Toxic synovitis

Alternative Names: Synovitis - toxic; Transient synovitis

Toxic synovitis is a condition affecting children that causes hip pain and limping.

Causes of Toxic synovitis

Toxic synovitis occurs in children before puberty begins. It is a type of arthritis of the hip. Its cause is not known, but boys are affected more often than girls (approximately 4 to 1).

Toxic synovitis Symptoms

Symptoms may include:

• Hip pain (on one side only)
• Limp
• Thigh pain, in front and toward the middle of the thigh
• Knee pain
• Low-grade fever, less than 101° Fahrenheit

Aside from the hip discomfort, the child does not usually appear ill.

Tests and Exams

Toxic synovitis is diagnosed when other, more serious conditions have been ruled out, such as:

• Septic hip
• Slipped capital femoral epiphysis
• Legg-Calve-Perthes disease

Tests used to diagnose toxic synovitis include:

• Ultrasound of the hip
• X-ray of the hip
• ESR
• C-reactive protein (CRP)
• Complete blood count (CBC)

Other tests that may be done to rule out other causes of hip pain:

• Aspiration of fluid from the hip joint
• Bone scan
• MRI

Treatment of Toxic synovitis

Treatment often includes limiting activity to make the child more comfortable. However, there is no danger with performing normal activities. The health care provider may prescribe nonsteroidal anti-inflammatory medications (NSAIDS) to reduce pain.

Prognosis (Outlook)

The hip pain goes away within 7 - 10 days.

Potential Complications

Toxic synovitis goes away on its own. There are no expected long-term complications.

When to Contact a Health Professional

Call for an appointment with your child's health care provider if:

• Your child has unexplained hip pain or a limp, with or without a fever
• Your child has been diagnosed with toxic synovitis and the hip pain lasts for longer than 10 days, the pain gets worse, or a high fever develops

Sankar WN, Horn BD, Wells L, Dormans JP. Transient monoarticular synovitis (toxic synovitis). In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 19th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 670.

Review Date: 8/2/2011
Reviewed By: Neil K. Kaneshiro, MD, MHA, Clinical Assistant Professor of Pediatrics, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

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