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Transient (Toxic) Synovitis of Hip/observation hip/Irritable hip or coxalgia fugax

  1. It is self limitiing, inflammatory condition of synovium, that usually lasts only a short time.
  2. It is most common cause of hip pain and limping in children under 10 year of age. It is also known as irritable hip, observation hip, coxitis serosa and coxalgia fugax.
  3. The condition is seen most often in children between 3-12 years of age and manifest with rapid onset of hip pain, limited range of joint motion and limping. Boys are affected 2-3 times as often as girls. 95% case are unilateral, right and left hips are affected equally.
  4. A recent history of an upper respiratory tract infection of viral origin is usually present.
  5. Pain is usually acute, mild & localized to groin but may be chronic, severe and referred to medial thigh or knee.
  6. Physical examination is characterized by gaurded rotation of hip joint. Pain can be elicited at the extreme of motion, especially abduction and medial rotation. Terderness in groin, antalgic gait and hip in slight flexion, external rotation and abduction.

  1. The patient rarely have temperature above 380C or indications of systemic illness. The white blood cells (WBC) count, C-reactive protein level, and erythrocyte sedimentation rate (ESR) usually are with in normal limits.

Radiography are normally unremarkable or may demonstrate slightly widened joint space medially. Bone density is normal in all cases; if alteration in normal densities is present, another source of hip pain should be sought. Loss of hip capsular shadow is related to holding in abduction & external rotation.

  1. Ultrasound reveals mild effusion and widening of joint space.

Description: ACEP_July2012-Hip1    Description: synovitis-hip-1b

  1. Ultrasonographic guided aspiration of hip joint (for cytological, histological evaluation and culture sensitivity of aspirate) is the best way of making definitive diagnosis and differentiating septic arthritis and transient synovitis.
  2. Treatment is observation and traction.

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