Rapidly Progressive Left Hip Pain In A 43-Year-Old Male Celestine Nnaeto, MD, Jarem Lloyd, MD, Maheep Vikram, MD, Kevin Waninger, MD, St Luke’s University Health Network, Bethlehem, PA

Introduction Differential Diagnosis Conclusion The purpose of this case report is to ►► Transient synovitis ►► Imaging: Hip x-ray showed chronic ►► Numerous cases of transient synovitis present a rare cause of rapidly progressive ►► Bursitis avulsion fracture of the left anterior- have been reported in children. It left hip pain in an adult black male. ►► Reactive arthritis inferior Iliac. No acute fractures or especially occurs in ages 3-10 years ►► septic arthritis arthritic changes. Figure 1. old following viral infection. Transient ►► osteonecrosis ►► MRI left hip showed intra-articular synovitis in children is often managed History ►► femoral head fracture synovial inflammatory changes supportively with NSAIDs as needed ►► Muscle strain associated with small joint fluid and for pain control, and lower extremity ►► 43-year-old black male with history of ►► Labral tear no evidence of bone marrow changes. weightbearing as tolerated. recent URI and remote left ankle injury ►► Arthritis Figures 2, 3, and 4. ►► On the other hand, acute reactive who presents to sports medicine clinic ►► Hip dislocation ►► Working diagnoses: Transient arthritis, synovitis, or septic arthritis with complaint of rapidly progressive ►► Labs: WBC and CRP within normal synovitis. of the hip are well documented left hip pain for two days. His pain limits; ESR 14. phenomenon in adults. They are started two days prior to presentation often associated with rheumatologic and became progressively worse. diseases, trauma, arthritis, gout, or Pain is sharp, nonradiating, and infection. Just like transient synovitis, primarily located in the left groin. It is they all presents with hip or groin pain. exacerbated by any lower extremity hip Definitive diagnosis may sometimes movement. He also have associated include invasive procedure such as difficulty ambulating on the left lower arthrocenthesis or arthrotomy. It is extremity due to pain. Although his Figure 2. particularly very important to recognize profession requires prolonged standing that transient synovitis of the hip, a far less benign pathology, may also and walking, he denies any known occur in adults. To date, only a few trauma to the left lower extremity, fever, cases of transient synovitis of the hip chills, focal weakness or paresthesia. has been reported in adults. Just as in children, the few cases of transient Figure 1. synovitis reported in adults occurred Figure 3. following viral illness. It is a diagnosis Physical exam Treatment of exclusion that requires good history and exam. CBC, ESR, CRP, X-ray or ►► Patient was ambulating with antalgic Upon initial presentation the patient was u/s may be done to r/o other etiologies. gait and minimal weight bearing on placed on crutches due to difficulty walking Recognition of transient synovitis in the left lower extremity. There was no from his severe pain. After x-ray on initial adult will likely prevent unnecessary hip deformity, swelling or ecchymosis. presentation failed to reveal any acute expensive or morbidity related No piriformis, trochanteric, or groin pathology, MRI of his left hip was ordered diagnostic procedures and treatment. tenderness in the left hip. He had to further evaluate patient’s hip due to the difficulty with sitting or lying on the rapidly progressive nature of his symptoms, Figure 4. examination table due to severe left severe pain, and decreased range of Outcome eferences groin pain. There was significant groin motion due to pain, he was started on R pain with internal, external left lower Patient’s pain rapidly improved upon 1. Quintos-Macasa AM, Serebro L, Menon Y. Transient NSAIDs for pain control. After his CBC synovitis of the hip in an adult. South Med J. extremity logroll. Hip range of motion and MRI ruled out infectious etiology such starting the prednisone. He stopped 2006;99(2):184-185. examination was limited due to severe using the crutches two days later and 2. Laroche M, Moineuse C, Constantin A, et al. Do adults as abscess, he was started on prednisone develop transient synovitis of the hip? Three case reports. pain. There was no knee, trochanteric Dosepak. During his followup visit one by day three of prednisone treatment, Joint Bone Spine 2000;4:350-352. bursa or lumbar tenderness. he was able to sleep through the night 3. Nyska M, Buskila D, Howard CB, et al. Benign synovitis of week later, he reported that his symptoms the hip in adults. Br J Rheumatol 1993;32:820-821. rapidly improved within the next couple of without pain waking him up. Patient’s 4. Dzioba RB, Barrington TW. Transient monoarticular symptoms completely resolved without any synovitis of the hip joint in adults. Clin Orthop days after starting the prednisone. 1977;126:190-2 complications or sequelae.