Orthopedics-Online

Coxitis fugax

Synonyms in the broadest sense

"Hip runny nose", coxitis serosa, transitory synovitis of the hip

definition

The "hip runny nose" is a kind of inflammation of the hip joint. More precisely, it is a temporary abacterial irritation of the hip joint of children.

Occurrence of coxitis fugax

Usually the children affected are under 10 years old. Boys are affected four times as often as girls. The peak of the disease is between 3 and 8 years, whereby both younger and older children can become ill.
Both joints are affected equally often. So there is no tendency to one side of the body. Both hip joints are rarely affected at the same time (less than every twentieth child). An increased occurrence can be observed in the spring and late months of the year. In the summer, however, inflammation of the hip is rare.
A familial accumulation, i.e. possibly a genetic component, could not be confirmed to date. Coxitis fugax also seems to occur independently of congenital or acquired hip joint damage.

What causes coxitis fugax?

The origin of coxitis fugax is unclear. However, it has been observed that "hip rhinitis" is preceded by a banal, viral infection, usually of the upper respiratory tract or the gastrointestinal tract. Often this infection was about two weeks ago. A joint effusion then forms. Occasionally, transitions from coxitis fugax to Perthes disease have been described. The "hip runny nose" is therefore not an independent disease, but always the result of an infection.

Symptoms of coxitis fugax

Children's complaints with coxitis fugax appear suddenly. The children usually report the pain in the groin area.

The children stand out mainly because of their limping. The pain relieves the affected side. The limping that occurs in this way is called restraint limping. Occasionally, the pain of coxitis fugax also radiates to the nearby knee joint. This fact is typical of a "hip runny nose" and the parents should always see a doctor. The general well-being of the children is otherwise mostly unimpaired and do not have a fever.

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The hip joint is one of the joints that are exposed to the greatest stress.
The treatment of the hip (e.g. hip arthrosis, hip impingement, etc.) therefore requires a lot of experience.
I treat all hip diseases with a focus on conservative methods.
The aim of any treatment is treatment without surgery.
Which therapy achieves the best results in the long term can only be determined after looking at all of the information (Examination, X-ray, ultrasound, MRI, etc.) be assessed.

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Stress-related pain

Also characteristic of this childish hip pain is their load dependency.
So they do not occur under physical protection. In some cases, the pain can even be so pronounced that the children no longer want to walk at all, or they switch back to early childhood modes of transport such as crawling.

In addition, limited hip mobility on the affected side is typical. The affected children give a rotational movement in the hip, which is particularly uncomfortable and painful (Internal rotation), i.e. a type of movement in which the leg is only rotated by moving the hip joint.

Diagnosis of coxitis fugax

Ultrasound is the primary method used to diagnose coxitis fugax. This is a grateful examination method for children because it is neither invasive nor painful and can be performed quickly. The transducer can be placed directly on the hip joint. An enlarged joint space filled with fluid can be seen very well on ultrasound. The X-ray image, on the other hand, which is always associated with radiation exposure and which is therefore attempted to avoid in children as much as possible, usually does not show any abnormalities. Blood can be taken in the case of coxitis fugax, but usually does not show any changes in the inflammation parameters.

MRI for coxitis fugax

To diagnose coxitis fugax, first the history of the disease, a clinical examination, a blood test and then an ultrasound of the hip - once the affected side and then the opposite side.

The diagnosis of Coxitis fugax can be confirmed by the ultrasound examination. However, if there are indications of other diseases of the hip that must be ruled out urgently, an X-ray examination of the hip can be carried out or, in very rare cases, an MRI, magnetic resonance imaging.

In particular, if after 14 days there is no improvement in the course of the disease, further imaging diagnostics should be carried out.

You might also be interested in: MRI - what do I have to consider?

Illustration of the hip (CT pelvis)

Spine
Iliac blade (os ilium)
hip joint
Femoral head
Femoral neck
Symphysis
small rolling hillock (trochanter lesser)
large rolling mound (greater trochanter)

Therapy of coxitis fugax

The "hip runny nose" can - provided all other illnesses have been excluded - be treated waiting.
After a few days to weeks, the coxitis fugax resolves spontaneously. Meanwhile, the joint should be spared and relieved. This can be done, for example, with walking aids (crutches) happen. A general bed rest of 2 to 4 days would be the most effective method. So the "hip cold" can heal without consequences.
Another method is the extension of the leg. The leg is stretched in the hip and a slight pull is exerted on the hip joint so that the hip is relieved.
However, it is important not to overlook a possible bacterial inflammation, as this can damage the joint. In the case of severe pain, painkillers can definitely be given, but these must be tailored to children by the doctor.
Parents using pain relievers already in the household (mostly for adults) can cause harm to children. It is therefore essential that you speak to your doctor. Anti-inflammatory drugs (NSAIDs) can also be used if necessary.

Homeopathy for coxitis fugax

The most important measure for the treatment of Coxitis fugax is physical rest.
There are also some homeopathic remedies that can be taken to aid and relieve symptoms.

It will Ferrum phosphoricum recommended, an iron phosphate that works against fever and inflammation in the early and acute stages of illness.
Another remedy comes Drosera rotundifolia into consideration, which is obtained from the carnivorous plant sundew and can also be used for infections or bone pain.

Duration and prognosis for coxitis fugax

In most cases, the symptoms of coxitis fugax only last a few days.
Statistically, half of the patients are affected for one week. It takes about two weeks for the other half of the children to fully recover.

In summary, the coxitis fugax should normally have resolved on its own after two weeks without consequences. The duration of coxitis fugax can be positively influenced in a certain way and healing can be supported by consistently protecting yourself.
Since the hip pain only occurs when the patient is exerted, they usually try to take it easy on their own.
With the help of painkillers that are suitable for children, one can also achieve a subjective shortening of the duration of coxitis fugax by alleviating movement-dependent pain.

Thereupon the restraint limping is less or even no longer necessary, whereby the symptoms of coxitis fugax can be largely prevented, which decisively shortens their subjectively perceived duration.

Guidelines for coxitis fugax

The Diagnosis and treatment Coxitis fugax is laid down in guidelines.
These are guidelines for the doctor that show him a structured procedure in the event of suspected coxitis fugax, because it is extremely important to avoid this harmless one Runny nose Differentiate from other more serious illnesses that can lead to the same pain symptoms but require completely different treatment.

These guidelines contain the symptoms typical for coxitis fugax, measures that should be used for diagnosis, the recommended therapy, the prognosis, but also other diseases from which coxitis fugax must be differentiated (Differential diagnoses).

Can coxitis fugax also occur in adults?

Mostly children aged 3-8 years are affected, but adults can also be affected by coxitis fugax. However, this is very rare and, as for children, not dangerous.
In adults, however, due to the rarity of the occurrence, particular emphasis should be placed on clarifying other causes. Here, too, physical rest is the basis of the therapy. Relief when walking can be achieved by using crutches.

Why children get coxitis fugax much more often than adults is not yet clear. It usually occurs after an infection, such as a cold or gastrointestinal flu.

And children between 3-8 years of age get sick significantly more often due to the higher occurrence of germs in kindergarten and school. In adults, bacterial coxitis, i.e. hip inflammation caused by bacteria, should be ruled out as this requires immediate therapy.

Summary

The "hip runny nose" is an inflammation of the hip joint in children under 10 years. Usually a banal infection precedes it. The exact causes are unclear. The children affected are particularly noticeable for their limping. Coxitis fugax is the most common cause of hip pain in children between 3 and 8 years of age. In rare cases, both hip joints are affected. However, there is no bias towards any specific side of the body. With the help of the ultrasound, the joint effusion can be detected. X-rays, on the other hand, have proven to be less meaningful. Therapy consists of waiting because the "hip runny nose" recovers by itself and usually leaves an unaffected hip joint. Pain medication and anti-inflammatory drugs can also be prescribed. In any case, the affected hip joint must be relieved.