Transcript “Coxitis Simplex” Transient Synovitis

“Coxitis Simplex”
Transient Synovitis
Hlynur Georgsson
24/11/2003
Etiology
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Remains obscure
– Post-traumatic, allergic, infectious
Inflammation of synovial lining
 Often after URTI (32-50%) or virosis
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– 4x increase in viral titers seen in 45%
– Elevated interferon levels seen in 43%
– No association shown with B-19 or HHSV6
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History of Trauma in 17-30%
Epidemiology
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Most common cause of non-traumatic hip pain in children
– Annual incidence 0.2%
– 0.4-0.9% of pediatric ER admissions
– lifetime risk 3%
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Typically children aged 3-8y
– Boys>girls 2:1
– Seasonal increase in Autumn?
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Bilateral 5%
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– Symptomatically unilat. show bilat. effusions in 25%
Recurrence within 6 months in 4-15%
Presentation/History
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6 year old non-febrile boy with a limp and uni- or
bilateral hip-pain
Onset
– Acute, typically less than one week at presentation
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Pain
– Partial flexion and external rotation to minimize
intraarticular pressure
– Internal rotation especially restricted during
– Hip or groin region, occasionaly referred to ant. Thigh
or medial knee
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Typically no fever or low-grade
Workup
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Bloodstatus + WBC, ESR
X-ray
– maybe unspecific soft-tissue changes
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Ultrasonography
– Can detect as little as 2-3ml of fluid
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Arthrocentesis
– Ddx. Septic arthritis
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Three-phase bone scanning
– Ddx. Osteomyelitis, osteoma, occult fracture
Treatment
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NSAID
– Ibuprofen, Celebrex
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Aspiration therapeutic?
Full activity as tolerated vs. no weight-bearing?
? Traction ?
? Antihistamine, i.m. Steroids ?
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Full recovery 1-4w
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» 1-2% may go on to develop Perthes disease with avascular
necrosis of femoral head, Higher risk if delayed bone age
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Recurrence within 6m = 4-15%