Hip Acetabular Labral Tears

During physical activity, you rely on your hips to provide support, stability and mobility through a broad range of motion. Even during relatively passive activities like sitting or standing, your hips play a role in stabilizing your body. Because your hip joints are subjected to large force loads during physical activity and throughout the day, they can become injured, causing pain and disability.

One of the most common hip injuries in healthy people is an acetabular labral tear.

The Hip Labrum

Your hip is a ball and socket joint, formed where the ball of the femur fits into the acetabulum, the deep socket of the pelvis. The acetabulum is lined with a thick ring of fibro-cartilaginous tissue called the labrum, which works with the ligaments and muscles to maintain joint stability. The labrum also forms a seal for joint fluid, facilitating a smooth gliding movement between the ball and socket.

Biomechanics

The labrum stabilizes the hip joint by forming a seal, thereby creating negative pressure inside the joint. Biomechanical studies suggest that the negative pressure within the hip joint provides a more important and stronger mechanism of stability than the ligaments of the hip joint capsule. In fact, the labrum’s sealing effect is the most unique stabilizing mechanism in the human body.

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Disruption of the acetabular labrum is thought to “break the seal” of the hip joint, causing increased femoral head translation. This increases the contact pressure of the femoral head against the acetabulum, subsequently wearing out the joint cartilage.

Incidence and Prevalence

In physically active populations, the demands placed on the hips can lead to labral tears that produce pain and limit mobility. Sports like football and soccer demand large amounts of jumping, landing and kicking, subjecting the hip to a great deal of stress. Dancers, ice hockey players and figure skaters place huge demands on their hips as they cut, leap, glide and land. Long distance runners are often prone to labral tears due to repetitive overuse.

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Wear and tear over time can also cause labral tears, especially in people with bony abnormalities in either the ball or the socket, predisposing them to impingement. Abnormal bony structures of the hip are responsible for approximately 90 percent of labral tears.

Causes of Hip Labral Tears

A labral tear occurs when a segment of the labrum is pulled away from the hip socket, often in response to repetitive trauma.

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Causes may include

  • Bony abnormalities that lead to impingement
  • Weakened hip muscles
  • Faulty movement mechanics during repetitive activities
  • Distance running
  • Sports that require cutting, jumping, twisting and kicking
  • Excessive repetitive stretching in activities like yoga, dance or gymnastics

Symptoms of a Hip Labral Tear

In its early stages, a labral tear may be asymptomatic, or pain may appear suddenly for no apparent reason.

Symptoms may include

  • A deep ache at the front of the hip or groin
  • Painful licking, locking or catching sensations in the hip
  • Stiffness and reduced range of motion
  • Weakness in the hip area
  • Pain that increases with sitting or walking
  • Sharp pain in the hip or groin when squatting

Diagnosis

During diagnosis, your doctor will review your health history and ask questions about your physical activities and the onset of symptoms. They will also examine your hip, knees and back, and assess your postural alignment. You may be asked to walk, step up, squat, or balance on one leg. The therapist will also palpate your hip region to identify the locus of pain.

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At NYDNR, in addition to the above methods, we use real time diagnostic ultrasound to accurately diagnose acetabular labrum tears and to identify impingements caused by bony abnormalities. We also use video gait analysis, and C.A.R.E.N (Computer Assisted Rehabilitation Environment) motion analysis to assess hip function and identify mechanical deficiencies.

Treatment Options

Torn hip labral tissue cannot heal on its own. Physical therapy is the first line of treatment for a torn labrum. Rehabilitation focuses on increasing hip strength, mobility and motor control to relieve pain and reduce stress to the labrum. Most patients treated with physical therapy are able to return to satisfactory levels of physical activity.

While severe and traumatic labral tears may require surgery to remove or repair torn tissue, 50 percent of patients treated surgically remain symptomatic. Data indicates that surgery is no more effective than physical therapy treatment in most cases of labral tears.

Treatment at NYDNR

At NYDNR we use the latest technology to assess, treat and rehabilitate hip conditions, including acetabular labral tears. Treatment options may include physical therapy, dry needling, extracorporeal shock wave therapy (ESWT), Computer Assisted Rehabilitation Environment (C.A.R.E.N), force plate and motion capture analysis, and feedback/feed-forward retraining. We also use innovative therapies like Dynamic Neuromuscular Stabilization (DNS) and Anatomy in Motion to treat hip injuries.

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In this instance, an athlete was originally diagnosed with minor quadriceps muscle strain and was treated for four weeks, with unsatisfactory results. When he came to our clinic, the muscle was not healing, and the patients’ muscle tissue had already begun to atrophy.

Upon examination using MSUS, we discovered that he had a full muscle thickness tear that had been overlooked by his previous provider. To mitigate damage and promote healing, surgery should have been performed immediately after the injury occurred. Because of misdiagnosis and inappropriate treatment, the patient now has permanent damage that cannot be corrected.

The most important advantage of Ultrasound over MRI imaging is its ability to zero in on the symptomatic region and obtain imaging, with active participation and feedback from the patient. Using dynamic MSUS, we can see what happens when patients contract their muscles, something that cannot be done with MRI. From a diagnostic perspective, this interaction is invaluable.

Dynamic ultrasonography examination demonstrating
the full thickness tear and already occurring muscle atrophy
due to misdiagnosis and not referring the patient
to proper diagnostic workup

Demonstration of how very small muscle defect is made and revealed
to be a complete tear with muscle contraction
under diagnostic sonography (not possible with MRI)

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Complete tear of rectus femoris
with large hematoma (blood)

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Separation of muscle ends due to tear elicited
on dynamic sonography examination

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