Diagnosis: Hip Labral Tear
How Hip Labral Tear Presents
- Do you have hip or groin pain? Do you also get pain deep in your buttocks?
- Does the pain get worse after long periods of standing, sitting or walking?
- Do you get a sharp pain that is aggravated by walking or pivoting?
- Does your hip sometimes “lock”?
- Can you hear and feel clicking coming from your hip?
- Do you sometimes feel unstable at the hip? Does it give way?
If you have these symptoms, you may have a hip (acetabular) labral tear.
The acetabular labrum is a ring of fibrous cartilage surrounding the edge of your hip socket (acetabulum). It effectively deepens the hip socket and holds the head of the femur (thigh bone) in place, so it plays an important role in hip stability.
Hip Labral Tear (source: houstonmethodist.org)
How Hip Labral Tear is Diagnosed
It is difficult to definitively diagnose for labral tears through physical examinations in clinic because other hip diseases present similarly. Your physiotherapist may be able to diagnose for labral tear based on a history of childhood hip disorders such as acetabular dysplasia, Perthes Disease, Slipped Capital Femoral Epiphysis.
A detailed physical examination for labral tears includes the following tests:
- Limitations in hip range of motion
- FADIR or impingement sign
- FABER test
- Positive Trendelenburg sign
- Observation for mild limp
Importantly, clinical examination cannot determine the position of the labral tear, which may be important in treatment. Medical imaging investigations must be used.
Most accurate imaging method to determine the location, type and severity of tear is with arthroscopy. However, it is intrusive because an incision into the joint has to be made to slip the camera through.
Magnetic Resonance Arthrography is also a very reliable form of radiographic diagnosis and less intrusive than arthroscopy, however it has some risks too, as it requires the injection of a contrast medium into the hip joint.
Causes of Hip Labral Tear
Hip labral tears can occur due to a variety of causes. For example:
- Direct trauma from motor vehicle accidents, slips and falls
- Dislocation of the hip
- Sports or activities that require frequent pivoting (lateral rotation) on the hip such as soccer, hockey, golf, and ballet
- Extremes of hip movement, such as “doing the splits”
A large percentage (74%) of incidences have no known cause. They are believed to be from overuse, which leads to the accumulation of microdamage over time.
The labrum does not have a good blood supply, and thus its ability to heal is limited. In overuse injuries, the pain comes on gradually and worsens over time.In overuse injuries, the pain comes on gradually and worsens over time. #performbetter @pogophysio Click To Tweet
It has also been suggested that the incidence of labral tears increases with age. Some people are more predisposed to labral tears, such as those born with hip abnormalities (dysplasia), like a shallow hip socket, femoral or acetabular anteversion/retroversion.
Treatment of Hip Labral Tear:
Physiotherapy cannot “fix” labral tears. However, physio treatment aims to reduce pain and improve hip mobility by:
- Strengthening of the muscles around the painful hip
- Improve hip control and biomechanics
- Improve position of the pelvis during standing and walking
- Aim to reduce anterior forces on the hip joint
Your physio will advise you on postural, ergonomic and lifestyle changes, such as:
- Decrease pressure on the anterior hip by sitting without putting too much pressure on the thighs
- Sitting with knees above the hip
- Avoiding sitting cross legged
- Avoiding movements that cause hyperextension of the hip
- Increased participation in activities like cycling
Surgery should only be considered when conservative treatments have not been effective in reducing pain and improving function after 6 – 12 months. Evidence for surgery shows it produces mixed results, with one study finding that labral surgical repair lengthened recovery time compared to arthroscopic debridement.
Buxton, S., Bosmans, K., Vandebriel, D., Lowe, R., & Yona, T. (n.d.). Hip Labral Disorders Retrieved December 06, 2016, from http://www.physio-pedia.com/Hip_Labral_Disorders
Lewis, C. L., & Sahrmann, S. A. (2006). Acetabular Labral Tears. Physical Therapy, 86(1), 110.
Mayo Clinic Staff. (2016, November 18, 2016). Hip labral tear Retrieved December 06, 2016, from http://www.mayoclinic.org/diseases-conditions/hip-labral-tear/home/ovc-20270126