The acetabular labrum is a fibrocartilaginous ring around the socket component of the hip joint. Functions of the labrum include shock absorption, joint lubrication, improving joint stability and helping to distribute forces. Labrum tears can occur acutely or with chronic degeneration. Tears are difficult to diagnose with only a physical exam. Treatments involve either nonoperative methods or surgical methods or both.
Symptoms
Labrum tears may cause pain in the front of the hip or in the groin. There is also difficulty with moving the hip joint. Patients may have associated popping, catching and clicking sensations with movement of the hip joint.
Causes
According to Dr. Meghan Groh of the Department of Physical Medicine and Rehabilitation at Mount Sinai Hospital in New York City, historically, labrum tears were associated with slipped capital epiphysis, Legg-Calve-Perthes disease, major hip structural abnormalities and high velocity trauma, such as that in a car accident or fall. Isolated traumatic tears of the acetabular labrum are being more commonly diagnosed, however, due to sporting event injuries and traumas. There is also more research these days into impingement conditions of the bones and soft tissue structures of the hip leading to labrum tears.
Complications
Acetabular labrum tears may alter the mechanics of the hip joint, leading to a potentially increased risk for hip arthritis. This has not, though, been definitively proven.
Diagnosis
Diagnosis is very difficult to achieve by clinical exam alone. Patients often go to multiple providers and get no definitive diagnosis based on symptoms and clinical examination. Sometimes there is pain with hip extension, known as the McCarthy sign. Imaging may be helpful. Plain X-ray may reveal bony anatomy suggestive of abnormal hip development that may predispose an individual to an acetabular labrum tear. MRI arthrography, where contrast dye is injected into the joint, might help the radiologist make a diagnosis. The presence of a paralabral cyst makes it more likely that there is a labrum tear. The surgeon may also do an arthroscopy procedure of the hip joint and directly visualize the acetabular labrum tear.
Treatment
Treatment for tears of the acetabular labrum involves rest from activity, icing the joint, anti-inflammatory medications and physical therapy. Physical therapy will strengthen and stretch the muscles around the hip joint. When nonoperative measures fail to improve symptoms, a surgeon can use an arthroscope in the operating room to look at the tear. The surgeon will then clean up any torn tissue and repair any abnormalities. The arthroscope is a tiny camera that the surgeon uses, along with tiny incisions for instruments, to perform the surgical procedure.
References
- "AAOS Comprehensive Orthopaedic Review"; Jay R. Lieberman, M.D. (editor); 2008
- "Expert Guide to Sports Medicine"; Matthew F. Davis, M.D., et al.; 2005
- "Current Reviews in Musculoskeletal Medicine"; A Comprehensive Review of Hip Labral Tears; Megan M. Groh and Joseph Herrera; June 2009
