Transient synovitis

Transient synovitis
Other names	Transitory coxitis, Coxitis fugax, Acute transient epiphysitis, Coxitis serosa seu simplex, Phantom hip disease, Observation hip.[1]
The hip joint is formed between the femur and acetabulum of the pelvis.
Specialty	Rheumatology

Transient synovitis of hip (also called toxic synovitis; see below for more synonyms) is a self-limiting condition in which there is an inflammation of the inner lining (the synovium) of the capsule of the hip joint. 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).^[2] In everyday clinical practice however, irritable hip is commonly used as a synonym for transient synovitis. It should not be confused with sciatica, a condition describing hip and lower back pain much more common to adults than transient synovitis but with similar signs and symptoms.

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^[3]). It is the most common cause of sudden hip pain and limp in young children.^[4][5] Boys are affected two to four times as often as girls.^[5][6][7] The exact cause is unknown. A recent viral infection (most commonly an upper respiratory tract infection) or a trauma have been postulated as precipitating events, although these are reported only in 30% and 5% of cases, respectively.^[7]

Transient synovitis is a diagnosis of exclusion.^[4] 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. There is a limited range of motion of the hip joint. Nevertheless, children with transient synovitis of the hip can usually weight bear. This is an important clinical differentiating sign from septic arthritis.^[8] Blood tests may show mild inflammation. An ultrasound scan of the hip joint can show a fluid collection (effusion). Treatment is with nonsteroidal anti-inflammatory drugs and limited weight-bearing. The condition usually clears by itself within seven to ten days,^[5] but a small group of patients will continue to have symptoms for several weeks. The recurrence rate is 4–17%, most of which is in the first six months.^[9]