Hip Labral Disorders

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Original Editor - Karolyn Conolty, Kenny Bosmans

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Search Strategy

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Definition/Description

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Clinically Relevant Anatomy

The labrum of the hip is responsible for deepening the acetabulum to provide increased joint stability. It contains nerve endings to enhance proprioception, but may also be a source of pain.

Epidemiology /Etiology

The labrum is susceptible to traumatic injury from shearing forces that occur with twisting, pivoting and falling. The most common mechanism is an external rotation force in a hyperextended position.

Characteristics/Clinical Presentation

Patients with pain deep in the groin, instability of the hip, a "clicking" or "locking" feeling and stiffness of the hip might be suffering from an acetabular labral tear. These symptoms can increase when the patient's bearing weight or performing twisting movements of the hip. Pain may also occur while climbing stairs. Most patients (90%) diagnosed with acetabular labral tears have had complaints of pain in the anterior hip or groin. This can be an indication for an anterior labral tear, whereas buttock pain is more consistent with posterior tears and less common. 

Labral tears have been classified into 4 types:
- radial flap: most common, disruption of free margin of the labrum
- radial fibrillated: fraying of the free margin, associated with degenerative joint disease
- longitudinal peripheral: least common
- abnormally mobile: can result from a detached labrum

Differential Diagnosis

A variety of pathologies have to be taken into account when facing hip pain. In most cases this pain is situated in the anterior hip or goin region. Some patients might also complain about pain in the lateral region or deep in the posterior buttocks, but this is less common. Pain in the hip region van be due to hip joint contusion, strain, athlethis pubalgia, osteitis pubis, inflammatory arthritis, osteoarthritis, septic arthritis, piriformis syndrome, snapping hip syndrome, bursitis, femoral head avascular necrosis, fracture, dislocation, tumor, hernia, slipped femoral capital epiphysis, Legg-Calve-Perthes disease, or referred pain from the lumbosacral and sacroiliac areas.

Diagnostic Procedures

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MRa is thought to be the diagnostic imaging of choice to evaluate an acetabular labral tear.

Outcome Measures

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Examination

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Medical Management

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Physical Therapy Management

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Key Research

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Austin A, Meyer J, Powers C, Souza R. Identification of abnormal hip motion associated with acetabular labral pathology. J Orthop Sports Phys Ther. 2008;38(9):558-565.

Resources

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Clinical Bottom Line

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Recent Related Research (from Pubmed)

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References

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Martin R, Enseki K, Draovitch P, Trapuzzano T, Philippon M. Acetabular labral tears of the hip: Examination and diagnostic challenges. J Orthop Sports Phys Ther. 2006:36(7):503-515.

Enseki K, Martin R, Draovitch P, Kelly B, Philippon M, Schenker M. The hip joint: Arthroscopic procedures and postoperative rehabilitation. J Orthop Sports Phys Ther. 2006;36(7):516-525.