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

Imaging from plain radiographs, computed tomography (CT) and magnetic resonance imaging (MRI) are rather useless when identifying labral tears. The magnetic resonance arthrography (MRa) on the other hand is proven to be more succesful. MRa uses a dye injection into the hip capsule before imaging several planes with an MR. Although an MRa can give some indications for labral tears, studies have indicated that the sensitivity and specificity of the test varies. Diagnosis is there for best based on the combination of MRa, physical examination and arthroscopy. Arthroscopy is considered the golden standard and can be used for diagnostic as well as therapeutic means. 

Outcome Measures

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Examination

Hip labral disorders can be diagnosed during a thorough physical examination. In some cases the first signs can be spotted while observing the patient. During a brief walk the knee on the side of the affected hip might be slightly bend to absorb the shocks and lowering the weight bearing on that side. the step length of the affected leg may also be shortened to lower the pain. Aside from simple observation there are a number of provocative tests that can be performed. Because each test stresses a particular part of the acetabular labrum, they can also give an indication of where the tear is located.

for the McCarthy test, both hips have to be in a flexed position. The affected hip needs to be brought into extension. If this movement reproduces a painful click, the patient is suffering from a labral tear.

To identify an anterior labral tear, the patient's leg has to be brought into full flexion, lateral rotation and full abduction. Then the leg has to be extended with medial rotation and adduction. Patients with an anterior labral tear will experience sharp catching pain and in some cases there might be a "clicking" of the hip.

A posterior Labral tear is identified by bringing the patient's leg into extension, abduction and lateral rotation followed by an extension with medial rotation and adduction of the leg. Sharp catching pain with or without a "click" will be an indication for a posterior labral tear.

Medical Management

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Physical Therapy Management

So far there has been no research on the efficacy of hip mobilization or manipulation in the treatment of labral disorders. Although it is suggested that the therapy should focus on optimizing the alignment of the hip joint and the precision of joint motion, avoiding pivoting motions and correcting gait patterns. 

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

Groh M, Herrera J. A comprehensive review of hip labral tears. Curr Rev Musculoskelet Med 2009;2:105-117

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

Lewis CL, Sahrmann SA. Acetabular labral tears. Physical Therapy. 2006;89:110-21.

Schmerl M, Pollard H, Hoskins W. Labral Injuries of the hip: a review of diagnosis and management. J Manipulative Physiol Ther. 2005;28(8):632.

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.