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| Labral Tears |
Anterior hip or groin pain is a common complaint and can result from a number of musculoskeletal pathologies, one of which is a tear to the acetabular labrum. This is a mechanically induced pathology, thought to result from excessive forces at the hip joint. Although, acetabular labral tears have been identified as a source of hip pain they often evade detection, resulting in a long duration of symptoms, before diagnosis. The purpose of this article is to discuss the anatomy and function of the acetabular labrum and the causes, symptoms, diagnosis and treatment of acetabular labral tears.
Anatomy and function of the Acetabular Labrum
The acetabular labrum is a ring consisting of both fibrocartilage and dense connective tissue attached to the bony rim of the acetabulum (hip socket). The majority of the acetabular labrum is thought to have little or no blood supply. A variety of nerve endings and nerve end organs have been identified in the acetabular labrum, this accounts for the pain, pressure and deep sensation felt by patients with labral tears.
The function of the labrum is to aid in the stability and decrease the stress on the hip joint. The labrum aids in hip stability by deepening the hip joint. The labrum also reduces contact stresses by distributing the load throughout the articular cartilage.
Who is at risk of getting a Labral Injury?
A tear of the labrum could be a result of a number of causes. Direct trauma, including motor vehicle accidents and slipping and falling with or without hip dislocation are known causes of labral tears.
Also a number of sporting activities that require frequent external rotation of the hip have been attributed to causing labral tears such as football, hockey, golf, ballet, running and sprinting.
However, a large percentage are not associated with any known event or cause. In these cases the pain typically develops gradually and increases in intensity over time. Repetitive microtrauma is believed to be the cause of the labral lesions in these cases.
Another cause for labral tears are structural deformities around the hip, resulting in inadequate containment of the femoral head (ball) within the acetabulum (socket).
Symptoms
Patients with a tear of the labrum most consistently complain of hip pain. In 90% of patients pain is reported in the anterior (front) hip or groin region and less often in the side of the hip or deep in the buttocks. Patients with a labral tear also report a variety of mechanical symptoms including clicking, locking, catching or giving way. Other symptoms include movement limitations the most commonly reported being rotation of the hip.
Diagnosis
A tear of the acetabular labrum is difficult to definitively diagnose. In people with a tear standard radiographs (X-rays) are typically normal but may show signs of some degenerative changes to the hip joint.
MRI (magnetic resonance imaging/ arthrography) is the best form of non invasive diagnosis but can lead to false-positive results, with small tears often undetected.
Therefore, direct observation of the labrum by arthroscopy is the gold standard for diagnosis.
Treatment
Once a labral tear is diagnosed the most appropriate course of action is surgical intervention. Conservative medical treatment and physiotherapy has not been proven to be effective pre operatively. Excision or debridement of the torn tissue by arthroscopy is the most common procedure.
Physiotherapy following arthroscopic hip surgery is essential to get the best post operative prognosis and recovery. The aims of post-operative physiotherapy are to address any muscle imbalances around the hip, restore any range of movement deficits and restore a normal gait pattern. The physiotherapist will also guide a gradual return to the patient’s previous lifestyle/sport.
By Sharon Helsby (SOS Senior Physiotherapist / Specialist Hip Clinician)