Management

Alternative conditions must be excluded. Admit to hospital if diagnosis in doubt.

The mainstay of treatment is rest and appropriate analgesia. Ibuprofen has been shown to decrease the duration of symptoms. (1) This can be done in the home or in hospital as dictated by pain and/or social circumstances. The leg is best kept flexed and in some external rotation. Aspiration of effusion when present, may provide dramatic symptomatic relief.

The child should begin mobilising once the pain has settled. Symptoms generally resolve within one or two weeks (2).

A follow-up radiograph at 6 weeks may be taken to confirm exclusion of Perthes' disease.

References:

1. Kermond S et al. A randomized clinical trial: should the child with transient synovitis of the hip be treated with nonsteroidal anti-inflammatory drugs? Ann Emerg Med. 2002 Sep;40(3):294-9.
2. Krul M et al. Acute non-traumatic hip pathology in children: incidence and presentation in family practice. Fam Pract. 2010 Apr;27(2):166-70.