Further Outpatient Care

Advise patients with transient synovitis (TS) to return in 12-24 hours for a repeat examination. If significant symptoms persist for 7-10 days after the initial presentation, consider other diagnoses. Advise that all patients with transient synovitis have repeat radiography within 6 months to exclude Legg-Calvé-Perthes (LCP) disease.

A retrospective study that included 198 children with the diagnosis of a transient synovitis found that between the diagnosis of transient synovitis and a 3-month follow-up, 20 children did not remain symptom-free (10.1%). 4 (2%) of these patients were diagnosed with Perthes disease and the other 16 had a normal radiological follow-up. All children who were symptom-free had negative follow-up X-rays.^[25]

Inpatient & Outpatient Medications

Recommend nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen. NSAIDs may shorten the duration of symptoms. A study performed on 36 children with transient synovitis showed that those who took ibuprofen had a median duration of symptoms for 2 days. The control group taking a placebo had a mean duration of symptoms for 4.5 days.

Complications

Sequelae include coxa magna and mild degenerative changes of the femoral neck. Coxa magna is observed radiographically as an overgrowth of the femoral head and broadening of the femoral neck. Coxa magna leads to dysplasia of the acetabular roof and subluxation. An incidence rate of coxa magna of 32.1% has been reported in the first year following transient synovitis.

LCP disease develops in 1-3% of individuals with transient synovitis.

Prognosis

Patients with transient synovitis usually experience marked improvement within 24-48 hours. Two thirds to three fourths of patients with transient synovitis have complete resolution within 2 weeks. The remainder may have less severe symptoms for several weeks. The recurrence rate is 4-17%; most recurrences develop within 6 months. No increased risk of juvenile chronic arthritis is known; however, a slightly increased risk for later development of osteoarthritis may be noted.

Patient Education

Advise parents and/or caregivers to initially check the temperature of the patient with TS regularly and inform the physician of any fever. For patient education resources, see the Foot, Ankle, Knee, and Hip Center and Arthritis Center.

Questions

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