Transient synovitis of the hip

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Last reviewed: 2 Jun 2022

Last updated: 30 Oct 2018

A self-limiting inflammatory disorder of the hip that commonly affects young children between 2 and 12 years of age.

The most important differential diagnosis to exclude is septic arthritis.

More common in boys.

Presents acutely with mild to moderate hip pain and limp.

Treatment is supportive with activity restrictions and non-steroidal anti-inflammatory drugs as needed.

Definition

Transient synovitis is a self-limiting inflammatory disorder of the hip that commonly affects young children.

History and exam

Key diagnostic factors

presence of risk factors
limited movement
pain
limp
positive log roll

More key diagnostic factors

Other diagnostic factors

abducted and externally rotated hip
fever

Other diagnostic factors

Risk factors

2 to 12 years of age
male sex
history of recent upper respiratory infection

More risk factors

Diagnostic investigations

1st investigations to order

FBC
erythrocyte sedimentation rate
CRP
x-ray

More 1st investigations to order

Investigations to consider

ultrasound
MRI with contrast

More investigations to consider

Treatment algorithm

ACUTE

all patients

Contributors

Authors

James McCarthy, MD

Division Director

Department of Orthopaedic Surgery

Alvin H. Crawford Chair of Pediatric Orthopaedic Surgery

Professor

University of Cincinnati Department of Orthopaedic Surgery

Cincinnati Children’s Hospital Medical Center

Cincinnati

Disclosures

JM is a board member for the Pediatric Orthopaedic Society of North America. He has given workshops at annual teaching meetings for DePuy Synthes, received royalties from Lippincott Williams & Wilkins for editing a book, and received grant and travel money from Nuvasive.

Jaime Denning, MD

Assistant Professor

Orthopaedic Surgery

Cincinnati Children’s Hospital Medical Center

Cincinnati

Disclosures

JD declares that she has no competing interests.

Peer reviewers

Norm Otsuka, MD

Assistant Chief of Staff

Shriners Hospital for Children

Los Angeles

Disclosures

NO declares that he has no competing interests.

Michael Smith, MB, BChir, FRCS

Consultant Orthopaedic Surgeon

Department of Orthopaedics

Guy's & St Thomas' Hospital

London

Disclosures

MS declares that he has no competing interests.

Peter Cundy, MBBS, FRACS

Head of Orthopaedic Surgery

Women's & Children's Hospital

Adelaide

Australia

Disclosures

PC declares that he has no competing interests.

Differentials
- Septic arthritis
- Lyme arthritis
- Osteomyelitis
More Differentials
Guidelines
- ACR appropriateness criteria: acutely limping child up to age 5
More Guidelines
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Transient synovitis of the hip

Summary

Definition

History and exam

Key diagnostic factors

Other diagnostic factors

Risk factors

Diagnostic investigations

1st investigations to order

Investigations to consider

Treatment algorithm

all patients

Contributors

Authors

James McCarthy, MD

Disclosures

Jaime Denning, MD

Disclosures

Peer reviewers

Norm Otsuka, MD

Disclosures

Michael Smith, MB, BChir, FRCS

Disclosures

Peter Cundy, MBBS, FRACS

Disclosures

Differentials

Guidelines

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