with rest and time. […] It usually takes 2 weeks until tamariki fully recover. […] Most tamariki are back to normal before 2 weeks. […] No. Tamariki who have had irritable hip do not develop long-term problems in their hips.
#21 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. […] Patients with transient synovitis usually experience marked improvement within 24-48 hours. Two thirds to three fourths of patients with transient synovitis have complete resolution within 2 weeks. The remainder may have less severe symptoms for several weeks. The recurrence rate is 4-17%; most recurrences develop within 6 months. No increased risk of juvenile chronic arthritis is known; however, a slightly increased risk for later development of osteoarthritis may be noted. […] The possible etiologic relationship between transient synovitis and Legg-Calv-Perthes disease (LCP) is controversial. […] Approximately 1.5% of patients with transient synovitis develop LCP, Coxa magna, osteoarthritis, or recurrences.
#22 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. […] Patients with transient synovitis usually experience marked improvement within 24-48 hours. Two thirds to three fourths of patients with transient synovitis have complete resolution within 2 weeks. The remainder may have less severe symptoms for several weeks. The recurrence rate is 4-17%; most recurrences develop within 6 months. No increased risk of juvenile chronic arthritis is known; however, a slightly increased risk for later development of osteoarthritis may be noted. […] The possible etiologic relationship between transient synovitis and Legg-Calv-Perthes disease (LCP) is controversial. […] Approximately 1.5% of patients with transient synovitis develop LCP, Coxa magna, osteoarthritis, or recurrences.
#23 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. […] Patients with transient synovitis usually experience marked improvement within 24-48 hours. Two thirds to three fourths of patients with transient synovitis have complete resolution within 2 weeks. The remainder may have less severe symptoms for several weeks. The recurrence rate is 4-17%; most recurrences develop within 6 months. No increased risk of juvenile chronic arthritis is known; however, a slightly increased risk for later development of osteoarthritis may be noted. […] The possible etiologic relationship between transient synovitis and Legg-Calv-Perthes disease (LCP) is controversial. […] Approximately 1.5% of patients with transient synovitis develop LCP, Coxa magna, osteoarthritis, or recurrences.
#24 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. […] Patients with transient synovitis usually experience marked improvement within 24-48 hours. Two thirds to three fourths of patients with transient synovitis have complete resolution within 2 weeks. The remainder may have less severe symptoms for several weeks. The recurrence rate is 4-17%; most recurrences develop within 6 months. No increased risk of juvenile chronic arthritis is known; however, a slightly increased risk for later development of osteoarthritis may be noted. […] The possible etiologic relationship between transient synovitis and Legg-Calv-Perthes disease (LCP) is controversial. […] Approximately 1.5% of patients with transient synovitis develop LCP, Coxa magna, osteoarthritis, or recurrences.
#25 Irritable Hip In Children | KidsHealth New Zealand’s Trusted Voice On Children’s Health
https://www.kidshealth.org.nz/irritable-hip-in-children
Irritable hip is one of the most common causes of limping in tamariki (children). […] Irritable hip is not serious and your child will get better with rest and time. […] It usually takes 2 weeks until tamariki fully recover. […] Most tamariki are back to normal before 2 weeks. […] No. Tamariki who have had irritable hip do not develop long-term problems in their hips.
#26 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. […] Hip pain may also be referred from low back or pelvic pathology. […] Transient synovitis typically has an acute onset, and spontaneous recovery with no radiological abnormality or systemic upset. […] It is a self-limited condition with no recognized long-term sequelae and can be managed with oral analgesics and observation. […] 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 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 pain may be caused by conditions unique to the growing pediatric skeleton including Perthes disease, slipped capital femoral epiphysis and apophyseal avulsion fractures of the pelvis. […] 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. It is a self-limited condition with no recognized long-term sequelae and can be managed with oral analgesics and observation. […] Prognosis is largely dependent on the amount of femoral head involved, with a recent study citing femoral head involvement of more than 50% as the strongest predictor of poor outcome. Age greater than 6 years also conferred worse prognosis than younger children.
#28 Review for the generalist: evaluation of pediatric hip pain
https://pmc.ncbi.nlm.nih.gov/articles/PMC2686695/
A septic hip is a surgical emergency. […] The predicted probability of septic arthritis was determined for all sixteen combinations of these four predictors and is summarized 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. […] Prognosis is largely dependent on the amount of femoral head involved, with a recent study citing femoral head involvement of more than 50% as the strongest predictor of poor outcome. […] Age greater than 6 years also conferred worse prognosis than younger children. […] The Herring or lateral pillar classification also strongly correlates with outcome.
#29 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 pain may be caused by conditions unique to the growing pediatric skeleton including Perthes disease, slipped capital femoral epiphysis and apophyseal avulsion fractures of the pelvis. […] 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. It is a self-limited condition with no recognized long-term sequelae and can be managed with oral analgesics and observation. […] Prognosis is largely dependent on the amount of femoral head involved, with a recent study citing femoral head involvement of more than 50% as the strongest predictor of poor outcome. Age greater than 6 years also conferred worse prognosis than younger children.
#30 Review for the generalist: evaluation of pediatric hip pain
https://pmc.ncbi.nlm.nih.gov/articles/PMC2686695/
A septic hip is a surgical emergency. […] The predicted probability of septic arthritis was determined for all sixteen combinations of these four predictors and is summarized 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. […] Prognosis is largely dependent on the amount of femoral head involved, with a recent study citing femoral head involvement of more than 50% as the strongest predictor of poor outcome. […] Age greater than 6 years also conferred worse prognosis than younger children. […] The Herring or lateral pillar classification also strongly correlates with outcome.
#31 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 pain may be caused by conditions unique to the growing pediatric skeleton including Perthes disease, slipped capital femoral epiphysis and apophyseal avulsion fractures of the pelvis. […] 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. It is a self-limited condition with no recognized long-term sequelae and can be managed with oral analgesics and observation. […] Prognosis is largely dependent on the amount of femoral head involved, with a recent study citing femoral head involvement of more than 50% as the strongest predictor of poor outcome. Age greater than 6 years also conferred worse prognosis than younger children.
#32 Review for the generalist: evaluation of pediatric hip pain
https://pmc.ncbi.nlm.nih.gov/articles/PMC2686695/
A septic hip is a surgical emergency. […] The predicted probability of septic arthritis was determined for all sixteen combinations of these four predictors and is summarized 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. […] Prognosis is largely dependent on the amount of femoral head involved, with a recent study citing femoral head involvement of more than 50% as the strongest predictor of poor outcome. […] Age greater than 6 years also conferred worse prognosis than younger children. […] The Herring or lateral pillar classification also strongly correlates with outcome.
#33 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
SCFE may compromise the vascular supply to the femoral head and lead to avascular necrosis; all cases warrant urgent orthopedic referral, and unstable SCFE should be referred emergently. Unstable SCFE have a much greater risk of avascular necrosis. […] Clinical prediction rules serves as guidelines but clinical judgment ultimately dictates patient management.
#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
SCFE may compromise the vascular supply to the femoral head and lead to avascular necrosis; all cases warrant urgent orthopedic referral, and unstable SCFE should be referred emergently. Unstable SCFE have a much greater risk of avascular necrosis. […] Clinical prediction rules serves as guidelines but clinical judgment ultimately dictates patient management.
#35 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. […] Hip pain may also be referred from low back or pelvic pathology. […] Transient synovitis typically has an acute onset, and spontaneous recovery with no radiological abnormality or systemic upset. […] It is a self-limited condition with no recognized long-term sequelae and can be managed with oral analgesics and observation. […] 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.
#36 Review for the generalist: evaluation of pediatric hip pain
https://pmc.ncbi.nlm.nih.gov/articles/PMC2686695/
A septic hip is a surgical emergency. […] The predicted probability of septic arthritis was determined for all sixteen combinations of these four predictors and is summarized 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. […] Prognosis is largely dependent on the amount of femoral head involved, with a recent study citing femoral head involvement of more than 50% as the strongest predictor of poor outcome. […] Age greater than 6 years also conferred worse prognosis than younger children. […] The Herring or lateral pillar classification also strongly correlates with outcome.
#37 Review for the generalist: evaluation of pediatric hip pain
https://pmc.ncbi.nlm.nih.gov/articles/PMC2686695/
A septic hip is a surgical emergency. […] The predicted probability of septic arthritis was determined for all sixteen combinations of these four predictors and is summarized 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. […] Prognosis is largely dependent on the amount of femoral head involved, with a recent study citing femoral head involvement of more than 50% as the strongest predictor of poor outcome. […] Age greater than 6 years also conferred worse prognosis than younger children. […] The Herring or lateral pillar classification also strongly correlates with outcome.
#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
SCFE may compromise the vascular supply to the femoral head and lead to avascular necrosis; all cases warrant urgent orthopedic referral, and unstable SCFE should be referred emergently. Unstable SCFE have a much greater risk of avascular necrosis. […] Clinical prediction rules serves as guidelines but clinical judgment ultimately dictates patient management.
#39 Transient Synovitis – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK459181/
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. […] The major complication associated with transient synovitis is a recurrence of symptoms. […] The diagnosis of transient synovitis is difficult because there are no specific tests. Thus, the disorder is best managed by an interprofessional team that includes an orthopedic surgeon, radiologist, primary care provider, nurse practitioner, physical therapist, and sports physician. When patients present with hip pain and do not respond to the usual pain medication, referral to an orthopedic surgeon is recommended. Patients should be educated that the disorder is benign and will resolve within 7 to 14 days. However, the symptoms may recur. Despite adequate treatment, the risk of recurrence is high.
#40 Transient Synovitis – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK459181/
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. […] The major complication associated with transient synovitis is a recurrence of symptoms. […] The diagnosis of transient synovitis is difficult because there are no specific tests. Thus, the disorder is best managed by an interprofessional team that includes an orthopedic surgeon, radiologist, primary care provider, nurse practitioner, physical therapist, and sports physician. When patients present with hip pain and do not respond to the usual pain medication, referral to an orthopedic surgeon is recommended. Patients should be educated that the disorder is benign and will resolve within 7 to 14 days. However, the symptoms may recur. Despite adequate treatment, the risk of recurrence is high.
#41 Transient Synovitis – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK459181/
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. […] The major complication associated with transient synovitis is a recurrence of symptoms. […] The diagnosis of transient synovitis is difficult because there are no specific tests. Thus, the disorder is best managed by an interprofessional team that includes an orthopedic surgeon, radiologist, primary care provider, nurse practitioner, physical therapist, and sports physician. When patients present with hip pain and do not respond to the usual pain medication, referral to an orthopedic surgeon is recommended. Patients should be educated that the disorder is benign and will resolve within 7 to 14 days. However, the symptoms may recur. Despite adequate treatment, the risk of recurrence is high.
#42 Transient Synovitis – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK459181/
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. […] The major complication associated with transient synovitis is a recurrence of symptoms. […] The diagnosis of transient synovitis is difficult because there are no specific tests. Thus, the disorder is best managed by an interprofessional team that includes an orthopedic surgeon, radiologist, primary care provider, nurse practitioner, physical therapist, and sports physician. When patients present with hip pain and do not respond to the usual pain medication, referral to an orthopedic surgeon is recommended. Patients should be educated that the disorder is benign and will resolve within 7 to 14 days. However, the symptoms may recur. Despite adequate treatment, the risk of recurrence is high.
#43 Transient Synovitis – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK459181/
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. […] The major complication associated with transient synovitis is a recurrence of symptoms. […] The diagnosis of transient synovitis is difficult because there are no specific tests. Thus, the disorder is best managed by an interprofessional team that includes an orthopedic surgeon, radiologist, primary care provider, nurse practitioner, physical therapist, and sports physician. When patients present with hip pain and do not respond to the usual pain medication, referral to an orthopedic surgeon is recommended. Patients should be educated that the disorder is benign and will resolve within 7 to 14 days. However, the symptoms may recur. Despite adequate treatment, the risk of recurrence is high.