Guide for Transient Synovitis of the Hip in Children
Introduction
Physiotherapy in Calgary for Pediatric Issues
Welcome to Momentum Health's guide for Transient Synovitis of the Hip in Children.
Transient synovitis of the hip is an acute inflammatory condition of the inner lining of the hip. Transient means it is temporary and doesn't last long. Transient synovitis is also known as toxic synovitis or irritable hip.
This condition affects young children (boys more than girls) most often. In fact, it's the most common cause of acute hip pain in young children between the ages of three and 10. However, there are reports of transient synovitis in children less than one year old and in adults.
This guide will help you understand:
how the condition develops
how doctors diagnose the condition
what treatment options are available
Hear from some of our Pediatrics patients
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My daughter was the patient after a soccer injury left her unable to play. She enjoyed Keri-Ann’s straight forward explanations while assessing and Matt’s demonstration of exercises. She was... ”
“ My daughter was the patient after a soccer injury left her unable to play. She enjoyed Keri-Ann’s straight forward explanations while assessing and Matt’s demonstration of exercises. She was comfortable with both practitioners and how they treated her instead of referring to me when assessing her. She continues doing some of the exercises and returned to playing As a working parent I found booking evening sessions easy and the staff helpful ”
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Dr. Wowk treated my daughter for a sports concussion (and helped us realize the significant related whiplash). We were making no progress without his expertise - and not only did he provide top... ”
“ Dr. Wowk treated my daughter for a sports concussion (and helped us realize the significant related whiplash). We were making no progress without his expertise - and not only did he provide top quality professionalism - he was able to communicate with my daughter in a way that made her feel comfortable, and enabled her to provide the feedback he needed. I can't express enough how impressed I was with how he spoke to my young athlete daughter. Lastly, her health was the ultimate priority - and she was put through the same return-to-play protocol Dr. Wowk's professional athletes do...and after you are out for a significant amount of time you are nervous to return...both Dr. Wowk and the concussion specialized Physiotherapist Dr. Wowk referred us to reinstated her confidence to return to play. I am grateful we found him. ”
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Great Clinic! If you are looking for a great team for your family this is it. I take my sons here for Chiro with Dr Teac he is great with the kids and listens. All three boys have also had massage... ”
“ Great Clinic! If you are looking for a great team for your family this is it. I take my sons here for Chiro with Dr Teac he is great with the kids and listens. All three boys have also had massage both with Maria and Mattias. They love going for their massages and both of the Massage specialists have done an amazing job. My boys are 4,6,&12 so they do great with even young ones. I would definitely refer friends to this clinic and have on many occasions. ”
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We have been seeing Dr. Brad Fujimoto (Chiropractor) for years now and are really satisfied with each visit. When it comes to the services, he always makes sure each visit has been productive and... ”
“ We have been seeing Dr. Brad Fujimoto (Chiropractor) for years now and are really satisfied with each visit. When it comes to the services, he always makes sure each visit has been productive and beneficial. He's super friendly and interactive when we bring our 4 y/o to appointments as well. Fantastic guy. ”
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Dr. Brad is amazing!! He was able to pinpoint the issues I was having after giving birth to my daughter and treated them accordingly!! I will definitely be recommending him to any friends or family... ”
“ Dr. Brad is amazing!! He was able to pinpoint the issues I was having after giving birth to my daughter and treated them accordingly!! I will definitely be recommending him to any friends or family that need a chiropractor. Thanks again Dr. Brad! ”
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I have to take my daughter at this clinic for physiotherapy reasons and find them very professional and knowledgeable with dealing with the case. There was an instance where I have to take my daughter... ”
“ I have to take my daughter at this clinic for physiotherapy reasons and find them very professional and knowledgeable with dealing with the case. There was an instance where I have to take my daughter for an additional injury and I am amazed by thier holistic approach in dealing with it instead of either ignoring or making another appointment to deal with the current issues or new injury. We dealt with the Physiotherapist named: Joel Newman kinesiologist named: Nikola Zivanovic and very skilled and compassionate. Will recommend this clinic to anyone needing rehab/therapy/treatment. ”
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Great clinic, took my daughter there for Chiropractic. Dr Ally is super great with her, explained everything to me and fixed her right up for dance season. I have started seeing him as well now and... ”
“ Great clinic, took my daughter there for Chiropractic. Dr Ally is super great with her, explained everything to me and fixed her right up for dance season. I have started seeing him as well now and already feeling better. Highly recommend! All the staff are very friendly and appointments are flexible and easy to book. ”
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The team at Momentum is amazing. My husband, daughter and I have all been cared for and helped to get back to our activities with the expertise and support the fabulous physiotherapists and massage... ”
“ The team at Momentum is amazing. My husband, daughter and I have all been cared for and helped to get back to our activities with the expertise and support the fabulous physiotherapists and massage therapists. They work collaboratively, are so knowledgeable and genuinely care. ”
“
Great clinic, took my daughter there for Chiropractic. Dr Ally is super great with her, explained everything to me and fixed her right up for dance season. I have started seeing him as well now and... ”
“ Great clinic, took my daughter there for Chiropractic. Dr Ally is super great with her, explained everything to me and fixed her right up for dance season. I have started seeing him as well now and already feeling better. Highly recommend! All the staff are very friendly and appointments are flexible and easy to book. ”
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My husband and I have both been seeing Dr. Brad Fujimoto for years and have always been extremely happy with him - he has an amazing way of knowing exactly what you need treated and treating it... ”
“ My husband and I have both been seeing Dr. Brad Fujimoto for years and have always been extremely happy with him - he has an amazing way of knowing exactly what you need treated and treating it effectively. Dr. Brad also treated me during my first pregnancy and I had an uncomplicated natural birth. During my second pregnancy, my daughter was sideways-breech and I was scheduled for a c-section so I immediately went to see Brad and he treated me for a couple weeks with the goal of turning the baby and sure enough at 38 weeks she had turned and I was able to have a natural birth. We always highly recommend Brad to our friends and family. ”
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Whether it's for urgent care or ongoing chiropractic maintenance, Dr. Damen always attends to my needs professionally and efficiently. Recently, I brought my daughter in with a shoulder injury and he... ”
“ Whether it's for urgent care or ongoing chiropractic maintenance, Dr. Damen always attends to my needs professionally and efficiently. Recently, I brought my daughter in with a shoulder injury and he was able to treat her while making her laugh and feel right at home. In fact, she often asks to go see Dr. Damen! Highly recommended! ”
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Absolutely love this place! Staff are so friendly and always professional. Specifically go to see Dr. Ali for chiropractic issues. I've never been to see a chiro before, then had a back injury at work... ”
“ Absolutely love this place! Staff are so friendly and always professional. Specifically go to see Dr. Ali for chiropractic issues. I've never been to see a chiro before, then had a back injury at work which left me hardly being able to stand straight without excruciating pain. I was able to get in with Dr Ali the next day, knowing full well I needed a chiropractor now. Dr Ali walked me through everything and reassured me with all my fears. Have been seeing him for almost 2 years now, and both my husband and daughter now see him as well. 5 stars!! ”
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I want everyone to know how great Brad Fujimoto is, i have seen many different chiropractors in the past and none of them gave me the results that I am seeing right now with my lower back and left... ”
“ I want everyone to know how great Brad Fujimoto is, i have seen many different chiropractors in the past and none of them gave me the results that I am seeing right now with my lower back and left ankle. When he completes his adjustments, he is gentle, and efficient. He answers all of your questions and concerns. I recommended my daughter to see him as she suffers from costchondritus and was experiencing a flare up. Normally her flare ups are minimum 2 weeks however as soon as she began seeing brad her flare up came down in 3 days. He truly has a special touch. Thank you Brad for everything that you do. ”
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Great experience! They were able to get both me and my daughter in on short notice. Jason, the clinic director was very nice, and a master at making the first physio experience extremely positive for... ”
“ Great experience! They were able to get both me and my daughter in on short notice. Jason, the clinic director was very nice, and a master at making the first physio experience extremely positive for my 9 year old. Thanks, and keep up the Great work! ”
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We feel the need to express our gratitude to the people at Momentum Health Creekside. We just had the best physiotherapy experience. The reception was friendly and efficient. Our 15 year old daughter,... ”
“ We feel the need to express our gratitude to the people at Momentum Health Creekside. We just had the best physiotherapy experience. The reception was friendly and efficient. Our 15 year old daughter, Jamie, was booked with an amazing physiotherapist by the name of Russ Gothard. He was knowledgeable, professional and extremely kind. This instantly put our daughter at ease. As parents we take great comfort in knowing our child is in good hands. Special thank you to Peggy Tham for taking great care in setting up our appointment and to Russ for finding a solution to our daughter’s injury. Grateful, Pina and Jamie May 1, 2018 ”
The hip joint is a true ball-and-socket joint. The bones of the hip are the femur (the thighbone) and the pelvis. The top end of the femur is shaped like a ball. This ball is called the femoral head. The femoral head fits into a round socket on the side of the pelvis. This socket is called the acetabulum.
Transient synovitis affects the inner lining of the hip joint including the synovium and joint capsule. The synovium is a membrane that seals the synovial fluid in the joint to lubricate the joint surface. It is between the articular cartilage and the joint capsule. The joint capsule is a watertight sac that surrounds a joint. In the hip, the joint capsule is formed by a group of three strong ligaments that connect the femoral head to the acetabulum. These ligaments are the main source of stability for the hip. They help hold the hip in place.
Articular cartilage is the material that covers the ends of the bones of any joint. Articular cartilage is about one-quarter of an inch thick in the large, weight-bearing joints like the hip. In the hip, articular cartilage covers the end of the femur and the socket portion of the acetabulum in the pelvis. The cartilage is especially thick in the back part of the socket, as this is where most of the force occurs during walking and running.
Articular cartilage is white and shiny and has a rubbery consistency. It is slippery, which allows the joint surfaces to slide against one another without causing any damage. The function of articular cartilage is to absorb shock and provide an extremely smooth surface to make motion easier. We have articular cartilage essentially everywhere that two bony surfaces move against one another, or articulate.
Causes
What causes this condition?
The exact cause of this problem is unknown. In some cases, it may develop after a recent viral infection (such as a cold or upper respiratory infection). In a smaller number of children, trauma to the hip is followed by transient synovitis.
There is much debate about a possible link between transient synovitis and another condition called Legg-Calve-Perthes disease. In Perthes disease, the blood supply to the growth center of the hip (the capital femoral epiphysis) is disturbed, causing the bone in this area to die. The blood supply eventually returns, and the bone heals.
Only a small number of children with transient synovitis develop Legg-Calvé-Perthes disease. It's possible the prolonged increase in pressure inside the joint causes loss of blood supply to the hip. Some experts suspect children who develop Perthes disease may have undetected transient synovitis before collapse of the femoral head occurs.
Symptoms
What are the symptoms?
Inflammation and effusion (swelling) can cause sudden hip pain. Usually only one hip is involved. The child may refuse to walk or may limp when walking as the first sign of a problem. Younger children who aren't walking yet stop crawling or change the way they get around. They may cry at night or when having the diaper changed.
Your child may have a slight fever. A high fever is usually a sign of something more serious such as septic arthritis (bacterial infection of the hip) or osteomyelitis (bone infection).
In all age groups, there is usually a loss of hip motion. The child doesn't want to put weight on that leg. The painful symptoms may travel to the thigh, groin, or knee on the same side. Sometimes there isn't hip pain but just groin, thigh, or knee pain.
Your child may want to keep the hip and leg in a resting position of flexion (bent), external rotation (turned outward), and abduction (away from the other leg). This position opens up the joint capsule helps reduce the pain by taking pressure off the soft tissue structures.
Diagnosis
How do health care professionals diagnose this condition?
The history and physical examination are probably the most important tools the used to diagnose transient synovitis of the hip. When you first visit Momentum Health your physiotherapist will ask you or, if your child is old enough, even ask your child questions about when the pain started, where exactly the pain is, and what motions or activities make the pain better or worse.
Our physiotherapist in *client_area* will also conduct a physical examination to determine which movements cause pain or are limited. They will also palpate around the hip to locate the exact location of the pain.
The majority of patients will be referred to a doctor for further diagnostic tests such an X-ray, an ultrasound, and/or blood tests that can help to confirm or rule out the diagnosis. Once the diagnostic examination is complete, the physiotherapists at Momentum Health have treatment options that will help speed the recovery of your child so they can return to the carefree and active lifestyle they are meant to be living.
Our Treatment
The main goal of treatment for transient synovitis of the hip in children is to decrease the pain and maintain hip range of motion. After assessing your child, our physiotherapist at Momentum Health may choose to use ice on the hip if it is in the acute phase of pain or may apply heat at a later phase to decrease inflammation and assist with pain control.
Next, some gentle exercises may be prescribed by your physiotherapist to ensure that the hip maintains its range of motion and to assist in the healing process. These exercises should not cause pain. Many children will feel most comfortable if they keep the leg turned out during rest so they should be allowed to do this. Any position that is comfortable will help the healing process. Your physiotherapist will answer any questions you have on the ‘do’s’ and ‘don’t’s’ regarding exercise and positioning while the hip is healing.
Painful weight bearing on the injured leg should be avoided in order to decrease pain and allow healing. Some patients may need crutches to avoid painful weight bearing. Before leaving the clinic your physiotherapist will assess whether crutches should be used to ambulate for your child and, if needed, can adjust and fit the crutches. Generally, if the child cannot walk somewhat normally due to pain, then your physiotherapist will suggest that crutches be prescribed.
Finally, our physiotherapist in Calgary can advise on a return to activity schedule; vigorous physical activities such as running, jumping, and participating in sports activities should be avoided during the acute phase and will be added back as tolerated on the recommendation of your physiotherapist.
Momentum Health provides services for physiotherapy in Calgary.
Physician Review
X-rays are usually taken. Though radiographs don't show synovitis, they do help the physician rule out a fracture, tumor, or slipped capital femoral epiphysis (slippage of the growth plate). More advanced imaging such as MRI or bone scan may be needed if there is a need to rule out other more serious problems.
A blood test will show mild inflammation. If needed, the physician may order an ultrasound of the hip. This test will show any effusion (fluid collection) in the hip joint. Drawing the fluid out with a needle called needle aspiration will show if there is pus in the joint from septic (bacterial) arthritis. The fluid is clear in transient synovitis.
Antiinflammatory drugs will likely be prescribed along with rest from activity during the acute phase of pain.
Surgery
Surgery is not usually necessary. In severe cases of transient synovitis children may be hospitalized for observation and leg traction. Applying pull on the hip through the leg can reduce the pressure inside the joint capsule. If the child is cooperative, home traction may be possible.
