Orthopedics Book

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Transient Hip Tenosynovitis

Aka: Transient Hip Tenosynovitis, Transient Synovitis, Transient Tenosynovitis of the Hip, Irritable Hip, Toxic Synovitis
  1. See Also
    1. Pediatric Limp
  2. Etiology
    1. Idiopathic
  3. Epidemiology
    1. Incidence: Common
      1. Most common cause of limp with Hip Pain under age 10
      2. Peaks ages 3 to 6 years
    2. Boys more commonly affected than girls by a 4:1 ratio
    3. Unilateral involvement in 95% of cases
  4. Pathophysiology
    1. Inflammatory arthritis of the hip
  5. Symptoms
    1. Follows 3-6 days after Upper Respiratory Infection
  6. Signs
    1. Pain in hip, anteromedial thigh and knee
    2. Reduced Hip Range of motion
      1. Transient Synovitis
        1. Guarded hip rotation
      2. Septic Arthritis
        1. More pronounced spasm, guarding, and fixed position
    3. Fever
      1. Transient Synovitis: Low grade (under 39 C or 101 F)
      2. Septic Arthritis: Higher fever with malaise
  7. Labs
    1. Erythrocyte Sedimentation Rate (ESR)
      1. Transient Synovitis: slightly elevated
      2. Septic Arthritis: >25 mm/h (>40 is highly suggestive)
    2. Hip Synovial Fluid clear
  8. Radiology
    1. Hip XRay
      1. Bony landmarks normal
        1. No signs of Fracture or defect
        2. Rules out serious hip disease
          1. Aseptic necrosis
          2. Osteomyelitis
      2. Increased space between acetabulum and femoral head
    2. Hip Ultrasound
      1. Joint effusion
  9. Diagnosis: Decision rule
    1. Findings suggestive of Septic Arthritis
      1. Fever
      2. Inability to bear weight
      3. Erythrocyte Sedimentation Rate >40 mm Hg
      4. White Blood Cell count >12,000/mm3
    2. Interpretation
      1. All 4 factors absent rules out Septic Arthritis
      2. All 4 factors present strongly suggests infection
    3. References
      1. Kocher (2004) J Bone Joint Surg 86-A:1629-35
  10. Differential Diagnosis
    1. Septic Arthritis of the hip
      1. Keep high index of suspicion
      2. See Diagnosis above
  11. Management
    1. Non-weight bearing on affected leg
    2. Bed rest for 2 to 3 days
    3. NSAIDs
      1. May speed up recovery time
      2. Also offers Analgesic effect
      3. Kermond (2002) Ann Emerg Med 40:294-9
  12. Course
    1. Usually clears within 7 days

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