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Transient Synovitis

  • Author: Christine C Whitelaw, MD; Chief Editor: Lawrence K Jung, MD  more...
 
Updated: Oct 11, 2015
 

Background

Transient synovitis (TS) is the most common cause of acute hip pain in children aged 3-10 years. The disease causes arthralgia and arthritis secondary to a transient inflammation of the synovium of the hip.

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Pathophysiology

Biopsy reveals only nonspecific inflammation and hypertrophy of the synovial membrane. Ultrasonography demonstrates an effusion that causes bulging of the anterior joint capsule. Synovial fluid has increased proteoglycans.

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Epidemiology

Frequency

United States

Little data are available regarding the frequency of this illness. However, excluding infections and trauma, transient synovitis is one of the most common causes of joint pain in the pediatric age group.

International

The Netherlands report an incidence of 76.2 per 100,000 person-years.

Mortality/Morbidity

The possible etiologic relationship between transient synovitis and Legg-Calvé-Perthes disease (LCP) is controversial.[1] Although some children with transient synovitis may develop LCP, whether persistence of increased intraarticular pressure eventually causes avascular necrosis or whether patients may have a synovitis that occurs before detection of femoral head collapse is not fully known. Approximately 1.5% of patients with transient synovitis develop LCP, Coxa magna, osteoarthritis, or recurrences.

Sex

Transient synovitis affects boys twice as often as girls.

Age

Transient synovitis most frequently occurs in children aged 4-10 years;[2] however, transient synovitis has been reported in a 3-month-old infant and in adults. Nonetheless, children outside the typical age group are unlikely to have transient synovitis. Some teenagers with enthesitis-associated arthritis are initially diagnosed erroneously with toxic synovitis when they first present with hip pain.

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Contributor Information and Disclosures
Author

Christine C Whitelaw, MD Clinician, Department of Pediatrics, Division of Emergency Medicine, University of Louisville School of Medicine

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

Disclosure: Nothing to disclose.

Coauthor(s)

Kenneth N Schikler, MD Professor, Department of Pediatrics, Director, Divisions of Pediatric Rheumatology and Adolescent Medicine, University of Louisville School of Medicine and Kosair Children's Hospital; Professor (Part-time), Department of Pediatrics, University of Kentucky College of Medicine

Kenneth N Schikler, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Rheumatology, Society for Adolescent Health and Medicine, Childhood Arthritis and Rheumatology Research Alliance

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

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

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

Disclosure: Nothing to disclose.

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, New York Academy of Sciences

Disclosure: Nothing to disclose.

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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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