Toxic synovitis

Department of Orthopedics, Pediatric Orthopedic Division, University of Wisconsin Hospital, 600 Highland Avenue, K4/732 CSC, Madison, WI 53792, USA.
Skeletal Radiology (Impact Factor: 1.51). 08/2008; 37(11):963-5. DOI: 10.1007/s00256-008-0543-3
Source: PubMed


When a child develops hip pain or limping, it draws the immediate apprehension of parent and physician alike, despite the fact that the vast majority of these children will improve with little or no treatment. The concern is with the differential diagnosis because the symptoms of benign disorders of the hip may mimic serious disease and distinguishing between them can be quite difficult and often time dependent. Toxic synovitis (TS), also known as acute transient synovitis of the hip, is a condition in which there is nonspecific inflammation and hypertrophy of the synovium with an effusion in the hip joint. It is the most common cause of acute hip pain in children aged 3–10 years, and up to 3% of children have an episode at some time during their life. It is extremely uncommon in adults [9]. Although the diagnosis is usually one of exclusion, the etiology is unclear; parenthetically, many of these children have had an upper respiratory illness shortly before the onset of hip pain. Nearly all children recover within 2 weeks and without long-lasting effects. Four to 17% of children may have a recurrent episode. Children with recurrent episodes usually have a benign course, although, in about 10%, recurrent TS may be the presenting feature of a chronic inflammatory condition [10]. Treatment for TS focuses primarily on rest and anti-inflammatory medications, which shorten the course of the disorder [2]. While the treatment is rather straightforward, arriving at the diagnosis may be difficult. The differential diagnosis for a limping child with

3 Reads
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: • Arthritis can be a manifestation of multiple disease processes. Therefore, the clinician must consider a broad differential diagnosis, keeping a high degree of suspicion for diseases that may have serious consequences. Although this article reviews more common disease processes that present with arthritis, it is imperative to think outside of the scope of infectious and musculoskeletal entities and consider autoimmune, oncologic, and other processes as well. • The diagnostician should use a complete history and physical examination to determine further evaluation. In most cases, the diagnosis can be confirmed by the constellation of supporting historic features, examination findings, and laboratory or imaging results. • Appropriate diagnosis and management of pediatric arthritis can facilitate prompt recovery and prevent debilitating consequences. Table 4 offers a brief summary for treatment management. • Strong research evidence suggests that delay in decompression of infected joints, especially the hips and shoulders, and delayed initiation of antibiotics are poor prognostic factors. • Moderate research evidence indicates that the presence of fever, inability to bear weight, ESR >40 mm/hour, and a white blood cell count >12x106 is highly suggestive of pyogenic arthritis. • Some evidence exists regarding safety and efficacy of the use of biologic agents in treating children who have JIA. • Based on expert opinion, an interdisciplinary approach to the treatment of JIA results in improved quality of life.
    Preview · Article · Nov 2011 · Pediatrics in Review
  • [Show abstract] [Hide abstract]
    ABSTRACT: The appropriate imaging for pediatric patients (ages 0-5 years) being evaluated for limping depends on the clinical presentation, specifically, the presence of signs of infection, any localization of pain, and history of or suspected trauma. Common diagnoses causing limping in children are briefly reviewed, and recommended imaging techniques are discussed, including toddler's fracture, transient synovitis, septic arthritis, Legg-Calvé-Perthes disease, and osteomyelitis. The ACR Appropriateness Criteria(®) are evidence-based guidelines for specific clinical conditions that are reviewed every 2 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.
    No preview · Article · Aug 2012 · Journal of the American College of Radiology: JACR
  • [Show abstract] [Hide abstract]
    ABSTRACT: Septic arthritis and toxic synovitis are clinical conditions that can develop in association with various causes and involve symptoms such as pain, swelling, redness, sensitivity and restricted movement in the joint. A 42-year-old male presented to the emergency department with severe joint pain and nausea after injecting a 1-cc mixture of turpentine oil, eucalyptus oil, mint oil and thyme oil, which he purchased from an alternative medicine store, into his right knee with a syringe because of chronic knee pain. Ballottement and sensitivity were present at physical examination. Knee puncture yielded 60 cc of cloudy fluid. There was no growth in the material obtained. Improvement was observed following subsequent arthroscopic washing of the joint space and IV antibiotherapy, and the patient was discharged on day 21 of hospitalization with oral antibiotic and analgesic therapy. Intra-articular injection of foreign bodies into the knee joint space for therapeutic purposes, as in this case report, is a very rare occurrence, but may lead to potentially complicated arthritis.
    No preview · Article · Aug 2012 · Human & Experimental Toxicology
Show more