What Are the Most Common Causes of Sharp Hip Pain?

Hip synovitis is also called temporary synovitis. Is the most common cause of acute hip pain in children aged 3 to 10 years. Most men are common, and most children have sudden onset. The peak incidence was 3 to 6 years old, and the right side was more than the left side, with bilateral hip joints accounting for 5%.

Basic Information

nickname

Transient synovitis

English name

transient synovitis

English alias

transient synovitis of the hip

Visiting department

orthopedics

Multiple groups

3 to 10 years old

Common locations

hip joint

Common symptoms

Unilateral hip or groin pain

Causes of hip synovitis

The cause of the disease is unclear and may be related to viral infections, trauma, bacterial infections and allergic reactions (allergic reactions). Pathological examination showed non-infectious inflammation and synovial hyperplasia.

Clinical manifestations of hip synovitis

Unilateral hip or groin pain is the most common clinical symptom, and some patients may present with pain in the middle thigh or knee. It can manifest as night cry in very small patients, and careful examination can reveal painful claudication.

Attention should also be paid to the recent history of upper respiratory infections, pharyngitis, bronchitis, otitis media, etc., which can occur in nearly half of patients with hip synovitis.

Children with hip synovitis usually do not have fever or mildly elevated body temperature, and high fever is very rare.

Hip synovitis examination

Physical examination

The affected limb was hip flexed, with mild abduction and external rotation. Hip synovitis in one-third of patients with hip movements is barrier-free, but mild resistance to movement can still be felt, especially when abduction and internal rotation of the hip joint.

Pain in passive hip movement.

Keeping the patient in a supine position, the examiner can roll the patient's lower limbs and feel the involuntary protective contraction of the affected side muscles.

Patients with symptoms in the knee joint should check the knee joint, except for other diseases.

2. Imaging examination

(1) X-ray examination Generally, there is no abnormal manifestation of bone, sometimes it can be manifested as slight tilt of pelvis, swelling of hip joint capsule, widening of joint space, and no bone destruction.

(2) MRI examination MRI examination showed that the hip joint space on the affected side was widened and the joint cavity fluid was more clear than the plain radiograph. It can also show whether there is soft tissue occupying in the hip joint. MRI showed that the synovial tissue between the acetabulum and the femoral head cartilage showed a medium signal at T ₁ W1 and a high signal at T ₂ W1.

(3) Type B ultrasound examination The neck and neck anterior space of the hip and femur was significantly wider than that of the healthy side, and the bilateral difference was> 1mm. The anterior space of the femoral neck, that is, the maximum distance between the surface of the femoral neck periosteum and the outer edge of the joint capsule (the dividing line between the joint capsule and the iliopsoas).

2. Laboratory inspection

The total number of white blood cells is normal or slightly elevated.

The erythrocyte sedimentation rate is normal or slightly elevated. If the erythrocyte sedimentation rate is significantly higher than 20mm / h, combined with an increase in body temperature above 37.5 ° C, an increase in white blood cell count, etc., may indicate infectious arthritis.

C-reactive protein (CRP) is significantly elevated and is a sign of infectious arthritis.

Bacterial culture was negative.

Differential diagnosis of hip synovitis

1. Perthes disease (femoral skull inflammation)

Although the disease has lameness and hip pain, it has a long history. X-ray films show the deformation and compression of the femoral skull condyle.

2. Rheumatic joints and rheumatic fever in children

The disease is also common in children, and also has symptoms such as hip pain, muscle cramps, and claudication. However, the disease often develops gradually. Laboratory tests can increase white blood cell count and erythrocyte sedimentation, and the disease often affects multiple joints. .

3. Purulent arthritis

The disease also has hip pain, lameness, and pelvic tilt, but its body temperature is higher than normal, blood is higher than normal, and the disease is more severe. Puncture of the hip joint can extract pus.

4. Hip tuberculosis

It is a chronic disease with a long history and can show systemic symptoms of tuberculosis at the same time.

5. Pediatric congenital hip dislocation

The lameness was obvious, and the "4" test was positive. If it was unilateral, the lower limbs were not equal in length, but there was no obvious hip pain, muscle tension, and tenderness. X-ray films showed special manifestations.

Hip Synovitis Treatment

Manual treatment

Adapt to suffer from hip pain, patients with synovial impaction of the hip joint.

Traction therapy

Adapt to all children. The patient lies on his back, with the abducted limb 30 °, neutral position, and sustained horizontal skin traction of the affected limb. The weight of the traction is generally not more than 5 kg, and the traction time is 7 to 10 days. Exercise to prevent muscle atrophy.

3. Drug treatment

The use of non-steroidal anti-inflammatory drugs can shorten the duration of symptoms.

4.Physiotherapy

It is usually applied after the manual operation treatment, and it is moderate to feel warm without burning.

5. Surgical treatment

When conservative treatment is not effective, surgical removal of the synovium embedded in the joint can be taken in time to avoid delaying the disease.