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Transient synovitis — RACP Paediatrics MCQ

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EasyEmergencyTransient synovitisRACP Paediatrics

A 4-year-old has an acute onset limp and refuses to weight-bear on the right leg. He had a viral illness 1 week ago. Temperature is 37.2°C. The hip is held in flexion and external rotation with restricted internal rotation. WCC and CRP are normal. Ultrasound shows a small hip effusion. What is the most likely diagnosis?

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Correct answer: C — Transient synovitis

An acutely limping child aged 3-8 years with recent viral illness, low-grade or no fever, mildly restricted hip movements, normal inflammatory markers, and a small hip effusion is most likely transient synovitis (irritable hip). This is the most common cause of acute hip pain in children. Kocher criteria (fever, non-weight-bearing, ESR >40, WCC >12) help distinguish it from septic arthritis.

Reference: RCH Melbourne – 2023 – Acute Limp CPG; RACP Paediatric Curriculum – Emergency