Transient synovitis of the hip

Abstract

Transient synovitis is a benign, self-limiting condition that is diagnosed after the exclusion of more serious causes of acute hip pain in children. Although its etiology remains unclear, it is largely believed to be viral in nature. Transient synovitis typically presents as an acute onset of thigh pain with a limp or an unwillingness to bear weight. It can be distinguished from similar conditions by the absence of fever, as well as unremarkable bloodwork (WBC, CRP, ESR), radiographs, and hip aspiration. Conservative treatment and observation are the mainstay of management. Resolution of symptoms generally occurs by 1 week and may be accelerated by NSAIDs. Although numerous papers have emerged over the years with an effort to advance our understanding, many questions remain about its pathomechanics, etiology, and how to exclude other more serious conditions that present similarly.

Management of Pediatric Patients with Synovial Fluid White Blood-Cell Counts of 25,000 to 75,000 Cells/mm3 After Aspiration of the Hip

“…The second most common specific diagnosis in the overall cohort was Lyme arthritis (28%), which can generate a relatively high intra-articular WBC count. The third was TSH (17%), which has not been traditionally described as causing such high WBC counts, but its symptoms may mimic those of SAH closely [5][6][7] . While there was a significantly higher rate of SAH in the high synovial fluid WBC group than in the low synovial fluid WBC group, SAH also proved to be the ultimate diagnosis for a substantial percentage (n = 4; 17%) of patients with values of 25,000 to <50,000 cells/mm 3 (25 to <50 · 10 9 cells/L), with the number of cases in the Lyme (n = 6; 26%) and TSH (n = 6; 26%) categories each being only two greater than the number in the SAH category.…”

“…The challenge for pediatric health-care providers is to differentiate SAH from the more common entity of transient synovitis of the hip (TSH), a reactive, relatively benign inflammatory condition [5][6][7] . Differentiation between these two separate pathophysiologic processes is particularly challenging because the clinical presentation of TSH can be quite similar, or even identical, to that of SAH.…”

Aetiology of arthritis in hospitalised children: an observational study

“…Septic arthritis and transient synovitis can be differentiated using clinical and biological criteria19–21 and are managed differently due to the risk of general or local dissemination and joint sequelae in septic arthritis 1 22. Septic arthritis requires emergency hospitalisation for joint drainage and antibiotics,5–7 while transient synovitis can be treated with rest and painkillers 23. Thus, children with transient synovitis were not included in our hospital-based study, because they do not need hospitalisation and can be managed by secondary care clinicians.…”

Mesenchymal Stem Cell-Derived Exosomes: Immunomodulatory Evaluation in an Antigen-Induced Synovitis Porcine Model

“…It can be successfully treated with biologically based therapies such as platelet-rich plasma, or autologous conditioned serum (44, 45), or NSAIDs such as Ibuprofen or Naproxen (46). The MSCs-based therapies diminish the inflammatory response itself (12) and the intra-articular administration of MSCs has been found to reduce the nucleated cell counts in SF (47).…”