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Treatment of Transient Hip Tenosynovitis with NSAIDs



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Am Fam Physician. 2003 Jan 15;67(2):406.

Transient tenosynovitis of the hip (“irritable hip”) is a common emergency department problem among children three to 10 years of age. Sterile joint inflammation results in pain on hip movement and may manifest as limping or inability to walk. This benign condition usually resolves within seven days, but children and parents can be concerned about the symptoms. The etiology for this condition is unclear, although an infectious cause or antecedent is commonly postulated. Treatment options also have been unclear. Kermond and associates evaluated the use of ibuprofen, a safe and effective nonsteroidal anti-inflammatory drug (NSAID) frequently used in children for a variety of conditions, to treat transient tenosynovitis.

Children between 12 months and 12 years of age who presented to the emergency department with typical symptoms were evaluated by laboratory testing and hip ultrasonography for other causes of pain. Those without exclusion criteria, such as a contraindication to ibuprofen, were randomized in a double-blind manner to receive either ibuprofen syrup (10 mg per kg three times daily for five days, n = 17) or a placebo syrup (equivalent dosage, n = 19). All patients were re-evaluated within two to three days and afterward as needed. Acetaminophen could be taken as needed for pain.

Patients who received ibuprofen had a mean resolution of symptoms after two days, compared with the placebo group's mean of 4.5 days. Two patients in the ibuprofen group had symptoms beyond seven days, compared with four of the placebo-treated children. One participant in each group had a brief recurrence after treatment ended. Slightly less acetaminophen was taken by patients in the ibuprofen group. The ibuprofen group reported more adverse effects, including nausea, vomiting, and diarrhea, but there were no serious adverse effects and there was no significant difference in the discontinuation rate between the two groups.

The authors conclude that hip tenosynovitis symptoms may resolve more quickly with the use of ibuprofen, probably secondary to the NSAID's anti-inflammatory effects rather than its analgesic effects. Treatment with ibuprofen is safe and well tolerated.

Kermond S, et al. A randomized clinical trial: should the child with transient synovitis of the hip be treated with nonsteroidal anti-inflammatory drugs?. Ann Emerg Med. September 2002;40:294–9.


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