Dawaa Reference

acute

Transient synovitis of the hip (irritable hip)

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources4 sources

Transient Synovitis - StatPearls (NCBI Bookshelf NBK459181) - https://www.ncbi.nlm.nih.gov/books/NBK459181/ · MSF Essential Drugs 2024 (ibuprofen oral monograph) · Transient synovitis of the hip - disease-level clinical article (transient-synovitis-hip-full.txt) · Transient synovitis of the hip - disease-level clinical article (transient-synovitis-hip-clinical.txt)

Verified against4 documents
  • Transient Synovitis - StatPearls (NCBI Bookshelf NBK459181) - https://www.ncbi.nlm.nih.gov/books/NBK459181/
  • MSF Essential Drugs 2024 (ibuprofen oral monograph)
  • Transient synovitis of the hip - disease-level clinical article (transient-synovitis-hip-full.txt)
  • Transient synovitis of the hip - disease-level clinical article (transient-synovitis-hip-clinical.txt)

Verified date2026-08

Presentation reference

Is it this?

Reference only, to read alongside your own examination.

Symptoms — what the patient reports (4)

  • Acute one-sided hip pain or a limp that can progress to refusing to bear weight [groin pain · hip pain · limp]
  • A young child may just seem more agitated or cry more than usual instead of reporting pain [irritability]
  • A recent upper respiratory infection, sore throat, bronchitis, or ear infection often precedes the presentation and favors this diagnosis [sore throat]
  • A prior episode of transient synovitis raises the likelihood it has recurred

Signs — what you find (4)

  • Restricted hip motion, especially with abduction and internal rotation
  • The hip may be held flexed, turned outward and away from the body to reduce pressure in the joint
  • About a third of patients actually have a completely normal range of motion on exam [reduced range of movement]
  • Pain felt at the front of the hip on the same side during the FABER test points to a hip-joint problem

Tests (9)

  • Fever at presentation is less common with transient synovitis (about 30%) than septic arthritis (over half)
  • ESR runs highest with septic arthritis (44-64 mm/hr), intermediate with Lyme arthritis, lowest with transient synovitis (21-33 mm/hr)
  • A CRP over 2 mg/dL is an independent risk factor pointing toward septic arthritis
  • Plain x-rays can stay normal for months, though the joint space on the affected side is often mildly widened by fluid
  • Ultrasound reliably picks up fluid within the hip joint capsule
  • The Kocher criteria (non-weight-bearing, fever over 38.5C, ESR over 40 mm/hr, WBC over 12,000) help separate septic arthritis from transient synovitis
  • Meeting all four Kocher criteria together gives a 99.6% probability of septic arthritis
  • With none of the Kocher criteria present, the chance of septic arthritis drops below 0.2%
  • A temperature above 38.5C was the single strongest predictor of septic arthritis over hip pain

If not this — what else fits (8)

  • Osteomyelitis is on the differential for acute pediatric hip pain, since missing it can be serious
  • Septic arthritis is the critical diagnosis to exclude in a child with acute hip pain
  • A primary or metastatic bone lesion is on the differential for pediatric hip pain
  • Legg-Calve-Perthes disease is on the differential for pediatric hip pain
  • Slipped capital femoral epiphysis is on the differential for pediatric hip pain
  • Lyme arthritis is an additional differential for pediatric hip pain
  • Pyogenic sacroiliitis is an additional differential for pediatric hip pain
  • Juvenile rheumatoid arthritis is an additional differential for pediatric hip pain

Scores

  • Kocher criteria — Septic arthritis, or transient synovitis of the hip?

SourceStatPearls "Transient Synovitis" - disease-level clinical article

Presentation findings are traced to the source above.

1

IBUPROFEN

1st line

Strength100 mg

Formoral.liquid

Adult dose and duration

200 to 400 mg 3 to 4 times daily (max. 1200 mg daily) for a patient 12 years and over - According to clinical response; symptoms generally improve after 24 to 48 hours

Paediatric dose

5-10 mg/kg/dose

(Over 3 months of age: 5 to 10 mg/kg, given 3 or 4 times a day, with 30 mg/kg in a day as the usual ceiling. MSF's own absolute ceiling is higher: up to 40 mg/kg daily in a child. The suspension is 100 mg per 5 ml, and the MSF pipette is marked off by body weight - one kilogram graduation delivers 10 mg of ibuprofen.)

Age restriction: minimum 3 months

Dose by weight
3kg15-30 mg/dose
4kg20-40 mg/dose
5kg25-50 mg/dose
6kg30-60 mg/dose
7kg35-70 mg/dose
8kg40-80 mg/dose
9kg45-90 mg/dose
10kg50-100 mg/dose
11kg55-110 mg/dose
12kg60-120 mg/dose
13kg65-130 mg/dose
14kg70-140 mg/dose
15kg75-150 mg/dose
16kg80-160 mg/dose
17kg85-170 mg/dose
18kg90-180 mg/dose
19kg95-190 mg/dose
20kg100-200 mg/dose
21kg105-210 mg/dose
22kg110-220 mg/dose
23kg115-230 mg/dose
24kg120-240 mg/dose
25kg125-250 mg/dose
26kg130-260 mg/dose
27kg135-270 mg/dose
28kg140-280 mg/dose
29kg145-290 mg/dose
30kg150-300 mg/dose
31kg155-310 mg/dose
32kg160-320 mg/dose
33kg165-330 mg/dose
34kg170-340 mg/dose
35kg175-350 mg/dose
36kg180-360 mg/dose
37kg185-370 mg/dose
38kg190-380 mg/dose
39kg195-390 mg/dose
40kg200-400 mg/dose
41kg205-410 mg/dose
42kg210-420 mg/dose
43kg215-430 mg/dose
44kg220-440 mg/dose
45kg225-450 mg/dose
46kg230-460 mg/dose
47kg235-470 mg/dose
48kg240-480 mg/dose
49kg245-490 mg/dose
50kg250-500 mg/dose
Dose source

MSF Essential Drugs 2024 (ibuprofen oral monograph)

Why

Indication claim, disease article: once a full diagnostic work-up has established transient synovitis, the management is supportive care and rest from activity, with a non-steroidal anti-inflammatory available for the pain. The article names the class and not a molecule. Dose claim, MSF Essential Drugs 2024 ibuprofen oral monograph, under indications covering mild to moderate pain, fever and rheumatic disease: a child over 3 months takes 5 to 10 mg/kg, given 3 or 4 times a day, to a ceiling of 30 mg/kg daily. Ibuprofen is the NSAID the Egyptian register actually stocks as a paediatric suspension - 21 oral-liquid products under that spelling.

Cautions
  • PAIN RELIEF IS NOT A DIAGNOSTIC TEST. A child whose hip settles on ibuprofen may still have septic arthritis - see the referral and safety-netting advice before treating and sending home.
  • MSF contraindicates it in: a child under 3 months of age; allergy to any NSAID; peptic ulcer; a clotting defect, active bleeding, or surgery that risks heavy blood loss; severe kidney or liver impairment; severe heart failure; severe malnutrition; dehydration or hypovolaemia that has not been put right; and severe infection. A febrile, dehydrated or septic-looking child is the wrong child for an NSAID.
  • MSF lists as possible harms: allergic reactions, pain in the upper abdomen, peptic ulcer, bleeding, and impaired kidney function. It says to give the drug carefully to the elderly and to asthmatics.
  • MSF says: do not combine it with methotrexate, with anticoagulants, or with another NSAID; and to monitor the combination with a diuretic or an ACE inhibitor - the patient should drink plenty, to keep the kidneys out of trouble.
  • MSF on how to give it: with food, and with at least 4 hours between doses.
  • The disease article's other measures cost nothing - heat applied to the hip, or massage.
  • STOP AND RETHINK ON A TIMER - if the symptoms are still significant 7 to 10 days after the child first presented, think of another diagnosis. Do not keep repeating the syrup.
Egyptian brands
Egyptian brandManufacturerIndicative price
NOVA-PROFEN 100MG/5ML ORAL SUSP. 100MLSANOFI2.25 EGP
IBUPROFEN 100MG/5ML SUSP. 120 MLSEDICO5.00 EGP
MARCOFEN 100MG/5ML SUSP. 120MLGLAXO SMITHKLINE5.85 EGP
MAFO 100MG/5ML SYRUP 100 MLEIPICO25.00 EGP
IBUCALMIN 100MG/5ML SYRUP 120 MLMASH PREMIERE28.00 EGP
JUSPOLED 100MG/5ML SYRUP 120 MLEGPI > JASPER FOR PHARMACEUTICAL INDUSTRIES31.00 EGP
MEGAFEN-N 100MG/5ML SUSP. 120 MLRAMEDA35.00 EGP
BRUFEN 100MG/5ML SYRUP 150MLKAHIRA > ABBOTT LABORATORIES44.00 EGP
BRUFEMOL-N SUSP. 60 ML? strength differs? different route - not oral liquidARAB DRUG COMPANY (ADCO)4.50 EGP
IBUFEN 2% SUSP. 60ML? strength differs? different route - not oral liquidALEXANDRIA4.50 EGP
2

REST AND SUPPORTIVE CARE (NO DRUG THERAPY)

1st line
Dose source

Transient synovitis of the hip - disease-level clinical article (transient-synovitis-hip-clinical.txt)

Why

Rest is named ahead of any drug in the article's management sentence, and the expected course is what turns a frightening limp into a manageable week at home.

Cautions
  • Treatment is supportive: rest from activity, and nothing more heroic. (Transient Synovitis - StatPearls - NCBI Bookshelf, NBK459181)
  • THE COURSE TO PROMISE THE FAMILY - things usually start to ease within 24 to 48 hours. In about 75% of children everything has gone within 1 to 2 weeks; the rest keep milder symptoms for some weeks more. (Transient Synovitis - StatPearls - NCBI Bookshelf, NBK459181)
  • RECURRENCE IS COMMON AND IS NOT A FAILURE - the article puts it at as many as 20% to 25% of children in one place and at 4% to 17% in another, with most second episodes arriving inside 6 months. (Transient Synovitis - StatPearls - NCBI Bookshelf, NBK459181) Warn the parents so the second episode does not arrive as a crisis.
  • The main complication is simply that it comes back. (Transient Synovitis - StatPearls - NCBI Bookshelf, NBK459181)
  • Symptoms lasting past a month are a different disease - where they have run beyond 1 month, the article reports that a different pathology was found. (Transient Synovitis - StatPearls - NCBI Bookshelf, NBK459181)
3

REFERRAL & SAFETY-NETTING (NO DRUG THERAPY)

1st line
Dose source

Transient synovitis of the hip - disease-level clinical article (transient-synovitis-hip-clinical.txt)

Why

Transient synovitis is a diagnosis of exclusion, and everything it must be excluded from is worse than it is. Carries the Kocher criteria, the workup the article requires before the label is applied, and the serious differentials.

Cautions
  • RED FLAG - SEPTIC ARTHRITIS. The Kocher criteria: a white cell count above 12,000 per microlitre of serum; the child will not or cannot bear weight; fever above 38.5 degrees C; and an ESR above 40 mm/hr. With all four present, the article puts the probability of septic arthritis at 99.6%.
  • With none of those risk factors present at the visit, the article puts the chance of a septic hip below 0.2%. (Transient Synovitis - StatPearls - NCBI Bookshelf, NBK459181) Four negatives is the reassuring combination; three positives is an emergency.
  • TEMPERATURE IS THE STRONGEST SINGLE SIGN - a temperature above 38.5 C predicted septic arthritis better than anything else, and after it, in the article's stated order: a CRP above 1 mg/dL, then the ESR, then refusal to bear weight, then the white cell count. (Transient Synovitis - StatPearls - NCBI Bookshelf, NBK459181)
  • THIS IS NOT A CLINIC-ONLY DIAGNOSIS - the work-up the article asks for is a white cell count, a CRP, an ESR, an x-ray of the hip and an ultrasound. (Transient Synovitis - StatPearls - NCBI Bookshelf, NBK459181) Without those, the label has not been earned.
  • A CRP above 2 mg/dL is on its own a risk factor for septic arthritis. (Transient Synovitis - StatPearls - NCBI Bookshelf, NBK459181)
  • REFER FOR ASPIRATION WHERE THERE IS AN EFFUSION - ultrasound picks up fluid inside the joint capsule very reliably, and aspirating under ultrasound both relieves the pain and the stiffness and often separates this quickly from septic arthritis. (Transient Synovitis - StatPearls - NCBI Bookshelf, NBK459181)
  • IF IN DOUBT, ADMIT - where there is clinical concern, or the diagnosis will not settle, admitting the child allows repeated assessment after a first period of supportive treatment. (Transient Synovitis - StatPearls - NCBI Bookshelf, NBK459181)
  • THE OTHER DIAGNOSES TO EXCLUDE, in the article's list: osteomyelitis, septic arthritis, a primary or secondary bone lesion, Legg-Calve-Perthes disease, a slipped capital femoral epiphysis, and also Lyme arthritis, pyogenic sacroiliitis and juvenile rheumatoid arthritis. An overweight adolescent with hip or knee pain is a SCFE until x-rayed.
  • Acute hip pain calls for those alternatives to be excluded first, above all the ones that leave lasting damage when they are not caught quickly. (Transient Synovitis - StatPearls - NCBI Bookshelf, NBK459181)
  • LATE CONSEQUENCE TO KNOW ABOUT - Legg-Calve-Perthes disease follows in 1% to 3% of them. (Transient Synovitis - StatPearls - NCBI Bookshelf, NBK459181) A child with a second or third episode deserves an orthopaedic opinion, not another course of syrup.

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.