eMedicine Specialties > Pediatrics: General Medicine > Rheumatology

Transient Synovitis

Author: Christine C Whitelaw, MD, Clinical Instructor, Assistant Professor, Department of Pediatrics, University of Louisville School of Medicine
Coauthor(s): Kenneth N Schikler, MD, Director, Pediatric Rheumatology, Department of Pediatrics, Kosair Children's Hospital; Associate Professor, University of Louisville School of Medicine
Contributor Information and Disclosures

Updated: Jul 17, 2009

Introduction

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.

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.

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.

Mortality/Morbidity

The possible etiologic relationship between transient synovitis and Legg-Calvé-Perthes disease (LCP) is controversial. 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 may occur.

Sex

Transient synovitis affects boys twice as often as girls.

Age

Transient synovitis most frequently occurs when individuals are aged 3-10 years; 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.

Clinical

History

  • Hip pain: Unilateral hip or groin pain is the most common report; however, some patients with transient synovitis (TS) may report medial thigh or knee pain. Guidelines for chronic hip pain have been established.1  
  • Crying at night: 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 infection: Recent history of an upper respiratory tract infection, pharyngitis, bronchitis, or otitis media is elicited from approximately half of patients with transient synovitis.
  • Limp: 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.2
  • Fever: Children with transient synovitis are usually afebrile or have a mildly elevated temperature; high fever is rare.

Physical

  • Hip
    • 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.
  • Knee
    • 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.

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.

More on Transient Synovitis

Overview: Transient Synovitis
Differential Diagnoses & Workup: Transient Synovitis
Treatment & Medication: Transient Synovitis
Follow-up: Transient Synovitis
Multimedia: Transient Synovitis
References
[ CLOSE WINDOW ]

References

  1. [Guideline] American College of Radiology, Expert Panel on Musculoskeletal Imaging. Chronic hip pain. ACR Appropriateness Criteria. 2003;[Full Text].

  2. [Guideline] Fordham L, Gunderman R, Blatt ER, et al. Limping child--ages 0-5 years. ACR Appropriateness Criteria. 2007;[Full Text].

  3. Saulsbury, Frank T. MD. Lyme Arthritis presenting as Transient Synovitis of the Hip. Clinical pediatrics. October 2008;47:8333-835. [Medline].

  4. Del Beccaro MA, Champoux AN, Bockers T, Mendelman PM. Septic arthritis versus transient synovitis of the hip: the value of screening laboratory tests. Ann Emerg Med. Dec 1992;21(12):1418-22. [Medline].

  5. Kocher MS, Mandiga R, Zurakowski D, et al. Validation of a clinical prediction rule for the differentiation between septic arthritis and transient synovitis of the hip in children. J Bone Joint Surg Am. Aug 2004;86-A(8):1629-35. [Medline].

  6. Luhmann SJ, Jones A, Schootman M, et al. Differentiation between septic arthritis and transient synovitis of the hip in children with clinical prediction algorithms. J Bone Joint Surg Am. May 2004;86-A(5):956-62. [Medline].

  7. Kallio MJ, Unkila-Kallio L, Aalto K, Peltola H. Serum C-reactive protein, erythrocyte sedimentation rate and white blood cell count in septic arthritis of children. Pediatr Infect Dis J. Apr 1997;16(4):411-3. [Medline].

  8. Caird MS, Flynn JM, Leung YL, et al. Factors distinguishing septic arthritis from transient synovitis of the hip in children: a prospective study. The Journal of Bone and Joint Surgery. June 2006;88-B:1251-1257. [Medline].

  9. Jung ST, Rowe SM, Moon ES, et al. Significance of Laboratory and Radiologic Findings for Differentiating between Septic Arthritis and Transient Synovitis of the Hip. Journal of Pediatric Orthopedics. June 2003;23:368-372. [Medline].

  10. Butbul-Aviel Y, Koren A, Halevy R, et al. Procalcitonin as a Diagnostic Aid in Osteomyelitis and Septic Arthritis. Pediatric Emergency Care. December 2005;21:828-832. [Medline].

  11. Lee SK, Suh KJ, Kim YW, et al. Septic arthritis versus transient synovitis at MR imaging: preliminary assessment with signal intensity alterations in bone marrow. Radiology. May 1999;211(2):459-65. [Medline].

  12. Yang WJ, Im SA, Lim GY, et al. MR imaging of transient synovitis: differentiation from septic arthritis. Pediatr Radiol. Nov 2006;36(11):1154-8. [Medline].

  13. Skinner J, Glancy S, Beattie TF, Hendry GM. Transient Synovitis: is there a need to aspirate hip joint effusions?. European Journal of Emergency Medicine. 2002;9:15-8. [Medline].

  14. Kermond S, Fink M, Graham K, Carlin JB, Barnett P. A randomized clinical trial: should the child with transient synovitis of the hip be treated with nonsteroidal anti-inflammatory drugs?. Ann Emerg Med. Sep 2002;40(3):294-9. [Medline].

  15. Caird MS, Flynn JM, Leung YL, et al. Factors distinguishing septic arthritis from transient synovitis of the hip in children: a prospective study. The Journal of Bone and Joint Surgery. June 2006;88-B:1251-1257. [Medline].

  16. Cassidy JT, Petty RE. Textbook of Pediatric Rheumatology. 3rd ed. 1995:505.

  17. Chung SM. Diseases of the developing hip joint. Pediatr Clin North Am. Dec 1986;33(6):1457-73. [Medline].

  18. Connolly LP, Connolly SA. Skeletal scintigraphy in the multimodality assessment of young children with acute skeletal symptoms. Clin Nucl Med. Sep 2003;28(9):746-54. [Medline].

  19. Eggl H, Drekonja T, Kaiser B, Dorn U. Ultrasonography in the diagnosis of transient synovitis of the hip and Legg-Calve-Perthes disease. J Pediatr Orthop B. Jul 1999;8(3):177-80. [Medline].

  20. Fink PC, Dufort JE, Smith-Wright D. Orthopedic disorders. In: Pediatric Emergency Medicine. 1996:937.

  21. Hart JJ. Transient synovitis of the hip in children. Am Fam Physician. Oct 1996;54(5):1587-91, 1595-6. [Medline].

  22. Haueisen DC, Weiner DS, Weiner SD. The characterization of "transient synovitis of the hip" in children. J Pediatr Orthop. Jan-Feb 1986;6(1):11-7. [Medline].

  23. Keenan GF. Transient synovitis. In: The Five Minute Pediatric Consult. 1997:736.

  24. Kermond S, Fink M, Graham K. A Randomized Clinical Trial: Should the Child with Transient Synovitis of the Hip be Treated with Nonsteroidal Anti-inflammatory Drugs?. Annals of Emergency Medicine. 2002;40:294-9. [Medline].

  25. Koop S, Quanbeck D. Three common causes of childhood hip pain. Pediatr Clin North Am. Oct 1996;43(5):1053-66. [Medline].

  26. Robben SG, Lequin MH, Diepstraten AF, et al. Anterior joint capsule of the normal hip and in children with transient synovitis: US study with anatomic and histologic correlation. Radiology. Feb 1999;210(2):499-507. [Medline].

  27. Simon RR, Koenigsknecht SJ. Hip, pelvis, and thigh. In: Emergency Orthopedics: The Extremities. 1995:421.

  28. Snider RK. Transient synovitis of the hip. In: Essentials of Musculoskeletal Care. 1998:667-8.

  29. Wan JY, Soo AI, Gye-yeon L, et al. MR imaging of transient synovitis: differentiation from septic arthritis. Pediatric Radiology. November 2006;36:1154-1158. [Medline].

  30. Wingstrand H. Transient synovitis of the hip in the child. Acta Orthop Scand Suppl. 1986;219:1-61. [Medline].

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

transient synovitis, TS, acute transitory epiphysitis, coxitis fugax, coxitis serosa su simplex, epiphysitis irritable hip, observation hip, phantom hip, toxic synovitis, transitory coxitis, transitory hip arthritis, hip pain, osteoarthritis, upper respiratory tract infection, bronchitis, otitis media, log roll, treatment, diagnosis

[ CLOSE WINDOW ]

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.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Managing Editor

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.

CME Editor

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.

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.