ABSTRACT
Introduction: Transient synovitis is a common cause of hip pain in children. Patients present with acute limp, hip pain or referred pain to the knee. The mainstay of treatment consists of antiinflammatory medications and activity limitations. While the exact etiology of transient synovitis is unknown, there has been a noted relationship with an antecedent viral illness. We present one of the first reported cases of transient synovitis caused by COVID-19. Case Description: A 10-year-old male presented with concerns for left knee pain and limp. Five days prior, the patient developed general URI symptoms and was diagnosed with COVID-19, via rapid testing. His maximum temperature was 38.5°C at home and his respiratory symptoms resolved. Two days prior to presentation, he complained of left knee pain, which progressed to limp, and refusal to bear weight. He denied known injuries, trauma, visible bruising, swelling, redness, or warmth. He was afebrile and non-weight-bearing on his left leg, otherwise in no apparent distress. On physical exam, he exhibited full, painless range of motion of left knee, no bony tenderness, effusion, or cutaneous changes. There was refusal to bear weight on left leg, and significant pain with internal rotation of left hip. Lab work revealed there was no leukocytosis. C-reactive protein level and sedimentation rate were unremarkable. Radiographs of bilateral hip and pelvis, and left knee were obtained, which revealed no osseous abnormalities or significant effusion. Patient was given ibuprofen and on follow up exam he exhibited improved discomfort and willingness to bear weight. With a negative workup and clinical improvement, he was discharged with crutches, instructions for supportive care, and outpatient follow-up. Mother reported no complications during his recovery. He was able to wean from the crutches within a few days and returned to his usual gait within 3 weeks. Discussion: Transient synovitis can be clinically distinguished from septic arthritis with features of overall well appearance, lack of swelling or redness to the joint, and normal range of motion with mild pain. For our patient, Kocher criteria were helpful in distinguishing transient synovitis from septic arthritis, as well as the clinical improvement with NSAIDs. A clinical dilemma could occur if elevated inflammatory markers were present, as one might expect with acute COVID-19. Though transient synovitis is thought to be related to a viral etiology, there does not appear to be an increase in cases amidst the pandemic described in published literature. Conclusion: This case illustrates a patient who had COVID-19 with transient synovitis, a previously unreported sequela. When evaluating similar patients, providers should consider the possibility of COVID-19 and ensure appropriate testing and isolation.
ABSTRACT
In Ireland, the construction sector has such major influence on growth and economic stability that construction companies were able to restart operations during the COVID-19 pandemic, albeit with the development and implementation of a set of regulations by the Health and Safety Authority (HSA) and the Construction Industry Federation (CIF) to facilitate the safe return to work on sites across Ireland. The introduction of regulations is the first step in the provision of safe working conditions in relation to the pandemic and this research addresses the need to examine the functionality of, and compliance with such regulations. It should be noted that due to the nature of the pandemic, it would be the case that the regulations will be changing due to the emergence of virus variants, infection rates, and vaccination levels so this pilot study essentially takes a 'snapshot' that examines the suitability and compliance with regulations as currently imposed on the Irish construction sector. The study exclusively focused on staff working in micro and small to medium enterprises (m/SMEs) from mid-November to mid-December 2020. Interviews, centred around a 53-part questionnaire, were completed with 30 participants from 27 construction companies. Initial findings indicated the level of compliance with the regulations to be much lower than expected due to issues such as employee behaviour, difficulty in breaking of old habits and lack of supervisory personnel. Findings also indicate that 70% of participants found conflict between the new regulations for safe working relating to the pandemic and current Health and Safety procedures, listing issues such as worker isolation, manual handling issues and obstruction of both visibility and communication by facemasks. Typically, the responsibility for implementation and enforcement of the regulations has fallen into the remit of the Health and Safety personnel in the companies. The research, limited only to companies in the Irish construction sector, has raised many questions about the suitability of the current regulations and warrants further investigation as to why micro-enterprises and SMEs have difficulty with compliance. © 2021 Proceedings of the 37th Annual ARCOM Conference, ARCOM 2021. All Rights Reserved.