Transient Synovitis (Observation Hip)
Also known as Toxic Synovitis, this is the most common cause of hip pain and limping in children aged 3-8 years. It is a benign, self-limiting inflammation of the hip synovium, often following a viral infection.
1. Diagnosis & Differential
It is a diagnosis of exclusion. The main priority is to rule out Septic Arthritis (a surgical emergency).
Kocher Criteria (To rule out Septic Arthritis):
If a child has 3 or 4 of these signs, Septic Arthritis is highly likely (>93%):
1. Fever > 38.5°C.
2. Non-weight bearing (refusal to walk).
3. ESR > 40 mm/hr.
4. WBC > 12,000 cells/mm³.
*(Transient Synovitis usually has 0 or 1 of these).*
If a child has 3 or 4 of these signs, Septic Arthritis is highly likely (>93%):
1. Fever > 38.5°C.
2. Non-weight bearing (refusal to walk).
3. ESR > 40 mm/hr.
4. WBC > 12,000 cells/mm³.
*(Transient Synovitis usually has 0 or 1 of these).*
2. Clinical Features
- History: Recent Upper Respiratory Tract Infection (URTI) 1-2 weeks prior.
- Symptoms: Acute onset of limp or groin/knee pain. Child generally looks "well" (afebrile or low grade).
- ROM: Limited Abduction and Internal Rotation (spasm).
3. Management
- Bed Rest: Essential. Stop sports/running.
- NSAIDs: Ibuprofen for inflammation.
- Traction: Skin traction helps relieve spasm (rarely needed now).
- Prognosis: Resolves spontaneously in 3-7 days.
25 Practice MCQs
Q1. The most common cause of acute hip pain in children aged 3-8 is:
Answer: A). Far more common than others.
Q2. Transient Synovitis often follows:
Answer: A). Immune-mediated response.
Q3. Which of the following is NOT a Kocher criterion for Septic Arthritis?
Answer: C). Trauma is not a Kocher criterion. WBC > 12k is the 4th one.
Q4. In Transient Synovitis, X-rays usually show:
Answer: A). Used to rule out Perthes/Tumor.
Q5. The treatment of choice is:
Answer: A). It is self-limiting.
Q6. Ultrasound of the hip typically shows:
Answer: A). Fluid accumulation in the joint.
Q7. Typically, symptoms resolve within:
Answer: B). Very short duration.
Q8. Hip aspiration is indicated if:
Answer: A). To identify the organism and drain pus.
Q9. The most restricted movements are:
Answer: A). Capsule is tightest in these positions; fluid restricts them.
Q10. "Observation Hip" is another name for:
Answer: A). Because the main treatment is observation.
Q11. Does Transient Synovitis cause permanent damage?
Answer: B). Benign condition.
Q12. A key difference between Septic Arthritis and Transient Synovitis is:
Answer: A). Septic kids look "sick". TS kids look "well" despite limp.
Q13. C-Reactive Protein (CRP) is:
Answer: A). Strong predictor (>20).
Q14. Recurrence rate is:
Answer: A). Can happen again.
Q15. Legg-Calve-Perthes disease is a differential diagnosis. It usually presents:
Answer: A). TS is acute onset.
Q16. Log roll test involves:
Answer: A). Pain with log roll suggests intra-articular pathology (synovitis).
Q17. Gender predilection:
Answer: A). More common in boys.
Q18. Which activity should be restricted?
Answer: A). Until limp resolves.
Q19. Is skin traction mandatory?
Answer: B). Old school, but helpful for pain control in some.
Q20. "Frog Leg" position helps because:
Answer: A). Position of comfort (Flexion, Abduction, ER).
Q21. A child with TS typically presents with pain in:
Answer: A). Always check the hip in a child with knee pain!
Q22. Antalgic gait means:
Answer: A). "Painful limp".
Q23. If symptoms persist > 2 weeks, you should suspect:
Answer: A). TS is short-lived.
Q24. Lyme disease should be considered if:
Answer: A). Can cause monoarticular arthritis.
Q25. Is aspiration curative?
Answer: A). Fluid removal helps comfort.
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