Transient Synovitis In Children: How To Diagnose And Treat It?

When children between 3 to 10 years complain of acute hip pain, the first probable diagnosis doctor’s will think about is transient synovitis aside from other causes. In transient synovitis or toxic synovitis, the child complains of acute hip pain with limping gait.

Transient synovitis is a type of arthritis of hip joint. It occurs in children who have not attained puberty, usually between 3 to 10 years. In some cases transient synovitis is reported in toddlers too. Boys are more affected as compared to girls; the ratio is 4: 1.

There is no definite cause known for transient synovitis in children, however many researchers consider trauma as a predisposing factor for the disease.

Many children develop transient synovitis after an attack of virus infection, for example after upper respiratory tract infection.

There was increase of viral antibodies titer in one research study. The other possible causes cited are post vaccine and allergic disposition amongst children.

Symptoms Of Transient Synovitis

The symptoms are sudden in onset.

  • The child complains of pain in hip, usually it is on one side of the hip.
  • Limping gait and therefore the child refuses to walk.
  • Pain in the middle and front of the thigh. The intensity of pain is moderate to severe.
  • Presence of low grade fever.
  • Complaint of pain in the knee joint.
  • Tenderness on palpation of the affected hip.

How To Diagnose Transient Synovitis?

A child who has sudden pain in his hip together with limping or unable to walk properly should be examined by a doctor right away. After examining the child, the physician will be able to determine the cause of pain. The child holds the affected hip in bent position slightly turned outwards. At the same time other leg and hip is found normal. The diagnosis is made when other probable reasons such as fracture, septic hip joint, legg-calve- perthes diseases are ruled out. In fact it is a disease of exclusion.

  • Blood test: ESR, C-reactive protein, complete blood count. All these parameters may be slightly raised. But if they are raised excessively, it may indicate other conditions such as septic arthritis.
  • Ultrasound of the hip joint may demonstrate fluid inside the capsule. However, it does not distinguish between septic arthritis and transient synovitis.
  • X-ray of hip usually is normal and it does not show any remarkable abnormality.
  • Aspiration of fluid from hip for cytological test. In transient synovitis the fluid is clear. In septic arthritis, the fluid is hazy and full of pus.
  • MRI (magnetic resonance imaging) is used when the diagnosis is inconclusive. MRI can differentiate between transient synovitis and septic arthritis.

Treatment For Transient Synovitis

In most cases the condition gets cured without any treatment in one week. But in some children the symptoms last for weeks together. The child is treated with medicines and home remedies to shorten the period of suffering and to reduce the intensity of pain and disability.

  • Warm fomentation at the site of pain and gentle Massage.
  • Advised bed rest for 7 days.
  • Avoid weight bearing on the affected leg.
  • NSAID medications in children. NSAID’s are anti inflammatory medicines and they help to reduce the inflammation and pain in hip joint.

Prognosis: There is marked improvement is one to two days. The symptoms completely resolve within two weeks. In some children there may be recurrence of transient synovitis.