Transient Synovitis Clinical Presentation

  • Author: Christine C Whitelaw, MD; Chief Editor: Lawrence K Jung, MD   more...
 
Updated: Apr 30, 2010
 

History

Unilateral hip or groin pain is the most common symptom reported; however, some patients with transient synovitis (TS) may report medial thigh or knee pain. Transient synovitis has the highest incidence rate among causes of nontraumatic hip pain in children.[2] Guidelines for chronic hip pain have been established.[3]

Very young children with transient synovitis may have no symptoms other than crying at night; however, a careful examination should reveal some degree of an antalgic limp. Recent history of an upper respiratory tract infection, pharyngitis, bronchitis, or otitis media is elicited from approximately half of patients with transient synovitis. Children with transient synovitis are usually afebrile or have a mildly elevated temperature; high fever is rare.

Some patients with transient synovitis may not report pain and may present with only a limp. Guidelines for diagnosis and treatment in children with a limp have been established.[4]

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Physical

Examination of the hip includes the following:

  • During physical examination, hold the hip in flexion with slight abduction and external rotation.
  • Examination of the individual with transient synovitis usually reveals mild restriction of motion, especially to abduction and internal rotation, although one third of patients with transient synovitis demonstrate no limitation of motion.
  • The hip may be painful even with passive movement.
  • The hip may be tender to palpation.
  • The most sensitive test for transient synovitis is the log roll, in which the patient lies supine and the examiner gently rolls the involved limb from side to side. This may detect involuntary muscle guarding of one side when compared to the other side.

Examination of the knee includes the following:

  • The knee of the individual with transient synovitis may have decreased range of motion only as it may include hip motion.
  • Any effusion or joint abnormality within the knee should suggest another disease process.
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Causes

No definitive cause of transient synovitis is known, although the following have been suggested:

  • Patients with transient synovitis often have histories of trauma, which may be a cause or predisposing factor.
  • One study found an increase in viral antibody titers in 67 of 80 patients with transient synovitis.
  • Postvaccine or drug-mediated reactions and an allergic disposition have been cited as possible causes.
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Contributor Information and Disclosures
Author

Christine C Whitelaw, MD  Clinical Instructor, Assistant Professor, Department of Pediatrics, University of Louisville School of Medicine

Christine C Whitelaw, MD is a member of the following medical societies: American Academy of Pediatrics and Kentucky Medical Association

Disclosure: Nothing to disclose.

Coauthor(s)

Kenneth N Schikler, MD  Director, Pediatric Rheumatology, Department of Pediatrics, Kosair Children's Hospital; Associate Professor, University of Louisville School of Medicine

Kenneth N Schikler, MD is a member of the following medical societies: Society for Adolescent Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine

Disclosure: Nothing to disclose.

Thomas JA Lehman, MD, FAAP, FACR  Clinical Professor of Pediatrics, Department of Pediatrics, Division of Pediatric Rheumatology, Weill-Cornell University; Chief, Hospital for Special Surgery

Thomas JA Lehman, MD, FAAP, FACR is a member of the following medical societies: PM American Allergy Society

Disclosure: Nothing to disclose.

Daniel Rauch, MD, FAAP  Director, Pediatric Hospitalist Program, Associate Professor, Department of Pediatrics, New York University School of Medicine

Daniel Rauch, MD, FAAP is a member of the following medical societies: Ambulatory Pediatric Association, American Academy of Pediatrics, and Society of Hospital Medicine

Disclosure: Baxter Honoraria Consulting

Chief Editor

Lawrence K Jung, MD  Chief, Division of Pediatric Rheumatology, Children's National Medical Center

Lawrence K Jung, MD is a member of the following medical societies: American Association for the Advancement of Science, American Association of Immunologists, American College of Rheumatology, Clinical Immunology Society, and New York Academy of Sciences

Disclosure: Nothing to disclose.

References

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Widening of the joint space. Note that the space is wider on the left side. Discrepancies greater than 1 mm indicate the presence of fluid.
 
 
 
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