Toxic Synovitis?

[geekygirly]

TL;DR: Anyone have experience with toxic synovitis? What were the symptoms? Or random hip pain in kids? What did it end up being? 

Yesterday afternoon after watching a movie on the sofa, DD got up and started complaining that her (left) leg was hurting, and limping a bit. I also noticed she was a little warm. I checked her temp and it was low grade (99.4), but she has had a sniffly/stuffy nose for several days so that wasn't necessarily weird. I asked her if anything happened at school and she said no. She claimed she had walked into the door of the washing machine when she was leaving the bathroom earlier, but even if she did I (1) doubt it would cause a severe injury, (2) didn't hear any cries of agony when leaving the potty earlier. I tried laying her on her back and feeling her leg and moving it around. The pain seemed to be coming from moving her hip, but she said it was minor. After a while though she seemed to be fine and was running around as normal, so I let it go.

This morning, she woke up at 6:45 crying that she wanted to get up and couldn't because her leg hurt too bad. I lifted her out of bed and DH and I have been trying to figure out how bad the situation is. The pain seems lessened since she got up and started walking around but she seems really timid about walking (wanting to hold onto us or to stuff) and asked to sit on the sofa and watch a show. Her temp is still mid-99s. 

I'm going to send an email to her teacher just to verify nothing happened at school yesterday, but I doubt it because they are pretty good about telling us that stuff. She did fall running around on the playground on Thursday and bit her lip, but the fact that she didn't start complaining about leg pain until 24-ish hours later makes me think it probably isn't that(?)

I was looking up possibilities online and came across toxic synovitis which seems to match her symptoms, but was wondering if anyone else had experience with it and how it presented: kidshealth.org/en/parents/toxic-synovitis.html . I also thought about growing pains but is it weird it is only one leg? 

We are going to call the pedi when they open, but with all the flu going around I admit I'm hesitant to bring her in unless we need to (but obviously will if we have to). 

Thanks for getting through all this and for any ideas you might have. 

[joy]

My daughter maybe had it.

She woke up with a low fever and refused to stand. If we tried to get her to stand, she cried terribly. My husband thought she broke something but I had heard of hip inflammation with viruses so I wasn’t surprised when the pediatrician diagnosed toxic synovitis. She did some range of motion tests and watched a video I took before diagnosing. Our daughter (14 months at the time) was also walking around the exam room at that point.

We were told to watch her and bring her back if she still wasn’t walking in two days. But, since she looked great then, that toxic synovitis was all. It was just inflammation due to a mild virus and not a cause for concern.

I’ll spare you the rest in detail, but my daughter regressed quickly and refused to walk for several days. The reason they have you call in two days after no improvement is the risk of bacteria in the joint. We ended up with bloodwork and a trip to the ER to rule that out.

To be very complete - the cause of her hip pain could have been three things: toxic synovitis, bacteria in the hip or juvenile rheumatoid arthritis (autoimmune). We are still in the process of determining if she has arthritis.

[flippinchica]

A few things. joy stated ithe main possibilities. Toxic synovitis is the most common of these but more common in toddlers and preschoolers. It usually responds to Motrin so I would try that. The biggest concern is infection in the joint because if not treated it con cause long term damage to the joint

[danib]

I had Acute Synovitis in my hip (not toxic, no temp). I started off achy but didn't think much of it because I have RA. After 2ish days I was limping an needed support moving from sitting to standing. Next day I couldn't walk and had to go to the ER.
I got bad, but I have multiple autoimmune diseases and my case was not typical.

Edit to add. One thing they checked in the ER was the ability to rotate my hip. SO i was laying on my back with legs straight and they held my lower leg and moved my leg up-down, side to side, and rotated inward and then outward. I could not rotate without extreme pain.

[linny]

My DD had it at 18 months. She was limping for a few days then her fever went up to 104.7 with tylenol and motrin on Christmas day. The after hours pediatrician sent us to the pediatric ER to make sure it was viral not bacterial. It was viral so we just had to let it run it's course. She limped for about 2 or 3 weeks if I remember correctly.

They told us bacterial would have felt warm to the touch, fever would have continued to increase, and if not treated, could cause long term issues with her joints.

[peppapig]

Growing pains can happen in one leg (as it does with my kiddos and my friends' kiddos) and usually flares up in the evening around dinner time and in the mornings. I have heard that the pain can be so bad that it can wake them from their sleep. Our ped says as long as the pain comes and goes and isn't constant, it usually isn't something concerning.

I hope you get some relief for you little one soon.

[blablabirdie]

My son had it. Or rather I don't know what it is called in English, but he woke up one morning and couldn't walk without screaming in pain. He didn't have much of a fever or other symptoms. I remember my son complained of knee pain, but the doctor explained that it was just how they describe it and did a few tests to show it was in the hip. Our doctor wanted us to go to the hospital to rule out anything else. The hospital standard routine for diagnosis included blood work, an x-ray and an ultrasound of the area. They ruled it was an infection that would pass and sent him home to rest. They said it it hasn't improved in a week to come back. 3 days later he was fine. But it was pretty scary. The doctor said it was not that uncommon and DS' preschool teacher said her kid had experienced it.

ETA He only had it in one leg, which they said was normal.  

[geekygirly]

Thanks for all the input everyone. We called the pedi and they want us to come in at 10:45. Will update with what they say.

ETA: joy , just out of curiosity, why do they think she might have RA? Has she had other problems since then? Or just because of that one bout?

peppapig Unfortunately the pain seems pretty constant at this point. She seems OK sitting/laying on the sofa but doesn't really want to walk.  

[joy]

Feb 3, 2018 8:21:25 GMT -6 geekygirly said:

Thanks for all the input everyone. We called the pedi and they want us to come in at 10:45. Will update with what they say.

ETA: joy , just out of curiosity, why do they think she might have RA? Has she had other problems since then? Or just because of that one bout?

peppapig Unfortunately the pain seems pretty constant at this point. She seems OK sitting/laying on the sofa but doesn't really want to walk.  

After two days of no walking they did blood work. Some of her results indicate that it could be an autoimmune problem. She also refused to use one hip but the doctor noted loss of range of motion in the other so both joints were affected at that time.

[Deleted]

geekygirly, I have no experience with toxic synovitis, but Dr Google isn’t your friend.

The sudden onset symptoms to the point of not walking are all alarming enough to me that I think you’re doing the right thing taking her in. Hopefully it’s something minor.

[gwapes]

Was she recently sick? When DS1 had it at 3, the ER doc and ortho said it presents after a cold/ virus. His did go away in a few days. Hope she feels better.

[mothafuckinteatime]

DS had it. It was treatable with Motrin but definitely scary at first. I noticed at the beginning and ends of the day his pain seemed worse and then got better throughout the day. He was limping for about 2 weeks, but otherwise okay.

[hardlyluck]

Ours was pretty much exactly like mothafuckinteatime.
DS1 has it at 18 months. Like gwapes mentioned his showed up after a cold too. The first day sucked cause he screamed about his hip hurting ever time I touched him. Motrin and rest were all we were told to do, he did limp for a few weeks but no lasting effects. He’s 4 now and it hasn’t happened again...although I can’t remember if the dr said it was only a one time thing or if it could reoccur.

[peppapig]

Feb 3, 2018 8:21:25 GMT -6 geekygirly said:

Thanks for all the input everyone. We called the pedi and they want us to come in at 10:45. Will update with what they say.

ETA: joy , just out of curiosity, why do they think she might have RA? Has she had other problems since then? Or just because of that one bout?

peppapig Unfortunately the pain seems pretty constant at this point. She seems OK sitting/laying on the sofa but doesn't really want to walk.  

I'm glad you are being seen. Yes, please update us.

[dogbutt]

I had it as a kid. I remember I couldn’t walk so I was pulling myself around in the floor. It scared the shit out of my mom. I hope you guys can figure out what is going on and your Dd starts feeling better ASAP.

[geekygirly]

Update: Pedi suspects toxic synovitis but is sending us to pediatric ER to run more tests and rule other things out. So we are otw there.

ETA: gwapes She is just getting over what was probably a minor cold (snotty nose and low-grade fever only symptoms and acting ok), but nothing major. They did a flu test in the office jic which was negative.

[geekygirly]

We are still here. They gave her Motrin and took X-rays which were fine (X-rays took a long time since they were backed up).

Motrin didn’t help with pain as much as they were hoping so now they’ve added Tylenol and just took blood work (put an IV in while they were at it jic, which DD was NOT happy about ). It sounds like they may do an ultrasound too.

[sweptaway]

geekygirly, I'm sorry you guys are at the hospital but glad they're being thorough. I hope they are just ruling things out and there isn't anything more serious happening. I might have missed it- how old is your DD?

[peachtree]

Okay very long story ahead.

When my DS2 was 17 months he woke up one day with a low fever and he refused to walk. He ended up having pyomyositis which is an infection of the muscle. But at first they thought it was a fracture or toxic synovitis.

I will type out the whole thing incase his symptoms stand out.

Took him in and they took x rays. They couldn’t see anything but said that wasn’t unusual in toddlers. Said to come back if anything changed.

That was a Wednesday I think. By Friday morning he was in a ton of pain and was only comfortable sitting am certain ways. Either in the Ergo or is highchair basically. Alternating Tylenol and Ibuprofen would take the edge off. But he was pretty lethargic so it was obvious he was sick.

Took him back this time to his main doctor and she drew blood and and said she would call in a few hours.

She called and based on the blood work said we needed to drive 2 and half hours to the nearest children’s ER.

They rushed him to surgery assuming that his hip had gone septic.
They drew fluid from three paces in the affected leg and it was clean so they stopped what they had planned to do and admitted him to the hospital. The next morning they did an MRI and could see his glut and hip muscles were infected. Apparently infection in a muscle will light up on an MRI.

He was diagnosed with pyomyositis. Which is a fancy word for a bacterial infection in the muscle. They started him on a very high dose of antibiotics for 21 days and he was as fine after the that.

The infectious disease specialist said in the whole state he sees one case a year. It happens when you get a bruise and a cut that allows the bacteria into a muscle. Usually in toddlers or teenage athletes because of how they tend to beat up there bodies.

I hope you get answers. Let me know if I can answer any questions. We had a scary 24 hours of not knowing what was wrong with lots of scary thoughts thrown around. I hope you get an answer ASAP.

[geekygirly]

sweptaway she is almost 4

peachtree thanks for sharing your story. Every bit of info is helpful.

Luckily we just got most of the blood results back and everything looks good so far (WBC is ok). We are waiting for a few more things on the blood work and then an ultrasound. They still are thinking toxic synovitis but want to rule anything else out (it sounds like it’s mostly a diagnosis of exclusion).

[peachtree]

Feb 3, 2018 15:12:55 GMT -6 geekygirly said:

sweptaway she is almost 4

peachtree thanks for sharing your story. Every bit of info is helpful.

Luckily we just got most of the blood results back and everything looks good so far (WBC is ok). We are waiting for a few more things on the blood work and then an ultrasound. They still are thinking toxic synovitis but want to rule anything else out (it sounds like it’s mostly a diagnosis of exclusion).

That is good. DS has a a high WBC and something else that indicated an infection was present that made then tell us to rush to the hospital.

They did tell us exactly what you said that they diagnose toxic synovitis by excluding other causes for the pain.

[geekygirly]

Otw home! The rest of the blood work looked good. Ultrasound showed a small amount of fluid which would be consistent with toxic synovitis. They said she should hopefully improve over the next few days but if no improvement by Mon-Tues or it gets worse (e.g., high fever) to head to CHOP where they could take a fluid sample. In the meantime Motrin every 6 hrs. FX she feels better tomorrow. Heading right to bed when we get home.

[peachtree]

Feb 3, 2018 17:55:23 GMT -6 geekygirly said:

Otw home! The rest of the blood work looked good. Ultrasound showed a small amount of fluid which would be consistent with toxic synovitis. They said she should hopefully improve over the next few days but if no improvement by Mon-Tues or it gets worse (e.g., high fever) to head to CHOP where they could take a fluid sample. In the meantime Motrin every 6 hrs. FX she feels better tomorrow. Heading right to bed when we get home.

Yeah for going home. Fingers crossed for continued improvement.

[joy]

Glad to hear this!

And hiya neighbor!

[geekygirly]

Just an update in case anyone was still wondering: DD is doing a LOT better! Once we got home from the ER Saturday night, she was willing to walk around a bit getting ready for bed. By yesterday, she was running around playing and acting her normal self again. We're going to keep her on the Motrin through today (although maybe stop waking her up for it MOTN) and then wean her off it. We did keep her home from preschool today between that and the late night for the Super Bowl, but expect her to be going tomorrow (unless the parade is tomorrow, in which case we might keep her home again ) Thank you all for all the well-wishes! It was so heartbreaking to see her unwilling to move on Saturday so I'm so relieved to see her recovering so quickly. 

[lifesaverz]

geekygirly, I’m glad she’s doing so much better!