Skip to textbook content
Doctor’s PassportTextbook
TopicsAll topics

Loading topic navigation…

Textbook navigation
TopicsAll topics

Loading topic navigation…
Educational draft · awaiting clinical reviewUse Rapid for revision, not patient-care decisions. Check current national and local guidance and the BNF or BNFC before acting.

Transient synovitis, Perthes disease and SUFE

Paediatrics and child health · UK scope · Sources checked 27 Aug 2026 · Clinical review pending

RapidFull
!
Suspected unstable SUFE

A pubertal young person has acute hip, thigh or knee pain and cannot walk even with crutches, with the leg resting externally rotated.

Action: Stop all weight bearing, do not force hip movement or attempt reduction, give analgesia, keep fasting if surgery is likely and contact orthopaedics immediately. Obtain bilateral AP pelvis and a safe cross-table lateral through the local radiology and orthopaedic protocol; avoid frog-leg positioning in an unstable hip.

Synopsis

Separate a self-limiting irritable hip from Perthes disease, slipped upper femoral epiphysis and infection, then protect the physis and femoral head through safe imaging, immediate non-weight-bearing and appropriately urgent orthopaedic care.

  • Hip disease in children commonly presents as thigh or knee pain. Examine both hips in every child with unexplained knee pain or a new out-toeing gait.
  • Transient synovitis usually affects a well, afebrile child after a viral illness, causes an acute limp with limited hip movement and should improve clearly within 48 hours and resolve over about a week.
  • Transient synovitis is a diagnosis of exclusion. Fever, systemic illness, complete non-weight-bearing, severe passive-movement pain or raised inflammatory markers require urgent assessment for septic arthritis or osteomyelitis.
  • Perthes disease is idiopathic interruption of blood supply to the capital femoral epiphysis, typically causing weeks or months of limp, activity-related groin, thigh or knee pain and loss of abduction and internal rotation in a child aged roughly 3 to 9 years.
  • Request AP pelvis and an appropriate lateral view of both hips for suspected Perthes disease; early radiographs may be normal, so persistent symptoms need orthopaedic review and sometimes MRI.
  • SUFE usually affects a peripubertal young person, especially with obesity, and causes hip, groin, thigh or isolated knee pain, limp, loss of internal rotation and obligatory external rotation during hip flexion.
  • Once SUFE is suspected, make the child strictly non-weight-bearing, provide analgesia, keep fasting if surgery is likely and obtain immediate orthopaedic advice. Do not ask them to walk for demonstration.
  • For a clinically stable SUFE, obtain bilateral AP pelvis and frog-leg lateral views according to the orthopaedic pathway. If unstable and unable to walk even with crutches, avoid frog-leg positioning and use a cross-table lateral selected with radiology and orthopaedics.
  • The standard definitive treatment for confirmed SUFE is urgent surgical stabilisation, commonly in-situ screw fixation. Forceful manipulation or attempted reduction can compromise femoral-head blood supply.
  • Review the opposite hip and growth or endocrine context. Bilateral disease is common enough to require surveillance; atypical age, low weight, short stature or endocrine features should prompt directed investigation.

Key red flags

Fever, systemic illness or shock with hip pain suggests septic arthritis or osteomyelitis rather than simple transient synovitis.

Complete refusal or inability to bear weight requires urgent assessment even when initial radiographs are normal.

An unstable SUFE must not be walked, frog-leg positioned or forcibly reduced because further displacement can compromise blood supply.

Persistent symptoms beyond the expected transient-synovitis course require review for Perthes disease, inflammatory disease, tumour or infection.

Night pain, weight loss, pallor, bruising, mass or lymphadenopathy raises concern for malignancy.

Back pain, weakness, altered reflexes or bladder and bowel change suggests spinal infection, tumour or neurological compression.

Atypical SUFE in a very young, short or underweight child warrants endocrine and renal assessment.

Unstable SUFE

Sudden severe hip or knee pain with inability to walk even using crutches indicates instability and high avascular-necrosis risk.

Infective mimic

Fever, toxicity, severe passive pain or complete non-weight-bearing makes septic arthritis the immediate priority.

Investigation priorities

01
First-line clinical risk assessmentFirst stepFirst line

Document temperature, appearance, weight bearing, pain severity, both-hip range and infection, neurological or malignancy features.

02
First-line bilateral pelvic radiographsFirst line

Obtain AP pelvis and an appropriate lateral view for persistent limp, restricted hip or suspected Perthes disease or SUFE.

Management branches

Likely transient synovitisConfirm the expected recovery

The child is well and afebrile, can bear some weight and has a short low-risk history after viral illness.

  1. Provide relative rest, age-appropriate analgesia and written advice to return immediately for fever, worsening pain or inability to bear weight.
  2. Review in approximately 48 hours and confirm clear functional improvement rather than relying only on reduced pain after medicine.
  3. If symptoms are not resolving by about one week, recur or become atypical, arrange imaging and specialist reassessment.

Key medicines

ParacetamolUse the current BNFC age- or weight-specific oral dose and maximum; prescribe a measurable paediatric formulation and review need as symptoms improve.Check all combination products and total daily exposure, use lower or less frequent dosing where hepatic risk requires it, and do not let analgesic response override red flags.
IbuprofenUse the current BNFC age- or weight-specific oral dose for a short course when an NSAID is appropriate.Avoid with dehydration, significant renal disease, active gastrointestinal bleeding, previous NSAID hypersensitivity or NSAID-sensitive asthma; it is not treatment for septic arthritis or SUFE.
Open full textbook →Answer 2 questions
Sources and review status5 sources · checked 27 Aug 2026 · clinical review pending+
Sources

Sources and review status

National guidance is shown before implementation-dependent detail. Typical adult dose examples remain subject to patient factors, contraindications and the live BNF or specialist protocol. Source check completed 27 Aug 2026; clinical approval remains outstanding.

  • NHS hip pain in childrenIrritable-hip recognition, urgent symptoms and the need to exclude infection, injury and Perthes disease.
  • NHS Tayside slipped upper femoral epiphysisCurrent UK SUFE risk factors, referred knee pain, examination traps and urgent surgical referral.
  • Oxford University Hospitals Perthes diseaseUK description of vascular pathology, presentation, follow-up, containment options and long-term joint risk.
  • NHSGGC atraumatic painful limbAge-patterned differential, radiographic approach, Perthes and SUFE findings and urgent orthopaedic assessment.
  • BNF for ChildrenCurrent child-specific paracetamol and ibuprofen doses, formulations, contraindications and maximum exposure.

Editorial contact: Doctor’s Passport editorial team. Source-check date is separate from clinical approval. Report a content problem ·

Content changes
Authoring stateRapid draftClinical stateAwaiting reviewJurisdictionUnited Kingdom