Toxic synovitis
Toxic synovitis is a condition affecting children that causes hip pain and limping.
Hip pain
Hip pain involves any pain in or around the hip joint. You may not feel pain from your hip directly over the hip area. You may feel it in your groi...
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Toxic synovitis occurs in children before puberty. It usually affects children from 2 to 12 years old. It is a type of inflammation of the hip. Its cause is not known. Boys are affected more often than girls. It can also occur after a common cold or viral infection.
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°F (38.33°C)
- Child only walking on toes and refusing to walk normally
Aside from the hip discomfort, the child does not usually appear ill.
Exams and Tests
Toxic synovitis is diagnosed when other more serious conditions have been ruled out, such as:
-
Septic hip (infection of the hip)
Septic hip
Septic arthritis is inflammation of a joint due to a bacterial or fungal infection. Septic arthritis that is due to the bacteria that cause gonorrhe...
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Slipped capital femoral epiphysis (separation of the ball of the hip joint from the thigh bone, or femur)
Slipped capital femoral epiphysis
A slipped capital femoral epiphysis is a separation of the ball of the hip joint from the thigh bone (femur) at the upper growing end (growth plate) ...
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Legg-Calve-Perthes disease (disorder that occurs when the ball of the thigh bone in the hip does not get enough blood, causing the bone to die)
Legg-Calve-Perthes disease
Legg-Calve-Perthes disease occurs when the ball of the thigh bone in the hip does not get enough blood, causing the bone to die.
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Tests used to diagnose toxic synovitis include:
-
Ultrasound of the hip
Ultrasound
Ultrasound uses high-frequency sound waves to make images of organs and structures inside the body.
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X-ray of the hip
X-ray
X-rays are a type of electromagnetic radiation, just like visible light. An x-ray machine sends individual x-ray waves through the body. The images...
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ESR
ESR
ESR stands for erythrocyte sedimentation rate. It is commonly called a "sed rate. "It is a test that indirectly measures the level of certain protei...
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C-reactive protein (CRP)
C-reactive protein
C-reactive protein (CRP) is produced by the liver. The level of CRP rises when there is inflammation in the body. It is one of a group of proteins,...
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Complete blood count (CBC)
Complete blood count
A complete blood count (CBC) test measures the following:The number of white blood cells (WBC count)The number of red blood cells (RBC count)The numb...
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Other tests that may be done to rule out other causes of hip pain:
-
Aspiration of fluid from the hip joint
Aspiration
Aspiration means to draw in or out using a sucking motion. It has two meanings:Breathing in a foreign object (for example, sucking food into the air...
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Bone scan
Bone scan
A bone scan is an imaging test used to diagnose bone diseases and find out how severe they are.
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Treatment
Treatment often includes limiting activity to make the child more comfortable. But, there is no danger with normal activities. Your child's health care provider may prescribe nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce pain.
Outlook (Prognosis)
The hip pain goes away within 7 to 10 days.
Possible Complications
Toxic synovitis goes away on its own. There are no expected long-term complications.
When to Contact a Medical Professional
Contact your child's provider for an appointment 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
Reviewed By
Neil K. Kaneshiro, MD, MHA, Clinical Professor of Pediatrics, University of Washington School of Medicine, Seattle, WA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
Sankar WN, Winell JJ, Horn BD, Wells L. The hip. In: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA: Elsevier; 2020:chap 698.
Singer NG, Onel KB. Evaluation of children with rheumatologic complaints. In: Hochberg MC, Gravallese EM, Smolen JS, van der Heijde D, Weinblatt ME, Weisman MH, eds. Rheumatology. 8th ed. Philadelphia, PA: Elsevier; 2023:chap 103.
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