Three-year-old little Manish watched his favorite cartoons on television for a long time. When he finally got up to play outside, he felt pain in his hip and started limping. He broke down in tears, unable to bear the pain. His mom found that he was also running a high fever, and took him to the hospital. The doctor diagnosed the condition to be a case of transient synovitis.
About transient synovitis of hip
Inflammation of the hip joint, leading to swelling of tissues around the hip joint of a single hip is called transient synovitis or toxic synovitis. This occurs mostly in children between the ages 3 years to 10 years and is seen more in boys. The pain lasts only for a short time, and hence the name ‘transient’.
Children with transient synovitis may limp with outwardly turned toes. The knee may be straight or bent and child may tip toe while walking. There might be pain in the thigh and knee, and the child may have a fever up to 101 F. The child may cry and refuse to walk. Discomfort of hip occurs on sitting in the same position for a long time. A recent bout of viral infection can start the symptoms of transient synovitis. Babies affected with transient synovitis, tend to cry when the diaper is being changed, as the hip joints move during the changing.
Causes
Transient synovitis is caused by a viral infection in which the virus lodges itself in the hip joint, causing swelling and pain. After affecting one hip, it may affect the other hip also. Toxic synovitis should not be confused with septic arthritis which is caused due to bacterial infection and can damage the joint for longer period. Transient synovitis can also occur as an allergic reaction to some other infection in the body.
Diagnosis
The doctor conducts physical examination in which he or she moves the knee, hip joint and other joints to find out, if the pain is coming from the hip joint. To find out if there is any fluid in the hip joint which is causing pain, the doctor conducts ultrasound of the hip in which sound waves of high frequency are used to create 3D images of the hip. X ray of the hip is also taken. A bone scan may be done in which a radioactive material is injected into the vein. This scan is used to study the areas with decreased or increased bone turn over. Other test used to diagnose transient synovitis is the MRI (magnetic resonance imaging) which uses magnetic field and radio waves to get clear of cross-sectional images of the hip joint.
Blood tests are also conducted to check for inflammatory markers for transient synovitis and to rule out other diseases that may be causing the pain. A blood test known as ESR or erythrocyte sedimentation rate test is done in which a blood sample is taken, and sent to lab for analysis to get a clear picture of the amount of inflammation in the body. For further analysis, the doctor may take a sample of fluid from the hip joint (aspiration) for lab analysis. A sample of blood is taken and sent to the laboratory to get a complete blood picture of the patient.
Treatment
The doctor prescribes non-steroidal anti-inflammatory drugs like Ibuprofen (Motrin, Advil) to relieve pain. Complete rest is advised for the child to reduce pain and swelling of the hip joint. The body temperature is checked every 12 hours by the doctor. The child will recover in a week after rest and medication, and can get back to normal activities. A hip X ray is taken after 6 months to check the condition of the hip joint.
Calling the doctor
The healthcare provider must be consulted if the child is limping with severe hip pain. If the child is undergoing treatment, and still the hip joint pain and swelling have not come down even after 10 days, then the doctor must be consulted. If high fever develops and the pain is getting worse then one needs to take the child to the doctor immediately.
Outlook
Generally, toxic synovitis goes away in a week, but sometimes it can stay for more than 4 weeks. If a child gets cold or any other viral infection, the virus can travel down to the hip joint and lodge there which results in getting transient synovitis repeatedly during childhood. The doctor should be consulted without fail if there is a history of repeated transient synovitis.
