Hip Labral Tears

,The hip is one of the largest joints in the body and is a very stable ball and socket joint. The labrum is a fibrocartilaginous (thick, strong cartilage) structure which attaches to the acetabulum (socket part of the hip). The labrum creates a vacuum within the hip which works to increase the depth of the socket, keeping the head of the femur (ball part of the joint) inside the acetabulum (socket) which in turn increases the stability of the joint, making it more difficult to dislocate the hip.

Along with increasing the stability in the hip, the labrum also; helps to lubricate the joint allowing it to move smoothly, acts as a shock absorber and distributes pressure evenly throughout the hip. These functions help to prevent early arthritic wear in the hip.

Labral Tears (Mechanism)

Hip labral tears are becoming more prevalent in sport, particularly in youth sport. A labral tear will cause pain if the labrum is torn, frayed or damaged. However, a labral tear can be present without any symptoms and go undetected for years, so it is difficult to know what the injury rate really is.

A hip labral tear can occur two ways. It can be caused acutely (all of a sudden) by trauma, like a motor vehicle accident, a fall (with or without a hip dislocation), slipping or a sports injury where the hip is forced into an extreme position. When this happens, the patient will often describe having heard a pop along with a catching feeling inside the hip.

It more commonly occurs gradually due to repetitive micro-traumas (repeated actions) in sports like golf, ballet, soccer, sprinting etc. that require regular forced rotation of the hip and high ground reaction force.

Symptoms:

There are two main types of labral tear:

1. Anterior Labral Tear: This is the type of tear that people experience most commonly. Generally, people will experience pain in the front of the hip and groin. People usually report a consistent dull ache with intermittent sharp pain, normally associated with specific movements. Often, a feeling of the hip clicking, catching, giving way and locking are noted. Occasionally, a person may complain of a pain in their buttock also. Day to day, a person with a hip labral tear will have difficulty with prolonged walking or sitting but generally, movements where the hip is required to rotate internally (inward) cause the biggest issue. For example, pivoting or getting in and out of the car. Most of the time, the pain will come on gradually and get worse to the point where they may experience the constant pain mentioned previously.

2. Posterior Labral Tear: These tears are less common and are located towards the back of the ball and socket joint. A person suffering with a posterior labral tear will experience pain “inside the hip” or in the buttocks.
   

Risk Factors / Causes:

Generally, a labral tear is secondary to one of the following conditions;

• Trauma: An acute injury including a subluxation (partial dislocation) or dislocation of the hip, damaging the labrum.

• FAI (Femoroacetabular Impingement): Is where either the head of the femur (ball part) or the acetabulum (socket part) has some sort of abnormality (bony growth etc) which causes a pinching of the labrum between the ball and socket. This has been seen to be the most common underlying issue regarding labral tears. If this underlying issue isn’t dealt with, it can cause premature arthritis in the hip.

• Capsular Laxity / Hip Hypermobility: This means that the hip stability is decreased. This lack of stability may cause increased pressure on the labrum leading to a labral tear.

• Dysplasia : This is a condition that some people are born with, whereby the socket part of the hip joint doesn’t fully cover the head of the femur (ball). As we mentioned before, any bony abnormality in either the ball or socket can cause to increased stress on certain areas of the hip and lead to a labral tear.

• Degeneration: Wear and tear on the hip joint over a long period of time will cause some abnormalities in the hip, such as cartilage damage, muscle overload etc. This can place increased pressure on certain parts of the joint which in turn will stress the labrum and may cause injury.

Treatment Options:

The first port of call when it comes to labral tears is conservative treatment which may include anti-inflammatory medication, physical therapy and rehabilitation.

Rehabilitation should be a holistic approach, whereby the athlete’s gait and movement patterns will be analysed. Generally, rehabilitation will include some hip mobility, focusing mostly on hip internal rotation (studies have shown that athletes with labral tears have significantly less hip internal rotation, than athletes who don’t). A rehabilitation programme should also include strength work to reduce the amount of hip adduction and internal rotation (which is the most uncomfortable position for people with a labral tear).

If an athlete has completed 12 weeks of physical therapy without a major improvement, steroid injections may be considered. If there is still no improvement, the athlete may be referred to a surgeon. Surgery has become popular for acetabular labral tears with positive short-term outcomes. Long term outcomes and complications from surgery are still under investigation.

Conclusion:

Hip labral tears are quite common, with many people having labral tears that they don't even know about. Pain associated with hip labral tears tend to come on gradually and might become quite severe over time. People who have FAI (femoroacetabular impingement) are more at risk of a labral tear and are also more likely to require surgery. If you have been diagnosed with a labral tear or FAI, please get in touch. We can start the conservative rehabilitation process remotely and continue in-clinic when the time is right! Thank you for reading, if you need me, you know where to get me!

Edel.

References:

1. https://physio-pedia.com/Overview_of_hip_labral_tears

2. https://physio-pedia.com/Labral_Tear

3. Cianci, A., Sugimoto, D., Stracciolini, A., Yen, Y.M., Kocher, M.S. and d'Hemecourt, P.A., 2019. Nonoperative management of labral tears of the hip in adolescent athletes: description of sports participation, interventions, comorbidity, and outcomes. Clinical journal of sport medicine, 29(1), pp.24-28.

4. Su, T., Chen, G.X. and Yang, L., 2019. Diagnosis and treatment of labral tear. Chinese medical journal, 132(2), p.211.

5. Roth, J. and Nepple, J.J., 2019. Athletic Injuries Involving the Hip. In The Pediatric and Adolescent Hip (pp. 841-853). Springer, Cham.

6. Chahla, J., Sherman, B., Philippon, M.J. and Gerhardt, M., 2019. Hip Injuries in Kicking Athletes. Operative Techniques in Sports Medicine, 27(3), pp.138-144.

7. Mallets, E., Turner, A., Durbin, J., Bader, A. and Murray, L., 2019. Short-term outcomes of conservative treatment for femoroacetabular impingement: a systematic review and meta-analysis. International journal of sports physical therapy, 14(4), p.514.