Toxic synovitis
My three-year-old daughter was recently hospitalized for the inability to walk. The final diagnosis was toxic synovitis which was described to us as a cold in her hip. I would like to know if this will reoccur and what if any other complications can be expected from this. Also, how common is this and why do certain people get it?
Question:Robert Steele
Robert W. Steele, MD, is a board certified pediatrician at St. John's Regional Health Center in Springfield, MO. He graduated from medical... Read more
There are a few symptoms that make pediatricians very nervous due to concern for serious disease. A stiff neck in a child with fever may mean there is meningitis brewing; a child that turns blue may have significant heart or lung disease; and the child who suddenly walks with a limp and complains of hip or knee pain may have a serious condition as well. Of course, there are other situations that make pediatricians stand up and take notice, but a child who suddenly develops a limp or won't walk is a child who needs immediate attention. Most of the time, the cause of the limp or inability to walk is minor and will get better with little intervention. But on occasion, the cause is more emergent requiring significant intervention at once. Unfortunately, the symptoms of benign disorders of the hip may mimic serious disease which makes distinguishing between the two quite difficult.
Toxic synovitis also known as acute transient synovitis of the hip is a condition in which there is inflammation and fluid within the hip joint. It is this swelling and fluid accumulation which causes joint pain. It is a rather common problem with up to 3 percent of children having an episode at some time during their life and may occur in children anywhere from the early toddler to the teenager. However, it usually happens to kids between 3-6 years of age. The exact cause of toxic synovitis is still unknown. The only thing that seems to be consistently associated with toxic synovitis is that many of these children have had an upper respiratory illness shortly before the onset of hip pain. This has led to speculation that the virus which is causing the cold also causes the synovitis. No matter what the cause, almost all children recover within two weeks and without long-lasting effects. Between 4-17 percent of children may have a second episode of toxic synovitis, but this usually occurs within 6 months of the first episode.
Treatment for this disorder focuses primarily on rest and taking anti-inflammatory medications. Rest usually consists of limiting the amount of walking done. Bedrest may be required at first to get rid of the pain, but then more use of the hip can be done gradually as the pain subsides. While the treatment is rather straight-forward, arriving at the diagnosis may be difficult. The biggest concern is making sure there is not a broken bone or bacteria in the joint space which can cause destruction of the hip. Sometimes this is easily distinguished by physical examination, however, x-rays may be required or a needle may need to be inserted into the joint space to collect fluid for examination.
Octmar, your daughter didn't really have a cold in her hip, but I think it is a good analogy to explain what was going on. When you have a cold, the swelling in your nose and sinus passages make you uncomfortable. You may have a sore throat as well. The hip is similar in that the inflammation also causes pain. The only difference in the two is that we know that the runny nose, sore throat, and stuffy head of a cold are caused by direct infection by a virus. For now, we don't know for sure exactly what causes toxic synovitis.
I hope this helps.
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