Transient Synovitis Clinical Presentation

Updated: Dec 20, 2018
  • Author: Christine C Whitelaw, MD; Chief Editor: Lawrence K Jung, MD  more...
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Presentation

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. [4] Guidelines for chronic hip pain have been established. [5]

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. A prospective study from the University of Edinburgh Medical School reported that the symptoms of vomiting, diarrhea, or common cold/runny nose were more likely to precede transient synovitis. Other symptoms suggestive of either viral or bacterial infections were not significantly prominent. [6]

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. [7]

A thorough history should include a description of the pain (location, character, onset, duration, change with activity or rest, aggravating and alleviating factors, night pain); recent trauma; mechanical symptoms (catching, clicking, snapping, worse during or after activity); systemic symptoms (fever, irritability, eating or drinking less); inflammatory symptoms (morning stiffness); neurological symptoms (weakness, altered sensation); weight-bearing status (inability to bear weight or inability to move the leg in children of non–weight-bearing age); effects of any previous treatments (antibiotics, analgesics, anti-inflammatories, physiotherapy); and the current level of function of the child. [8]

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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.

The lumbar spine, sacroiliac joint, knee, and abdomen should also be examined. A complete musculoskeletal examination to look for joint swelling should be performed if there is a history of inflammatory symptoms. [8]

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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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