Labral Tear

Welcome to Vrije Universiteit Brussel's Evidence-based Practice project. This space was created by and for the students in the Rehabilitation Sciences and Physiotherapy program of the Vrije Universiteit Brussel, Brussels, Belgium. Please do not edit unless you are involved in this project, but please come back in the near future to check out new information!!

Original Editors - Bilitis Crokaert

Lead Editors - Your name will be added here if you are a lead editor on this page.  Read more.

Search Strategy

• Databases: 
  - PubMED
  - Web of knowlegde
  - Libery
• Keywords:
  - Labral tear of the hip
  - Acetabular Labral tear (ALT)
  - Test of identification Labral Tear
  

Definition/Description

An acetabular labral tear can cause pain if the labrum is torn, frayed, or damaged. Labral tears cause groin pain or pain in the anterior side of the hip, and less commonly buttock pain . This mechanically induced pathology is thought to result from excessive forces at the hip joint for example: A tear could decrease the acetabular contact area and increase stress, which would result in articular damage, and destabilize the hip joint .

Anterior labral tears: the pain is more consistent and is situated on the anterior hip (anterosuperior quadrant) or at the groin. They frequently occur in European countries and the United States.
Posterior labral tears: are situated in the lateral region or deep in the posterior buttocks. They are less frequently in European Countries and United states but are frequent in Japan.

Clinically Relevant Anatomy

The acetabular labrum is a fibrocartilaginous rim, which encompasses the circumference of the acetabulum. It helps to keep the head of the femur inside the acetabulum, and varies greatly in form and thickness.

The labrum has 3 surfaces: aninternal articular surface next to the joint (avascular), external articular surface(vascular) contacting the joint capsule, and a basal surface that is attached to the acetabular bone and ligaments. The transverse ligaments surround the hip and help hold it in place while moving.

On the anterior side the labrum is triangular in the radial section and posterior side it is dimensionally square but with a rounded distal surface.

The functions of the acetabularlabrum are: joint stability, sensitive shock absorber, joint lubricator, and pressure distributor; decreasing contact stress between the acetabular and the femoral cartilage

Epidemiology /Etiology

In studies of patients with a labral tear, researchers have attributed the injury to a variety of causes.

- Direct trauma: motor accidents, falling with or without a hip dislocation, slipping.
- Sporting activities that require frequent external rotations or hyperextension: ballet, soccer, and hockey, running and sprinting.
- Specific movements incl. torsional or twisting movements :hyperabductionhyper abduction, hyperextension and hyperextension with lateral rotation.
- It is not age related: Patients with hip or groin pain could have a tear in their acetabularlabrum. Reported age of people with hip pain and a labral tear goes from 8 to 75 years old.
- Structural risk factors: acetabular dysplasia, degeneration,capsular laxity/ hip hypermobility and femeroacetabular impingement (FAI) (Byrd and Jones 2003, Wenger et al. 2004).

Characteristics/Clinical Presentation

- Sex: The both sexes have the same frequency.
- Symptoms: A constant dull pain with periods of sharp pain that worsens during activity. Walking, pivotating, prolonged sitting and impact activities aggravate symptoms. Some of the patients describe night-pain . The symptoms can have a long duration, with an average greater than 2 years.
- Mechanical Symptoms: variety of mechanical symptoms, including clicking (most frequently),locking or catching, or giving away. The significance of these signs are questionable.
- Range of motion:
These specific manoeuvres may cause pain in the groin:
- flexion, adduction, and internal rotation of the hip joint = anterior superior tear
- passive hyperextension, abduction, and external rotation = posterior tears

Differential Diagnosis

add text here

Diagnostic Procedures

add text here related to medical diagnostic procedures

Outcome Measures

add links to outcome measures here (also see Outcome Measures Database)

Examination

add text here related to physical examination and assessment

Medical Management

add text here

Physical Therapy Management

add text here

Key Research

add links and reviews of high quality evidence here (case studies should be added on new pages using the case study template)

Resources

add appropriate resources here

Clinical Bottom Line

add text here

Recent Related Research (from Pubmed)

see tutorial on Adding PubMed Feed

References

see adding references tutorial.