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University of Iowa News Release


Feb. 7, 2007

Toxic Synovitis A Common Cause Of Hip Pain In Children

A sudden, unexplained limp in their child would cause any parent to worry.

However, toxic synovitis, the most common diagnosis for child hip pain, is rarely a serious condition, according to a University of Iowa pediatric orthopaedic specialist.

"Toxic synovitis is the most common cause of hip pain in children ages 4 to 10," said Stuart Weinstein, M.D., the Ignacio V. Ponseti Chair and Professor of Orthopaedic Surgery in the UI Department of Orthopaedics and Rehabilitation.

Toxic synovitis is a transient inflammation of the hip that occurs in children before the onset of puberty. It affects boys about four times more often than girls. The condition is self-limited, Weinstein noted, meaning it will disappear even if left untreated. There are no expected long-term complications. 

Symptoms of toxic synovitis include limping or a disturbance in the way the child walks or runs; hip pain in the groin, inner thigh or inner knee; and a low-grade fever. Children may also find it difficult to pull the leg apart or turn the leg in. Its cause is unknown but toxic synovitis sometimes can follow a viral infection, such as the common cold, Weinstein said.

It is treated symptomatically with anti-inflammatory drugs. Patients are often recommended to rest or use crutches. The condition is usually cured within about one week, but may take longer, which can be worrisome to parents and doctors, Weinstein said.

"Making the diagnosis is key because more serious conditions and diseases need to be ruled out first," Weinstein said. "Even though the serious conditions are a lot less common, it is crucial to identify them immediately."

Serious conditions may include an infection in the hip joint, septic arthritis, a form of leukemia or Legg-Calve-Perthes disease, a condition that predisposes the hip to arthritis.

To distinguish toxic synovitis from other conditions, doctors may aspirate the hip, perform blood tests or use magnetic resonance imaging (MRI), x-ray, bone scan or ultrasound techniques.

"If children have a limp or have hip, inner groin or inner knee pain, they should be evaluated by a knowledgeable physician immediately," Weinstein said.

STORY SOURCE: University of Iowa Health Science Relations, 5139 Westlawn, Iowa City, Iowa 52242-1178

MEDIA CONTACT: David Pedersen, 319-335-8032, Writer: Krystal Loewe