Hip labral tears

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Clinically Relevant Anatomy

The hip labral complex is a fibrocartilaginous structure that lines the acetabular socket and increases its surface area by 28%.¹ It functions to increase joint stability  and  contibutes to propreoceptive feedback. The labrum works to maintain approriate synovial fluid pressure and keeps the fluid within the articular cartilage to decrease the forces of direct load between the femoral head and acetabular surfaces.The labrum is comprised of type I collagen and is typically between 2-3mm thick. It is  thinner in the anterior region and is thought to be  more highly innervated anteriorly and superiorly via free nerve endings.¹

Mechanism of Injury / Pathological Process

There are five possible etiologies of labral tears that are currently recognized: Femoroacetabular impingement (FAI),trauma,capsular laxity, dysplasia, and degeneration. ^1,2 FAI has been categorized into two types: cam and pincer. Cam type impingment exists with a large femoral head with resulting abdnormal junction between the femoral head and neck. This causes impingement between the femur and acetabular rim, particularly during hip flexion and internal rotation.¹
Pincer impingement occurs with an acetabular overcoverage, causing abutment of the femoral head into the acetabulum.Cam impingement is the proposed etiology of atererosuperior labral tears, and pincer type is thought to be on eof the causes posterioinferior chondral lesions.² Traumatic injury to the hip labum is thought to occur with a shearing force associated with twisting and falling. This can lead to joint instabililty resulitng in abnormal movment patterns with eventual degenerative changes and labral fraying.² Capsular laxity with resulting labral pathology is thought to occur in one of two ways; cartilage disorders (ie. Ehlers-Danlos syndrome) or rotational laxity resulting from excessive external rotation. These forces are often seen in certain sports including ballet,hockey,and gymnastics. ² Hip dysplasia occurs with development of a shallow acetabular socket resulting in decreased coverage of the femoral head. This places increased stress into the anterior portion of the hip joint, resulting in impingement and possible tears over time. ¹

Clinical Presentation

There is some variation in the presentation of hip labral tears.  Frequently patients present with anterior hip and groin pain, although some do present with GT, buttock, and/or medial knee pain. Mechanical symptoms associated with a tear are clicking, popping,giving way,catching,and stiffness. Patients offent describe a dull ache which increases with activities such as running or brisk walking. ¹
Some special tests performed are: FABER test,scour test, resisted SLR, and  anterior hip impingement test^1,2

Diagnostic Procedures

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