Hip labral tear

Definition

A hip labral tear involves the ring of soft elastic tissue, called the labrum, that follows the outside rim of the socket of your hip joint. The labrum acts like a socket to hold the ball at the top of your thighbone (femur) in place.

Athletes who participate in such sports as ice hockey, soccer, football, golf and ballet are at higher risk of developing a hip labral tear. Structural abnormalities of the hip also can lead to a hip labral tear.

Symptoms include hip pain or a "catching" sensation in your hip joint. Initial treatment may include pain relievers and physical therapy. Using arthroscopic techniques, surgeons can remove loose fragments from within the joint and trim or repair the hip labral tear.

Hip joint

Hip joint

A ring of soft tissue, called the labrum, follows the outside rim of the socket of your hip joint. It acts a little like a socket to hold the ball of your thighbone (femur) in place. If the ...

Symptoms

Many hip labral tears cause no signs or symptoms. Occasionally, however, you may experience one or more of the following:

• A locking, clicking or catching sensation in your hip joint
• Pain in your hip or groin
• Stiffness or limited range of motion in your hip joint

Causes

The cause of a hip labral tear may be:

• Trauma. Injury to or dislocation of the hip joint — which can occur during car accidents or from playing contact sports such as football or hockey — can cause a hip labral tear.
• Structural abnormalities. Some people are born with hip problems that can accelerate wear and tear of the joint and eventually cause a hip labral tear.
• Repetitive motions. Sports-related and other physical activities — including the sudden twisting or pivoting motions common in golf or hockey — can lead to joint wear and tear that ultimately results in a hip labral tear.

Hip joint

Hip joint

A ring of soft tissue, called the labrum, follows the outside rim of the socket of your hip joint. It acts a little like a socket to hold the ball of your thighbone (femur) in place. If the ...

Risk factors

The following factors may increase your risk of a hip labral tear:

• Overuse. People who participate in sports or other activities that require repeated twisting or pivoting motions are more likely to experience a hip labral tear.
• Pre-existing hip problems. Conditions or diseases that increase the amount of friction within the hip joint may increase the risk of a hip labral tear.

Complications

A hip labral tear may predispose you to develop osteoarthritis in that joint in the future.

Preparing for your appointment

While you may initially consult your family physician, he or she may refer you to a doctor who specializes in hip disorders or sports medicine.

What you can do
You may want to write a list that includes:

• A detailed description of your symptoms
• Information about any medical problems you've had
• Information about the medical problems of your parents or siblings
• All of the medications and dietary supplements you take
• Questions you want to ask the doctor

Because your time with your doctor may be limited, it's a good idea to prepare your questions ahead of time. For a hip labral tear, some questions you might want to ask include:

• What caused this to happen?
• Do I need any tests to confirm that I have a hip labral tear?
• What treatments are available?
• How long do I need to wait before having surgery?
• What types of surgery can be performed?
• What are the risks of surgery?
• What will happen if I don't have surgery?
• What kind of recovery period is needed after surgery?
• Will I need physical therapy after surgery?
• How long will my activity be restricted?
• Can I play sports again?
• How can I prevent another injury from occurring?

What to expect from your doctor
Your doctor may ask:

• Where exactly does it hurt?
• When did the pain start?
• Did anything precipitate it?
• Does any action make the pain better or worse?

During the physical exam, your doctor will move your leg, and especially your hip joint, around in various positions to check for pain and evaluate your hip's range of motion. He or she may also want to watch you walk. Your doctor may also check the musculoskeletal and neurological health of your hip joint and leg by testing your:

• Reflexes
• Muscle strength
• Muscle tone
• Sensation
• Coordination
• Balance

Tests and diagnosis

A hip labral tear rarely occurs in isolation. In most cases, other structures within the hip joint have also sustained injuries. Diagnostic tests can help determine exactly what's going on inside your joint.

Imaging scans

• X-rays. X-rays are excellent at visualizing bone. However, X-rays don't produce images of soft tissue, so these images can't be used to diagnose a labral tear, only to rule out fractures or structural abnormalities.
• Magnetic resonance imaging (MRI). Using a strong magnetic field, MRIs provide detailed images of soft tissues. A contrast material may be injected into the hip joint space to better define a labral tear that may be present.

Anesthesia injection
Hip pain can be caused by problems within the joint or outside the joint. Your doctor may suggest injecting an anesthetic into the joint space. If this relieves your pain, it's likely that your problem is inside your hip joint.

Treatments and drugs
Treatment choices will depend on the severity of your symptoms. Some people recover in a few weeks with conservative treatments, while others may require arthroscopic surgery to repair or remove the torn portion of the labrum.

Medications
Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin, others) and naproxen (Aleve, others), can relieve pain and reduce inflammation.

Pain can also be controlled with an injection of corticosteroids into the joint.

Treatments and drugs

Treatment choices will depend on the severity of your symptoms. Some people recover in a few weeks with conservative treatments, while others may require arthroscopic surgery to repair or remove the torn portion of the labrum.

Medications
Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin, others) and naproxen (Aleve, others), can relieve pain and reduce inflammation.

Pain can also be controlled with an injection of corticosteroids into the joint.

Therapy
A physical therapist can teach you exercises to maximize hip range of motion and improve hip strength and stability. A physical therapist can also analyze the movements you perform that put stress on your hip joint and help you avoid these forces.

Surgical and other procedures
If you have a hip labral tear and experience hip pain for more than four to 12 weeks despite physical therapy, or if you have mechanical symptoms of your hip locking, your doctor may recommend arthroscopic surgery — in which a fiber-optic camera and surgical tools are inserted via small incisions in your skin.

Depending on the cause and extent of the tear, the surgeon may cut out and remove the torn piece of labrum or repair the torn tissue by sewing it back together.

Many people are able to return to sports within four to six months after the surgery.

Lifestyle and home remedies

After an injury such as a hip labral tear, one of the first things you need to do is rest your hip and modify your activity so that you avoid jarring motions.

Your doctor may prescribe prescription-strength NSAIDs, or he or she may recommend over-the-counter medications, such as ibuprofen (Advil, Motrin, others) and naproxen (Aleve, others), to help lessen your pain.

Prevention

A common cause of hip labral tear is athletic trauma or repetitive stress from athletic activity. Proper training and conditioning of commonly used muscles and those that support them might help reduce the risk of a hip labral tear.