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Toxic synovitis
Synovitis - toxic; Transient synovitis
Toxic synovitis is a condition affecting children that causes hip pain and limping.
Hip pain
Hip pain involves any pain in or around the hip joint. You may not feel pain from your hip directly over the hip area. You may feel it in your groi...
Causes
Toxic synovitis occurs in children before puberty. It is a type of arthritis of the hip. Its cause is not known. Boys are affected more often than girls.
Arthritis
Arthritis is inflammation of one or more joints. A joint is the area where 2 bones meet. There are more than 100 different types of arthritis....
Symptoms
Symptoms may include:
- Hip pain (on one side only)
- Limp
- Thigh pain, in front and toward the middle of the thigh
- Knee pain
- Low-grade fever, less than 101°F (38.33°C)
Aside from the hip discomfort, the child does not usually appear ill.
Exams and Tests
Toxic synovitis is diagnosed when other, more serious conditions have been ruled out, such as:
-
Septic hip
Septic hip
Septic arthritis is inflammation of a joint due to a bacterial or fungal infection. Septic arthritis that is due to the bacteria that cause gonorrhe...
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Slipped capital femoral epiphysis
Slipped capital femoral epiphysis
A slipped capital femoral epiphysis is a separation of the ball of the hip joint from the thigh bone (femur) at the upper growing end (growth plate) ...
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Legg-Calve-Perthes disease
Legg-Calve-Perthes disease
Legg-Calve-Perthes disease occurs when the ball of the thigh bone in the hip does not get enough blood, causing the bone to die.
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Tests used to diagnose toxic synovitis include:
-
Ultrasound
of the hip
Ultrasound
Ultrasound uses high-frequency sound waves to make images of organs and structures inside the body.
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X-ray
of the hip
X-ray
X-rays are a type of electromagnetic radiation, just like visible light. An x-ray machine sends individual x-ray particles through the body. The im...
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ESR
ESR
ESR stands for erythrocyte sedimentation rate. It is commonly called a "sed rate. "It is a test that indirectly measures how much inflammation is in...
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C-reactive protein
(CRP)
C-reactive protein
C-reactive protein (CRP) is produced by the liver. The level of CRP rises when there is inflammation throughout the body. It is one of a group of p...
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Complete blood count
(CBC)
Complete blood count
A complete blood count (CBC) test measures the following:The number of red blood cells (RBC count)The number of white blood cells (WBC count)The tota...
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Other tests that may be done to rule out other causes of hip pain:
-
Aspiration
of fluid from the hip joint
Aspiration
Aspiration means to draw in or out using a sucking motion. It has two meanings:Breathing in a foreign object (sucking food into the airway). A medic...
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Bone scan
Bone scan
A bone scan is an imaging test used to diagnose bone diseases and find out how severe they are.
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Treatment
Treatment often includes limiting activity to make the child more comfortable. But, there is no danger with normal activities. The health care provider may prescribe nonsteroidal anti-inflammatory medicines (NSAIDS) to reduce pain.
Outlook (Prognosis)
The hip pain goes away within 7 to 10 days.
Possible Complications
Toxic synovitis goes away on its own. There are no expected long-term complications.
When to Contact a Medical Professional
Call for an appointment with your child's provider if:
- Your child has unexplained hip pain or a limp, with or without a fever
- Your child has been diagnosed with toxic synovitis and the hip pain lasts for longer than 10 days, the pain gets worse, or a high fever develops
References
Horowitz R. Pediatric orthopedic emergencies. In: Adams JG, ed. Emergency Medicine: Clinical Essentials . 2nd ed. Philadelphia, PA: Elsevier Saunders; 2013:chap 25.
Sankar WN, Horn BD, Wells L, Dormans JP. The hip. In: Kliegman RM, Stanton BF, St Geme JW III, Schor NF, eds. Nelson Textbook of Pediatrics . 20th ed. Philadelphia, PA: Elsevier; 2016:chap 678.
Review Date: 7/13/2015
Reviewed By: C. Benjamin Ma, MD, Professor, Chief, Sports Medicine and Shoulder Service, UCSF Department of Orthopaedic Surgery, San Francisco, CA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.
