eMedicine Specialties > Pediatrics: General Medicine > Rheumatology

Transient Synovitis: Treatment & Medication

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

Treatment

Medical Care

  • Apply heat and massage to individuals with transient synovitis (TS).
  • If the diagnosis of transient synovitis is equivocal or the patient is uncomfortable, hospitalize for observation and traction. Home treatment also can include traction. Skin traction of the hip in 45° of flexion minimizes intracapsular pressure.
  • Treatment with ibuprofen may shorten the duration of symptoms.14

Activity

  • Advise bedrest for 7-10 days, allowing the patient to rest in a position of comfort.
  • Advise the patient with transient synovitis not to bear weight on the affected limb.
  • Advise the patient with transient synovitis to avoid full unrestricted activity until the limp and pain have resolved.

Medication

Nonsteroidal anti-inflammatory drugs (NSAIDs)

These agents have analgesic, antiinflammatory, and antipyretic activities. They act by inhibiting cyclooxygenase activity, which results in decreased prostaglandin synthesis. Other mechanisms, such as inhibition of leukotriene synthesis, lysosomal enzyme release, lipoxygenase activity, neutrophil aggregation, and various cell-membrane functions, may also exist.

Naproxen and ibuprofen are the most frequently prescribed NSAIDs in children, with a suspension form and safety and efficacy studies available. The COX-2 inhibitors have not yet been studied adequately in the pediatric population.


Naproxen (Aleve, Naprosyn, Anaprox)

NSAID that inhibits cyclooxygenase, thus inhibiting formation of prostaglandins.

Adult

0.5-1 g/d PO divided bid

Pediatric

10-20 mg/kg/d PO divided bid

May increase serum concentrations of digoxin, methotrexate, and lithium; may decrease effect of furosemide; increased methotrexate blood concentrations may be severe or fatal; may increase PT when taking anticoagulants (instruct patients to watch for signs of bleeding); coadministration with other ulcerogenic agents (eg, other NSAIDs, corticosteroids) may increase risk of GI complications

Documented hypersensitivity; impaired renal function; active hepatic inflammation; gastritis and/or peptic ulcer disease; platelet dysfunction

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions

Pregnancy category D in third trimester; caution with decreased renal function, ulcers, and GI bleeds; CNS effects (eg, dizziness, fatigue) and GI effects (eg, abdominal pain, nausea, heartburn) are more common adverse reactions


Ibuprofen (Motrin, Advil)

NSAID that inhibits cyclooxygenase, thus inhibiting formation of prostaglandins.

Adult

400 mg PO q4-6h, 600 mg q6h, or 800 mg q8h while symptoms persist; not to exceed 3.2 g/d

Pediatric

30-40 mg/kg/d PO divided tid/qid

May increase serum concentrations of digoxin, methotrexate, and lithium; may increase PT when taking anticoagulants (instruct patients to watch for signs of bleeding); coadministration with other ulcerogenic agents (eg, other NSAIDs, corticosteroids) may increase risk of GI complications

Documented hypersensitivity; impaired renal function; active hepatic inflammation; gastritis and/or peptic ulcer disease; platelet dysfunction

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions

Pregnancy category D in third trimester; caution with decreased renal function, ulcers, and GI bleeds; CNS effects (eg, dizziness, fatigue) and GI effects (eg, abdominal pain, nausea, heartburn) are more common adverse reactions

More on Transient Synovitis

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

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Further Reading

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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

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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.

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.

 
 
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