Hip Labral Tear

Have you been diagnosed with a hip labral tear?  A labral tear of the hip can be difficult to diagnose.  What is a labral tear?  What are the symptoms associated with labral tears?  How is a tear generally diagnosed?  And most importantly, what are the best treatment options? 


What is A Labral Tear?

The hip is a ball and socket joint formed by the head of the femur (ball) and the acetabulum of the pelvis (socket).  The labrum of the hip is a piece of cartilage, attached to the acetabulum, and functions to increase the depth of the socket, helping to keep the ball in the socket.  This cartilage, like the cartilage of the shoulder or knee, can tear causing pain, limited range of motion, and limited function. 



Why Do Hip Labral Tears Occur?

Labral tears can occur for a variety of reasons.  Tears can occur based on a trauma such as a twist or pivot when running or impact such as a motor vehicle accident.  Tears can also occur because of repetitive motion, an irregular shape of the head of the femur or a misalignment of the head of the femur in the socket.    When the head of the femur is irregular it is similar to sand paper scraping against the tissue, resulting in labral tears.   

Signs and Symptoms

The most common symptom associated with hip labral tears is hip or groin region pain.  The common signal patients use is called the “C” sign.  Patients will form a “C” with their hand and grab the outside of their hip.   Patients will often describe the pain as being “deep” and can also describe symptoms of catching or locking. 


In addition to pain, limited range of motion is also a common complaint.  The ability to bring the knee up toward the chest (hip flexion) or the knee toward the opposite shoulder (internal rotation) often is limited and can reproduce pain. 

A final symptom associated with labral tears is limited function.  Activities such as extended sitting can reproduce the “deep” anterior hip pain.  Extended walking and going up stairs may also be limited and reproduce pain. 



Diagnosis

The diagnosis of a labral tear is made both with physical exam and diagnostic tests.  Physical exam tests such as the hip scouring and Faber tests are often positive.  Range of motion testing will often find limitation with motions including hip flexion and internal rotation. 

Diagnostic tests including x-rays and MRIs are useful in making a diagnosis of a labral tear.  X-rays show the bones and thus an x-ray of the hip joint is helpful in determining the alignment of the femur with the acetabulum.  However, because the labrum is soft tissue, it will not show up on an x-ray.  Therefore, an MRI is necessary in order to make a definitive diagnosis.   


Best Treatment Options

A hip labral tear does not necessarily mean surgery.  The size and location of a tear influences whether surgery is necessary or whether conservative treatment options can be successful.  Micro tears that occur from repetitive trauma often respond well to conservative treatment.  Typical conservative treatment options for labral tears include rest, anti-inflammitory medication (NSAIDS), ice therapy, physical therapy, and steroid injections.  The goal of these conservative treatments is to reduce inflammation, restore normal range of motion, and thus restore function. 

If conservative treatment options are not successful, surgery may be necessary.  Surgery for hip labral tears is performed arthroscopically.   Small incisions are made in order to allow instruments to access the internal aspect of the hip joint and repair the labrum.  Following surgery crutches are generally utilized for up to two weeks. Post operative physical therapy is an important part of the recovery process.  During physical therapy normal hip range of motion and strength will be re-established in order to help regain normal function.  Return to sport activity such as football or basketball can take up to 4-5 months.

 

Because hip arthroscopy is not as common as knee or shoulder arthroscopy, it is important to find a surgeon that specializes in arthroscopic hip procedures.  As will all surgeries there are risks and should be considered before deciding on any surgical procedure.


Summary

  • The labrum of the hip is a piece of cartilage attached to the socket of the hip and functions to help keep the ball of the femur in the socket.
  • The labrum can be injured from small repetitive trauma or by a sudden traumatic event.  Hip alignment and femoral head irregularities can also result in injuries to the labrum.
  • Deep groin pain, catching, locking, and limited hip range of motion are the most common symptoms associated with hip labral tears.
  • MRI is the most definitive way of making a diagnosis.
  • Conservative treatment typically involves anti-inflammatory medication, rest, injections and physical therapy.
  • If conservative treatment is not successful, hip arthroscopy can be a successful option with an experienced surgeon.


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