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Transient synovitis of the hip

  • Overview
  • Theory
  • Diagnosis
  • Management
  • Follow up
  • Resources
Last reviewed: 23 Apr 2025
Last updated: 06 Dec 2022

Summary

Definition

History and exam

Key diagnostic factors

  • limited movement
  • pain
  • limp
  • positive log roll
Full details

Other diagnostic factors

  • abducted and externally rotated hip
  • fever
Full details

Risk factors

  • 2 to 12 years of age
  • male sex
  • history of recent viral illness
Full details

Diagnostic tests

1st tests to order

  • CBC
  • erythrocyte sedimentation rate
  • CRP
  • radiograph
Full details

Tests to consider

  • ultrasound
  • MRI with contrast
Full details

Treatment algorithm

ACUTE

all patients

Contributors

Authors

Ishaan Swarup, MD, FAAOS, FAAP

Assistant Professor of Clinical Orthopaedic Surgery

Director, Pediatric Orthopaedic Trauma

Associate Fellowship Director, Pediatric Orthopaedic Surgery

University of California

San Francisco

CA

Disclosures

IS is the author of a reference cited in this topic.

Acknowledgements

Dr Ishaan Swarup would like to gratefully acknowledge Professor James McCarthy and Dr Jaime Denning, previous contributors to this topic.

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. JM has worked as a consultant for Nuvasive within the past 5 years, and frequently gives academic ground rounds lectures. JD declares that she has no competing interests.

Peer reviewers

Norm Otsuka, MD

Assistant Chief of Staff

Shriners Hospital for Children

Los Angeles

CA

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

UK

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.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

Kocher MS, Zurakowski D, Kasser JR. Differentiating between septic arthritis and transient synovitis of the hip in children: an evidence-based clinical prediction algorithm. J Bone Joint Surg Am. 1999 Dec;81(12):1662-70. Abstract

Jain N, Sah M, Chakraverty J, et al. Radiological approach to a child with hip pain. Clin Radiol. 2013 Nov;68(11):1167-78.Full text  Abstract

American College of Radiology. ACR appropriateness criteria: acutely limping child up to age 5. 2018 [internet publication].Full text

Pediatric Orthopaedic Society of North America. Transient synovitis of the hip: study guide. [internet publication].Full text

Kermond S, Fink M, Graham K, et al. A randomized clinical trial: should the child with transient synovitis of the hip be treated with nonsteroidal anti-inflammatory drugs? Ann Emerg Med. 2002 Sep;40(3):294-9. Abstract

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

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