Irritable hip,in children

Irritable Hip in Children (Transient Synovitis of the Hip)

Overview
Irritable hip, medically known as transient synovitis of the hip, is a self-limiting condition that commonly affects children, usually between the ages of 3 and 10. It is the most frequent cause of hip pain and limping in this age group. The condition is characterized by temporary inflammation of the synovial lining of the hip joint, leading to pain, stiffness, and restricted mobility. Although benign, it is important to distinguish it from more serious causes of hip pain in children, such as septic arthritis or slipped upper femoral epiphysis (SUFE).

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Causes and Risk Factors

The exact cause is not fully understood, but contributing factors include:

• Viral infection: Often follows an upper respiratory tract infection, gastroenteritis, or otitis media.

• Post-viral immune reaction: An inflammatory response may occur after the infection.

• Minor trauma: A preceding minor fall or injury may sometimes be reported.

• Age and sex: More common in boys than girls, typically aged 3–10.

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Symptoms

Children with irritable hip often present with:

• Sudden onset of hip pain or groin pain.

• Limping or refusal to walk.

• Pain that may radiate to the thigh or knee.

• Limited range of motion in the affected hip, especially internal rotation.

• Mild low-grade fever may be present, but high fever suggests a more serious condition like septic arthritis.

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Diagnosis

Diagnosis is clinical but requires exclusion of more serious conditions:

• History and examination: To identify preceding infections, trauma, or systemic signs.

• Blood tests: ESR, CRP, and white cell count (normal in transient synovitis; elevated in septic arthritis).

• Hip ultrasound: May show an effusion (fluid in the joint).

• X-ray: Often normal, used to rule out SUFE, Legg-Calvé-Perthes disease, or trauma.

• MRI (rarely): Used if symptoms persist or diagnosis remains uncertain.

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Treatment

Irritable hip is usually self-limiting and resolves within 1–2 weeks. Management focuses on symptomatic relief:

• Rest and activity modification: Encourage the child to rest; avoid weight-bearing until symptoms improve.

• Analgesics:

  • Paracetamol (acetaminophen): 10–15 mg/kg every 4–6 hours (maximum 60 mg/kg/day).

  • Ibuprofen: 5–10 mg/kg every 6–8 hours (maximum 40 mg/kg/day).

• Hydration and supportive care: Adequate fluids and comfort measures.

• Follow-up: Review within 48 hours to ensure improvement. Persistent or worsening symptoms require re-evaluation for alternative diagnoses.

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Prognosis

• Most cases resolve spontaneously in 7–10 days, though some may take up to 2 weeks.

• Recurrence is possible but usually infrequent.

• No long-term joint damage is expected.

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Red Flags (Require Urgent Medical Attention)

Immediate evaluation is necessary if the child develops:

• High fever (>38.5 °C).

• Severe, persistent pain.

• Inability to bear weight at all.

• Signs of systemic illness (fatigue, poor feeding).

• Night pain or symptoms lasting longer than 2 weeks.

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Drug Interactions and Precautions

• Paracetamol and ibuprofen are generally safe in children but should not be given in higher-than-recommended doses.

• Avoid aspirin in children due to the risk of Reye’s syndrome.

• Ibuprofen should be used cautiously in children with asthma, kidney disease, or a history of gastrointestinal bleeding.

• Always cross-check with any medications the child is already taking.