Transient synovitis of the hip

This is the commonest cause of irritable hip in the paediatric age group. It is characterized by hip pain and refusal to weight bear in a child who may be otherwise systematically well. The haematological and biochemical parameters are generally normal. Plain X-rays may reveal widening of the joint space due to an effusion or they may be normal. The child is generally apyrexial, although there may have been recent history of a concomitant viral infection.

The important differential diagnosis is septic arthritis. The clinician needs to be sure that it is transient synovitis of the hip that is being treated rather than septic arthritis as the latter condition can rapidly destroy the hip joint if not treated aggressively. Investigations must be performed to exclude septic arthritis and if there is any doubt as to the exact diagnosis, a specimen of hip-joint fluid must be obtained for culture to exclude septic arthritis.

Treatment in the acute phase consists of rest, with or without the use of traction, until the symptoms subside. The patient is then mobilized as pain allows. The symptoms often resolve spontaneously.

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