March 27, 2018
Your hips act as the foundation for your entire body. Your hips contribute to your core strength which allow you to move your legs and provide support for your upper body.
The hip is a ball and socket joint. The head of your femur (the ball) fits into the acetabulum of your pelvic bone (the socket). If you imagine the acetabulum as a cup, the labrum is a thick ring of fibrous collagen that surrounds it. Its function is to increase the surface area of that cup, increasing stability by giving the femoral head more surface area to move around against. It also creates a semi-airtight seal that helps to maintain the levels of synovial fluid, which acts as a lubricator between the femoral head and acetabular cartilage.
A labral tear occurs any time that ring of collagen rips. When they occur in the hip, they are called either a hip labral tear or an acetabular labral tear. In this article, we’re going to go over the symptoms, diagnosis, treatment options, and recovery for hip labral tears.
Dr. Steve Hamilton, of Beacon Orthopaedics & Sports Medicine, is a sports medicine physician and orthopaedic surgeon who specializes in arthroscopic surgery of the hip. If you exhibit any or all of the symptoms in the article, or you’ve lost mobility in your hip, please schedule an appointment with Dr. Hamilton immediately.
Types of Labral Tears
There are multiple kinds of labral tears, and they are classified by where on the labral they occur:
- Anterior tears—Facing the groin, most common location
- Posterior tears—Facing the buttocks
- Traumatic—Result from an acute injury
- Degenerative—Result from repetitive microtrauma over a longer period of time
- “Catching” feeling in hip
- Decreased range of motion
- Decreased strength
- Breakdown of posture
- Locking of the hip
The main symptoms of a torn labrum are hip and groin pain, which also happen to be main symptoms of a number of other hip-related conditions and disorders, including:
- Stress fractures
- And many others
The sheer number of conditions and disorders that exhibit similar symptoms to hip labral tears make it sometimes difficult to diagnose with a physical examination alone.
Methods of Diagnosis
Imaging and Tests
The two most commonly utilized imaging tests for a hip labral tear are:
- Magnet Resonance Imaging (MRI)
- Magnetic Resonance Arthrography (MRA)
Other methods, such as radiographs and bone scans are other common tests for hip issues, but the two above are best for diagnosing hip labral tears.
Diagnosis is also possible through a physical examination. In a physical examination, your gait and range of motion will be examined. In addition, there are a variety of physical tests that allow a doctor to bend your legs in certain ways and make a diagnosis based on the flexibility of your hips and when/where pain occurs. The two most popular of these tests are:
- The FABER Test
- The Impingment Test (add link)
Be aware, however, that these tests cannot always accurately diagnose acetabular labral tears since pain and range-of-motion restrictions aren’t exclusive to the labral tears.
Risk Factors for Hip Labral Tears
Microtrauma caused by hyperextension of the hip paired with external femoral rotation is the quickest path to an acetabular labral tear. In other words, repeated pivoting and twisting cause labral tears. Which means ballet dancers, hockey players and baseball pitchers are among the most likely to develop a hip labral tear during the course of their careers. Golfers, soccer players, gymnasts, and runners also frequently perform microtrauma-inducing activities.
Aside from that, the second most common cause is a forceful, sudden trauma, such as a fall or a car accident.
Most patients are initially treated with a conservative treatment course including medications, physical therapy and possible injections. Physical therapy can work to remove pain, strengthen the area, and restore range of motion to the injured hip. Surgery may be an effective treatment option if you fail to improve with a nonoperative approach.
Surgery for hip labral tears involves evaluating the hip and repairing the labrum. To do this, depending on the location and severity of the tear, the labrum is either stitched back together or reconstructed if repair is not possible. The goal of a labral repair or reconstruction is to restore your hips normal anatomy.
Dr. Hamilton performs a minimally invasive, highly technical hip preservation surgery. This surgery uses a small, flexible camera called an arthroscope to enter the labral area without making a large incision. Overall, the process produces less scarring, improves overall recovery time, and is much easier on the body than more traditional forms of open surgery.
As a part of your hip labral surgery recovery plan, you will be placed on a phased physical therapy plan. This plan will include a set of stretches and exercises, and each phase has its own objectives. Know that this is just a roadmap and your progress through these stages will depend on your levels of strength, pain, and mobility following surgery.
Get Up and Running
If you want to remain active all your life, your hips are essential. If you have any of the symptoms listed above, or if you’re worried you’re at risk for a hip labral tear, Beacon can help. While the above article offers helpful advice, only a specialist can properly advise you on the state of your hip. Dr. Steve Hamilton is a Steadman Hawkins-trained surgeon who is an expert at minimally invasive hip labral surgeries.