Trainee Advanced Clinical Practitioner Diary- Day 20 - Critical Care Practitioner

Trainee Advanced Clinical Practitioner Diary- Day 20

5 year old male presented with difficulty in walking. He had been suffering with an ear infection for which he had been treated the previous few days. He complained of pain in both thighs and increased pain on rotation of the hips.

Transient synovitis is the most common cause of non-traumatic hip pain in children, Incidence of arthritis in urban Finnish children, Arthritis Rheum 1986The characterization of “transient synovitis of the hip” in children. J Pediatr Orthop 1986, and is more common in boys than girls at a ratio of 2:1.

Fever should raise the suspicion of a septic arthritis, Factors distinguishing septic arthritis from transient synovitis of the hip in children. J Bone Joint Surg Am 2006,  Symptoms can involve both hips in 5% of cases.

Patients have an antalgic gait and keep the hip in abduction and external rotation.

Treatment is conservative management with rest and non steroidals, A randomized clinical trial: should the child with transient synovitis of the hip be treated with nonsteroidal anti-inflammatory drugs? Ann Emerg Med 2002.

Prognosis is usually excellent with recovery within one to four weeks,

This is an inflammatory condition affecting the mesenteric lymph nodes. It can present with acute or chronic pain and because of the location of the lymph nodes it can sometimes mimic appendicitis. Acute appendicitis in children: evaluation with US. Radiology 1990

Diagnosis is by ultrasound and a normal appendix has to be also demonstrated. Causes of such an adenitis include viral and bacterial gastroenteritis, group A strep pharyngitis, inflammatory bowel disease and lymphoma.

WebMD- Mesenteric Lymphadenitis

Radiopaedia- Mesenteric Lymphadenitis


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