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My very active 23 month old son had irritable hip in February this year - it lasted around 2.5 weeks in total. Three doctors (including an orthopedic surgeon) saw him and agreed it was a "slight" irritable hip. During this time he had an xray done which came back clear and no concerns were raised.

He recovered completely. However, following a very active weeekend and a cough/cold which started two weeks ago he has developed a limp again. As last time, he is acting completely normal (including running, climbing, jumping etc) and has not had a fever at all. His joints are not red or swollen and he allows me to move his hips freely. His only symptom is stiffness when walking and i have noticed that he has been turning his leg out slightly whilst walking. I took him to the GP two days ago and based on my son's behaviour he was not worried at all. He told me that given the clear xray 4.5 months ago and the fact that he recently had a viral illness, it is likely a recurrence of irritable hip and to return after a week if he had not improved. Today is day 4 and he is showing signs of improvement though still a bit stiff.

My question is - does irritable hip tend to recur this way? It has only been 4.5months since the last episode (although this has been his first illness since then) but should I press for further tests? I am paranoid that he has some form of Juvenile arthritis even though i cannot see any redness/swelling and he has not had fevers. Dr Google is only stressing me further with this one! I am also 5.5months pregnant with raging hormones which does not help my stress levels :(


ANSWER: Hi, Louise,

"Irritable hip" is a meaningless term to me.  I suspect he had what we would call "toxic synovitis" a transient irritation, maybe viral in nature, of the hip joint. This condition can recur with other viral illnesses.  Without the red, heat, swelling or fever, JRA would be uncommon.  I would just watch.  
Good luck with the pregnancy, Dr. Olson

---------- FOLLOW-UP ----------

QUESTION: Thank you very much. Yes, I am referring to toxic synovitis (which for some reason is called irritable hip over here!). His progress has been slow, for instance it is now not noticeable when he runs, only when he walks slowly. At what point do you think I should take him in to be re-examined? At the week mark like the dr suggested or if he doesnt recover by the 14 day mark by which he was better last time? I know from experience that this takes a lot of patience but unfortunately im a worrier!

Thanks again

ANSWER: Hi, Louise,

Oh, Tox syn as we say!  Most kids get better quickly, but there are reports in the literature of prolonged, months, recovery.  I would give it 2-3 weeks and at that time, recheck if all is not well. If all is not well, then then time may be to explore other possibilities, although strongly this sounds like toxic synovitis.  

Good luck, Dr. Olson

---------- FOLLOW-UP ----------


Sorry one last question... Today is the one week mark and my son has been improving (albeit slowly). He seemed much better today except for this evening before bed when out of nowhere the limp appeared to get worse again :( Given this apparent setback should I take him to the dr in the morning or do you suggest waiting a few more days to see how he carries on? Is it likely a dr will order further tests at this stage or continue with a wait and see approach given his age?I am so worried I can barely function and stories of leukaemia/perthes/juvenile arthritis online Makes things worse.

I should also mention that we did stop nurofen 2 days ago (day 5) as he seemed to have improved and other than this evening has continued to improve slowly. Should we re-start nurofen?

Thanks again


I would restart the med.  It may help reduce any remaining inflammation and using it for another week would be reasonable.

Improving, albeit slowly, is good.  Again, the improvement pretty much eliminates the serious and chronic diseases you are worried about.  A bit of a set back may have been due to the stopping of the med or a mild injury/strain.  If this is no better in a week or so, see your doctor and have a discussion re further lab tests or referral to a peds ortho person.

Good luck, and if I can be of help to you, don't feel bashful about asking, Dr. Olson


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David Olson, MD


I would be happy to attempt to answer any questions about general pediatric topics, either medical issues or behavioral issues. This would include all the various questions one receives in a busy pediatric practice. I`m a board certified pediatrician in northern Michigan and have been in practice for over 15 years. I enjoy the teaching role I have in our practice and would enjoy the opportunity to help others with their pediatric problems.

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