Transient synovitis of the hip
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Transient synovitis of the hip refers to a self-limiting acute inflammatory conditionscondition affecting the synovial lining of the hip. It is considered one of the most common causes of hip pain and limping in young children.
Epidemiology
It typically affects young children (3-8 year olds). There is a recognised increased male predilection.
Pathology
There exact pathogenesis is not well known. Several theories have been proposed. In some situations, it may follow an upper respiratory tract infection. Some have suggested a viral aetiology (e.g. related to Parvovirus B-19 and /or Herpes simplex virus 6 infections while others have proposed a post-traumatic aetiology with subsequent development of chemical synovitis,
Clinical presentation
Patients typically present with hip pain for one to three days, associated with limping or the refusal to bear weight.
Radiographic features
Plain film
Features are non specific although in some cases there may be an increase in medial joint space in the affected hip 5.
Ultrasound
Useful at demonstrating a joint effusion which is often seen in the anterior recess. Herniation of the synovial membrane through a joint capsular defect (pseudodiverticulum) between the iliopsoas muscle and the anterior border of the joint capsule may be seen in very small proportion of patients (~2%) 1.
MRI
Described features include 6
- symptomatic hip joint effusion
- synovial enhancement
- contralateral joint effusion
- synovial thickening
- signal alterations and enhancement in surrounding soft tissue
- there is usually no signal alteration in adjacent marrow.
Treatment and prognosis
It is a self-limiting disorder usually has no residual sequelae. Recurrences are possible. Management is usually supportive.
Differential diagnosis
For imaging appearances consider
- septic arthritis: on MRI there is often signal abnormality in marrow 8
For the clinical limping there can be much wider differential of other childhood arthritides (e.g. juvenile rheumatoid arthritis 1).
-<p><strong>Transient synovitis of the hip</strong> refers to a self-limiting acute inflammatory conditions the synovial lining of the hip. It is considered one of the most common causes of hip pain and limping in young children.</p><h4>Epidemiology</h4><p>It typically affects young children (3-8 year olds). There is a recognised increased male predilection.</p><h4>Pathology</h4><p>There exact pathogenesis is not well known. Several theories have been proposed. In some situations, it may follow an upper respiratory tract infection. Some have suggested a viral aetiology (e.g. related to Parvovirus B-19 and /or Herpes simplex virus 6 infections while others have proposed a post-traumatic aetiology with subsequent development of chemical synovitis, </p><h4>Clinical presentation</h4><p>Patients typically present with hip pain for one to three days, associated with limping or the refusal to bear weight. </p><h4>Radiographic features</h4><h5>Plain film</h5><p>Features are non specific although in some cases there may be an increase in medial joint space in the affected hip<sup> 5</sup>.</p><h5>Ultrasound</h5><p>Useful at demonstrating a joint effusion which is often seen in the anterior recess. Herniation of the synovial membrane through a joint capsular defect (pseudodiverticulum) between the iliopsoas muscle and the anterior border of the joint capsule may be seen in very small proportion of patients (~2%)<sup> 1</sup>.</p><h5>MRI</h5><p>Described features include <sup>6</sup></p><ul>- +<p><strong>Transient synovitis of the hip</strong> refers to a self-limiting acute inflammatory condition affecting the synovial lining of the hip. It is considered one of the most common causes of hip pain and limping in young children.</p><h4>Epidemiology</h4><p>It typically affects young children (3-8 year olds). There is a recognised increased male predilection.</p><h4>Pathology</h4><p>There exact pathogenesis is not well known. Several theories have been proposed. In some situations, it may follow an upper respiratory tract infection. Some have suggested a viral aetiology (e.g. related to Parvovirus B-19 and /or Herpes simplex virus 6 infections while others have proposed a post-traumatic aetiology with subsequent development of chemical synovitis, </p><h4>Clinical presentation</h4><p>Patients typically present with hip pain for one to three days, associated with limping or the refusal to bear weight. </p><h4>Radiographic features</h4><h5>Plain film</h5><p>Features are non specific although in some cases there may be an increase in medial joint space in the affected hip<sup> 5</sup>.</p><h5>Ultrasound</h5><p>Useful at demonstrating a joint effusion which is often seen in the anterior recess. Herniation of the synovial membrane through a joint capsular defect (pseudodiverticulum) between the iliopsoas muscle and the anterior border of the joint capsule may be seen in very small proportion of patients (~2%)<sup> 1</sup>.</p><h5>MRI</h5><p>Described features include <sup>6</sup></p><ul>
-</ul><h4>Treatment and prognosis</h4><p>It is self-limiting disorder usually has no residual sequelae. Recurrences are possible. Management is usually supportive.</p><h4>Differential diagnosis</h4><p>For imaging appearances consider</p><ul><li>-<a title="Septic arthritis" href="/articles/septic-arthritis">septic arthritis</a>: on MRI there is often signal abnormality in marrow <sup>8</sup> </li></ul><p>For the clinical limping there can be much wider differential of other childhood arthritides (e.g. <a title="juvenile rheumatoid arthritis (JRA)" href="/articles/juvenile-idiopathic-arthritis">juvenile rheumatoid arthritis</a> <sup>1</sup>).</p>- +</ul><h4>Treatment and prognosis</h4><p>It is a self-limiting disorder usually has no residual sequelae. Recurrences are possible. Management is usually supportive.</p><h4>Differential diagnosis</h4><p>For imaging appearances consider</p><ul><li>
- +<a href="/articles/septic-arthritis">septic arthritis</a>: on MRI there is often signal abnormality in marrow <sup>8</sup> </li></ul><p>For the clinical limping there can be much wider differential of other childhood arthritides (e.g. <a href="/articles/juvenile-idiopathic-arthritis">juvenile rheumatoid arthritis</a> <sup>1</sup>).</p>
References changed:
- 1. Pauroso S, Di Martino A, Tarantino CC et-al. Transient synovitis of the hip: Ultrasound appearance. Mini-pictorial essay. J Ultrasound. 2011;14 (2): 92-4. <a href="http://dx.doi.org/10.1016/j.jus.2011.03.003">doi:10.1016/j.jus.2011.03.003</a> - <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3558088">Free text at pubmed</a> - <a href="http://www.ncbi.nlm.nih.gov/pubmed/23396680">Pubmed citation</a><span class="auto"></span>
- 2. Kwack KS, Cho JH, Lee JH et-al. Septic arthritis versus transient synovitis of the hip: gadolinium-enhanced MRI finding of decreased perfusion at the femoral epiphysis. AJR Am J Roentgenol. 2007;189 (2): 437-45. <a href="http://dx.doi.org/10.2214/AJR.07.2080">doi:10.2214/AJR.07.2080</a> - <a href="http://www.ncbi.nlm.nih.gov/pubmed/17646472">Pubmed citation</a><span class="ref_v3"></span>
- 3. Hart JJ. Transient synovitis of the hip in children. Am Fam Physician. 1996;54 (5): 1587-91, 1595-6. <a href="http://www.ncbi.nlm.nih.gov/pubmed/8857781">Pubmed citation</a><span class="auto"></span>
- 4. Do TT. Transient synovitis as a cause of painful limps in children. Curr. Opin. Pediatr. 2000;12 (1): 48-51. <a href="http://www.ncbi.nlm.nih.gov/pubmed/10676774">Pubmed citation</a><span class="auto"></span>
- 5. Marchal GJ, Van Holsbeeck MT, Raes M et-al. Transient synovitis of the hip in children: role of US. Radiology. 1987;162 (3): 825-8. <a href="http://dx.doi.org/10.1148/radiology.162.3.3544039">doi:10.1148/radiology.162.3.3544039</a> - <a href="http://www.ncbi.nlm.nih.gov/pubmed/3544039">Pubmed citation</a><span class="auto"></span>
- 6. Yang WJ, Im SA, Lim GY et-al. MR imaging of transient synovitis: differentiation from septic arthritis. Pediatr Radiol. 2006;36 (11): 1154-8. <a href="http://dx.doi.org/10.1007/s00247-006-0289-9">doi:10.1007/s00247-006-0289-9</a> - <a href="http://www.ncbi.nlm.nih.gov/pubmed/17019590">Pubmed citation</a><span class="auto"></span>
- 7. 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. 1999;211 (2): 459-65. <a href="http://dx.doi.org/10.1148/radiology.211.2.r99ma47459">doi:10.1148/radiology.211.2.r99ma47459</a> - <a href="http://www.ncbi.nlm.nih.gov/pubmed/10228529">Pubmed citation</a><span class="auto"></span>
- 8. Caird MS, Flynn JM, Leung YL et-al. Factors distinguishing septic arthritis from transient synovitis of the hip in children. A prospective study. J Bone Joint Surg Am. 2006;88 (6): 1251-7. <a href="http://dx.doi.org/10.2106/JBJS.E.00216">doi:10.2106/JBJS.E.00216</a> - <a href="http://www.ncbi.nlm.nih.gov/pubmed/16757758">Pubmed citation</a><span class="auto"></span>
Systems changed:
- Musculoskeletal
Images Changes:
Image 1 MRI (T2) ( create )
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