Transient synovitis: is there a need to aspirate hip joint effusions?

@article{Skinner2002TransientSI,
  title={Transient synovitis: is there a need to aspirate hip joint effusions?},
  author={J Skinner and Stephen Glancy and Tom F. Beattie and G. M. A. Hendry},
  journal={European Journal of Emergency Medicine},
  year={2002},
  volume={9},
  pages={15-18}
}
There is debate as to the optimal management of children with hip joint effusions especially regarding the decision to aspirate. The objective of this study was to determine whether there is a need to aspirate hip joint effusions detected on ultrasound in patients with clinical transient synovitis (TS) and to identify the natural history of these effusions. Twenty-five children with proven hip joint effusions were followed up sequentially by clinical and radiological examination until symptom… 
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18 Citations
Highly Influential Citations
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Methods Citations
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18 Citations

What is the clinical course of transient synovitis in children: a systematic review of the literature
TLDR
The majority of the studies indicate that children with TS recover within two weeks; recurrence was seen in 0-26% of the cases; Children with TS should be followed at least six months to increase the likelihood of not missing Legg-Perthes’ disease.
Transient synovitis of the hip: a comprehensive review.
TLDR
Transient synovitis is a benign, self-limiting condition that is diagnosed after the exclusion of more serious causes of acute hip pain in children, and is largely believed to be viral in nature.
Septic arthritis or transient synovitis of the hip in children: the value of clinical prediction algorithms.
  • J. Sultan, P. Hughes
  • Medicine, Psychology
    The Journal of bone and joint surgery. British volume
  • 2010
TLDR
Clinical predictors should be applied with caution when assessing a child with an irritable hip, and a high index of suspicion, and close observation of patients at risk should be maintained.
The limping child: an algorithm to outrule musculoskeletal sepsis
TLDR
This multivariate model enables the exclusion of ‘musculoskeletal sepsis’ as a differential diagnosis in limping children with none of these three presenting variables with 99% certainty.
ACR Appropriateness Criteria® limping child--ages 0 to 5 years.
Epidemiology of Irritable Hip in Western Scotland: A Follow-Up Study
TLDR
A follow-up study of children discharged from the RHCG ED in Glasgow, Scotland from January to December 2017 found a younger age profile than other studies, and no overt association with social deprivation.
Pediatric Nontraumatic Hip Pathology
Sonography for the investigation of a child with a limp
TLDR
The hip area is also a common site for referred pain, which often poses a diagnostic challenge particularly in the young child who may not verbalise the point of pain and may not report an injury.
Pathologie de la hanche chez l’enfant Diagnosis of hip pain in childhood
TLDR
Nous envisagerons successivement les modalites du dianostic clinique et paraclinique, puis les etiologies en separant es pathologies inflammatoires et mecaniques, en excluant les athologies traumatiques fracturaires ainsi que les maladies sseuses constitutionnelles.
La hanche chez l’enfant de 0 à 17 ans
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References

SHOWING 1-10 OF 29 REFERENCES
Ultrasound in the diagnosis and follow-up of transient synovitis of the hip.
Of 59 patients (2-15 years of age) with acute synovitis of the hip, one patient developed Perthes disease (1.7%) and the others transient synovitis. The diagnostic criterion for intracapsular…
Septic arthritis versus transient synovitis of the hip: the value of screening laboratory tests.
Joint effusion in children with an irritable hip: US diagnosis and aspiration.
TLDR
Clinical evaluation, radiographs, and sonograms together determined the need for US-guided aspiration, which allowed selection of only those with septic arthritis for operative drainage and shortened that procedure.
Ultrasound examination of the irritable hip.
TLDR
A protocol of management for irritable hip is proposed, using ultrasonography at the first presentation of certain categories of patients, to reduce the number of early radiographs by 75%.
Transient synovitis of the hip. Its incidence, epidemiology and relation to Perthes' disease.
TLDR
Factors associated with the incidence of Perthes' disease included prolonged time in traction before the range of hip movement became normal, increase in joint space on the initial radiographs and the recurrence of hip symptoms after initial relief.
Management of irritable hip: a review of hospital admission policy.
TLDR
The case notes of all children admitted during the preceding five years for observation with painful hips were analysed to determine significant diagnostic factors and thus to design and admission policy and are expected to result in a significant reduction in admission rates.
Transient synovitis of the hip in children: role of US.
TLDR
The authors retrospectively studied the value of hip arthrosonography in 46 children with clinical symptoms suggesting pathologic hip conditions, and found increased echogenicity of the articular fluid was found in both transient synovitis and septic arthritis.
The irritable hip: immediate ultrasound guided aspiration and prevention of hospital admission.
TLDR
The traditional approach to management is questioned and the advantages of the protocol highlighted, including earliest diagnosis of sepsis and other serious pathology, avoidance of hospital admission, and the relief of pain by joint decompression.
Ultrasonography in the management of painful hips in children.
TLDR
The anterior capsular distance was determined in 10 children with painful or irritable hips and none of the 7 hips subsequently required further diagnostic workup or treatment and all have had a satisfactory outcome.
Pediatric hip effusions: evaluation with power Doppler sonography.
TLDR
Normal flow on power Doppler sonograms does not allow exclusion of septic arthritis and should not preclude aspiration when clinically warranted, and the results suggest that increased flow in most patients with septicthritis is not depicted.
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