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Transient Synovitis M67.90 727.9

 

synonyms: transient synovitis, TS, toxic synovitis

Transient Synovitis ICD-10

Transient Synovitis ICD-9

  • 727.9 Unspecified disorder of synovium, tendon and bursa

Transient Synovitis Etiology / Epidemiology / Natural History

  • Most common cause of acute hip pain in children aged 3-10 years
  • Nonspecific inflammation and hypertrophy of the synovial membrane identified in biopsy speicimens.

Transient Synovitis Anatomy

Transient Synovitis Clinical Evaluation

  • Unilateral hip or groin pain. May report medial thigh or knee pain.
  • Recent history of an upper respiratory tract infection, pharyngitis, bronchitis, or otitis media in 50% of patients
  • Limp may be only initial complaint
  • Generally afebrile or mildly elevated temperature; high fever is rare.
  • Hip pain with passive ROM.

Transient Synovitis Xray / Diagnositc Tests

  • A/P pelvis, A/P and frog lateral of the hip. May be normal or demonstrated soft tissue swelling / effusion / joint space widening.
  • Ultrasonography guided aspiration: Indicated for temp >99.5°F, or ESR >20, of severe hip pain with ROM. Demonstrates an effusion that causes bulging of the anterior joint capsule.
  • CBC and ESR may be slightly elevated. ESR >20 mm/h and/or temperature>37.5°C indicates septic hip.

Transient Synovitis Classification / Treatment

  • NSAIDs, activity limitations, NWB while painful, consider bedrest.
  • Hosptial admission indicated for observation in equivocal cases.
  • Patients generally improve markdly in 24-28 hours. May have mild symptoms for several weeks.

Transient Synovitis Associated Injuries / Differential Diagnosis

  • Septic Hip
  • Perthes Disease / Avascular necrosis
  • SCFE
  • Fracture
  • Gonococcal arthritis
  • Lyme Diseasse
  • Rheumatic arthralgias
  • Tumor

Transient Synovitis Complications

  • Coxa Magna
  • Perthes Disease: @2%.

Transient Synovitis Follow-up Care

  • Repear xrays in 6-12 months to eval for Perthes disease.

Transient Synovitis Review References