# Transient synovitis of the hip (irritable hip) - Category: acute - Review status: reviewed (every claim checked against a document named on this page) - Sources: Transient Synovitis - StatPearls (NCBI Bookshelf NBK459181) - https://www.ncbi.nlm.nih.gov/books/NBK459181/ · MSF Essential Drugs 2024 (ibuprofen oral monograph) · Transient synovitis of the hip - disease-level clinical article (transient-synovitis-hip-full.txt) · Transient synovitis of the hip - disease-level clinical article (transient-synovitis-hip-clinical.txt) - Verified date: 2026-08 ## Verified against - Transient Synovitis - StatPearls (NCBI Bookshelf NBK459181) - https://www.ncbi.nlm.nih.gov/books/NBK459181/ - MSF Essential Drugs 2024 (ibuprofen oral monograph) - Transient synovitis of the hip - disease-level clinical article (transient-synovitis-hip-full.txt) - Transient synovitis of the hip - disease-level clinical article (transient-synovitis-hip-clinical.txt) ## Treatment metadata - Ibuprofen — 100 mg — oral.liquid - Rest and supportive care (no drug therapy) - Referral & safety-netting (no drug therapy) ## Complete treatment card ```text TRANSIENT SYNOVITIS OF THE HIP (IRRITABLE HIP) Sources: Transient Synovitis - StatPearls (NCBI Bookshelf NBK459181) - https://www.ncbi.nlm.nih.gov/books/NBK459181/ · MSF Essential Drugs 2024 (ibuprofen oral monograph) · Transient synovitis of the hip - disease-level clinical article (transient- synovitis-hip-full.txt) · Transient synovitis of the hip - disease-level clinical article (transient-synovitis-hip-clinical.txt) Review status: REVIEWED against 4 sources listed above (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (4) - Acute one-sided hip pain or a limp that can progress to refusing to bear weight [groin pain · hip pain · limp] - A young child may just seem more agitated or cry more than usual instead of reporting pain [irritability] - A recent upper respiratory infection, sore throat, bronchitis, or ear infection often precedes the presentation and favors this diagnosis [sore throat] - A prior episode of transient synovitis raises the likelihood it has recurred SIGNS - what you find (4) - Restricted hip motion, especially with abduction and internal rotation - The hip may be held flexed, turned outward and away from the body to reduce pressure in the joint - About a third of patients actually have a completely normal range of motion on exam [reduced range of movement] - Pain felt at the front of the hip on the same side during the FABER test points to a hip-joint problem TESTS (9) - Fever at presentation is less common with transient synovitis (about 30%) than septic arthritis (over half) - ESR runs highest with septic arthritis (44-64 mm/hr), intermediate with Lyme arthritis, lowest with transient synovitis (21-33 mm/hr) - A CRP over 2 mg/dL is an independent risk factor pointing toward septic arthritis - Plain x-rays can stay normal for months, though the joint space on the affected side is often mildly widened by fluid - Ultrasound reliably picks up fluid within the hip joint capsule - The Kocher criteria (non-weight-bearing, fever over 38.5C, ESR over 40 mm/hr, WBC over 12,000) help separate septic arthritis from transient synovitis - Meeting all four Kocher criteria together gives a 99.6% probability of septic arthritis - With none of the Kocher criteria present, the chance of septic arthritis drops below 0.2% - A temperature above 38.5C was the single strongest predictor of septic arthritis over hip pain IF NOT THIS - what else fits (8) - Osteomyelitis is on the differential for acute pediatric hip pain, since missing it can be serious - Septic arthritis is the critical diagnosis to exclude in a child with acute hip pain - A primary or metastatic bone lesion is on the differential for pediatric hip pain - Legg-Calve-Perthes disease is on the differential for pediatric hip pain - Slipped capital femoral epiphysis is on the differential for pediatric hip pain - Lyme arthritis is an additional differential for pediatric hip pain - Pyogenic sacroiliitis is an additional differential for pediatric hip pain - Juvenile rheumatoid arthritis is an additional differential for pediatric hip pain Score Kocher criteria - Septic arthritis, or transient synovitis of the hip? Source StatPearls "Transient Synovitis" - disease-level clinical article Status traced to the source above 1. IBUPROFEN [1st line] Adult 200 to 400 mg 3 to 4 times daily (max. 1200 mg daily) for a patient 12 years and over - According to clinical response; symptoms generally improve after 24 to 48 hours Peds 5-10 mg/kg/dose (Over 3 months of age: 5 to 10 mg/kg, given 3 or 4 times a day, with 30 mg/kg in a day as the usual ceiling. MSF's own absolute ceiling is higher: up to 40 mg/kg daily in a child. The suspension is 100 mg per 5 ml, and the MSF pipette is marked off by body weight - one kilogram graduation delivers 10 mg of ibuprofen.) Age restriction: minimum 3 months 3kg -> 15-30 mg/dose 4kg -> 20-40 mg/dose 5kg -> 25-50 mg/dose 6kg -> 30-60 mg/dose 7kg -> 35-70 mg/dose 8kg -> 40-80 mg/dose 9kg -> 45-90 mg/dose 10kg -> 50-100 mg/dose 11kg -> 55-110 mg/dose 12kg -> 60-120 mg/dose 13kg -> 65-130 mg/dose 14kg -> 70-140 mg/dose 15kg -> 75-150 mg/dose 16kg -> 80-160 mg/dose 17kg -> 85-170 mg/dose 18kg -> 90-180 mg/dose 19kg -> 95-190 mg/dose 20kg -> 100-200 mg/dose 21kg -> 105-210 mg/dose 22kg -> 110-220 mg/dose 23kg -> 115-230 mg/dose 24kg -> 120-240 mg/dose 25kg -> 125-250 mg/dose 26kg -> 130-260 mg/dose 27kg -> 135-270 mg/dose 28kg -> 140-280 mg/dose 29kg -> 145-290 mg/dose 30kg -> 150-300 mg/dose 31kg -> 155-310 mg/dose 32kg -> 160-320 mg/dose 33kg -> 165-330 mg/dose 34kg -> 170-340 mg/dose 35kg -> 175-350 mg/dose 36kg -> 180-360 mg/dose 37kg -> 185-370 mg/dose 38kg -> 190-380 mg/dose 39kg -> 195-390 mg/dose 40kg -> 200-400 mg/dose 41kg -> 205-410 mg/dose 42kg -> 210-420 mg/dose 43kg -> 215-430 mg/dose 44kg -> 220-440 mg/dose 45kg -> 225-450 mg/dose 46kg -> 230-460 mg/dose 47kg -> 235-470 mg/dose 48kg -> 240-480 mg/dose 49kg -> 245-490 mg/dose 50kg -> 250-500 mg/dose Source MSF Essential Drugs 2024 (ibuprofen oral monograph) Why Indication claim, disease article: once a full diagnostic work-up has established transient synovitis, the management is supportive care and rest from activity, with a non-steroidal anti-inflammatory available for the pain. The article names the class and not a molecule. Dose claim, MSF Essential Drugs 2024 ibuprofen oral monograph, under indications covering mild to moderate pain, fever and rheumatic disease: a child over 3 months takes 5 to 10 mg/kg, given 3 or 4 times a day, to a ceiling of 30 mg/kg daily. Ibuprofen is the NSAID the Egyptian register actually stocks as a paediatric suspension - 21 oral-liquid products under that spelling. Caution PAIN RELIEF IS NOT A DIAGNOSTIC TEST. A child whose hip settles on ibuprofen may still have septic arthritis - see the referral and safety-netting advice before treating and sending home. MSF contraindicates it in: a child under 3 months of age; allergy to any NSAID; peptic ulcer; a clotting defect, active bleeding, or surgery that risks heavy blood loss; severe kidney or liver impairment; severe heart failure; severe malnutrition; dehydration or hypovolaemia that has not been put right; and severe infection. A febrile, dehydrated or septic-looking child is the wrong child for an NSAID. MSF lists as possible harms: allergic reactions, pain in the upper abdomen, peptic ulcer, bleeding, and impaired kidney function. It says to give the drug carefully to the elderly and to asthmatics. MSF says: do not combine it with methotrexate, with anticoagulants, or with another NSAID; and to monitor the combination with a diuretic or an ACE inhibitor - the patient should drink plenty, to keep the kidneys out of trouble. MSF on how to give it: with food, and with at least 4 hours between doses. The disease article's other measures cost nothing - heat applied to the hip, or massage. STOP AND RETHINK ON A TIMER - if the symptoms are still significant 7 to 10 days after the child first presented, think of another diagnosis. Do not keep repeating the syrup. Egypt NOVA-PROFEN 100MG/5ML ORAL SUSP. 100ML SANOFI 2.25 EGP IBUPROFEN 100MG/5ML SUSP. 120 ML SEDICO 5.00 EGP MARCOFEN 100MG/5ML SUSP. 120ML GLAXO SMITHKLINE 5.85 EGP MAFO 100MG/5ML SYRUP 100 ML EIPICO 25.00 EGP IBUCALMIN 100MG/5ML SYRUP 120 ML MASH PREMIERE 28.00 EGP JUSPOLED 100MG/5ML SYRUP 120 ML EGPI > JASPER... 31.00 EGP MEGAFEN-N 100MG/5ML SUSP. 120 ML RAMEDA 35.00 EGP BRUFEN 100MG/5ML SYRUP 150ML KAHIRA > ABBO... 44.00 EGP BRUFEMOL-N SUSP. 60 ML ARAB DRUG COM... 4.50 EGP -> ? strength differs, ? different route - not oral liquid IBUFEN 2% SUSP. 60ML ALEXANDRIA 4.50 EGP -> ? strength differs, ? different route - not oral liquid 2. REST AND SUPPORTIVE CARE (NO DRUG THERAPY) [1st line] Adult Source Transient synovitis of the hip - disease-level clinical article (transient-synovitis- hip-clinical.txt) Why Rest is named ahead of any drug in the article's management sentence, and the expected course is what turns a frightening limp into a manageable week at home. Caution Treatment is supportive: rest from activity, and nothing more heroic. (Transient Synovitis - StatPearls - NCBI Bookshelf, NBK459181) THE COURSE TO PROMISE THE FAMILY - things usually start to ease within 24 to 48 hours. In about 75% of children everything has gone within 1 to 2 weeks; the rest keep milder symptoms for some weeks more. (Transient Synovitis - StatPearls - NCBI Bookshelf, NBK459181) RECURRENCE IS COMMON AND IS NOT A FAILURE - the article puts it at as many as 20% to 25% of children in one place and at 4% to 17% in another, with most second episodes arriving inside 6 months. (Transient Synovitis - StatPearls - NCBI Bookshelf, NBK459181) Warn the parents so the second episode does not arrive as a crisis. The main complication is simply that it comes back. (Transient Synovitis - StatPearls - NCBI Bookshelf, NBK459181) Symptoms lasting past a month are a different disease - where they have run beyond 1 month, the article reports that a different pathology was found. (Transient Synovitis - StatPearls - NCBI Bookshelf, NBK459181) 3. REFERRAL & SAFETY-NETTING (NO DRUG THERAPY) [1st line] Adult Source Transient synovitis of the hip - disease-level clinical article (transient-synovitis- hip-clinical.txt) Why Transient synovitis is a diagnosis of exclusion, and everything it must be excluded from is worse than it is. Carries the Kocher criteria, the workup the article requires before the label is applied, and the serious differentials. Caution RED FLAG - SEPTIC ARTHRITIS. The Kocher criteria: a white cell count above 12,000 per microlitre of serum; the child will not or cannot bear weight; fever above 38.5 degrees C; and an ESR above 40 mm/hr. With all four present, the article puts the probability of septic arthritis at 99.6%. With none of those risk factors present at the visit, the article puts the chance of a septic hip below 0.2%. (Transient Synovitis - StatPearls - NCBI Bookshelf, NBK459181) Four negatives is the reassuring combination; three positives is an emergency. TEMPERATURE IS THE STRONGEST SINGLE SIGN - a temperature above 38.5 C predicted septic arthritis better than anything else, and after it, in the article's stated order: a CRP above 1 mg/dL, then the ESR, then refusal to bear weight, then the white cell count. (Transient Synovitis - StatPearls - NCBI Bookshelf, NBK459181) THIS IS NOT A CLINIC-ONLY DIAGNOSIS - the work-up the article asks for is a white cell count, a CRP, an ESR, an x-ray of the hip and an ultrasound. (Transient Synovitis - StatPearls - NCBI Bookshelf, NBK459181) Without those, the label has not been earned. A CRP above 2 mg/dL is on its own a risk factor for septic arthritis. (Transient Synovitis - StatPearls - NCBI Bookshelf, NBK459181) REFER FOR ASPIRATION WHERE THERE IS AN EFFUSION - ultrasound picks up fluid inside the joint capsule very reliably, and aspirating under ultrasound both relieves the pain and the stiffness and often separates this quickly from septic arthritis. (Transient Synovitis - StatPearls - NCBI Bookshelf, NBK459181) IF IN DOUBT, ADMIT - where there is clinical concern, or the diagnosis will not settle, admitting the child allows repeated assessment after a first period of supportive treatment. (Transient Synovitis - StatPearls - NCBI Bookshelf, NBK459181) THE OTHER DIAGNOSES TO EXCLUDE, in the article's list: osteomyelitis, septic arthritis, a primary or secondary bone lesion, Legg-Calve-Perthes disease, a slipped capital femoral epiphysis, and also Lyme arthritis, pyogenic sacroiliitis and juvenile rheumatoid arthritis. An overweight adolescent with hip or knee pain is a SCFE until x-rayed. Acute hip pain calls for those alternatives to be excluded first, above all the ones that leave lasting damage when they are not caught quickly. (Transient Synovitis - StatPearls - NCBI Bookshelf, NBK459181) LATE CONSEQUENCE TO KNOW ABOUT - Legg-Calve-Perthes disease follows in 1% to 3% of them. (Transient Synovitis - StatPearls - NCBI Bookshelf, NBK459181) A child with a second or third episode deserves an orthopaedic opinion, not another course of syrup. Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)