History and exam
Key diagnostic factors
common
presence of risk factors
Risk factors include history of upper respiratory illness, age between 2 and 12 years, and male sex.
limited movement
Hip motion may be limited, but the patient will usually allow movement through a limited arc of motion or micromotion. Restriction of motion may be particularly apparent in abduction and internal rotation. However, some patients may not display any restriction in hip movement.
pain
There may be pain on hip movement, even with passive movement, and there may be tenderness on palpation of the hip or groin.[2]
limp
Patient will typically be able to walk, but with a noticeable limp and for limited distances. Sudden onset of limping on awakening is suggestive of transient synovitis compared to other diagnoses.[4]
positive log roll
The log roll is the most sensitive test for transient synovitis of the hip. In this examination, the patient lies supine and the leg is rolled gently from side to side. A positive test results in involuntary muscle guarding in the affected limb.
Other diagnostic factors
common
abducted and externally rotated hip
Patient will typically rest with hip abducted and externally rotated.
uncommon
absent or low-grade fever
Absence of fever is typically indicative of transient synovitis compared to other causes of non-traumatic limping, particularly septic arthritis.[4] One of the four primary predictors of septic arthritis is body temperature >38.5°C (>101.3°F); therefore, patient's temperature should be <38.5°C (<101.3°F) in transient synovitis.
However, the presence of fever does not exclude transient synovitis. One 2024 study reported that 13% of children diagnosed with transient synovitis had experienced fever at home prior to presenting to the paediatric accident and emergency department, compared to 100% in children with septic arthritis.[4]
Risk factors
strong
2 to 12 years of age
Uncommonly occurs in children <2 years, children >12 years, and adults.
male sex
About twice as common in boys as in girls.[6]
weak
history of recent viral illness
Parents often report a history of upper respiratory infection or gastrointestinal illness in the days and weeks prior to the episode.[8]
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