paediatric
Transient Synovitis of the Hip
intermediate
6 min
28 marks
6 questions
Clinical Scenario
A 4-year-old boy presents with a 2-day history of right hip pain and limp. His mother reports he had an upper respiratory tract infection last week. He is afebrile and looks well. On examination, he walks with an antalgic gait favoring the right leg. The right hip has mildly reduced internal rotation with pain at extremes of motion. Passive range is nearly full. He is otherwise well with no systemic features. Blood tests show WCC 9 × 10⁹/L, CRP 8 mg/L, and ESR 15 mm/hr.
AP pelvis radiograph of a 4-year-old child with transient synovitis of the right hip. There is subtle widening of the joint space compared to the left, suggesting effusion. The femoral head and acetabulum appear normal with no bony abnormalities. Shenton's line is intact bilaterally. There is no evidence of Perthes disease changes. Ultrasound confirmation of effusion is recommended.
Image source: Open Access medical literature (NIH/PubMed Central) • CC-BY License
Questions
Question 1 (4 marks)
Describe the clinical features and how to differentiate from septic arthritis.
Question 2 (5 marks)
Explain the Kocher criteria and their application.
Question 3 (6 marks)
What is the investigation algorithm for an irritable hip?
Question 4 (5 marks)
What is the management and expected course?
Question 5 (4 marks)
What is the relationship between transient synovitis and Perthes disease?
Question 6 (4 marks)
What are other differential diagnoses for pediatric hip pain?
Exam Day Cheat Sheet
Must Mention
- •Kocher criteria (4 criteria, probabilities)
- •0-1 criteria = <3% septic, can observe
- •Self-limiting, resolves 7-10 days
- •Follow-up X-ray 6 weeks for Perthes
- •NSAIDs + rest = mainstay treatment
- •Safety net advice essential
Common Pitfalls
- •Wrong Kocher probabilities
- •No aspiration threshold (2+)
- •Missing Perthes follow-up
- •No safety net advice
- •Overtreatment
- •Wrong differentials