INJURIES TO THE HIP LABRUM

CAUSES

Labral tears may be the result of trauma, degeneration or occur as a result of bony pinching. Degenerative tears occur after years of repeated minor injuries, “drying out” of the cartilage as we age and/or may be associated with arthritis of the hip. Traumatic injuries can occur with any sporting activity that causes rapid hip motion especially associated with sudden stops and turns such as football, soccer, tennis, rugby, baseball or softball or with extremes of motion, such as dance, rowing, golf and martial arts.  Excessive bone on the acetabulum (hip socket) or on the femoral neck (below the ball of the joint) may lead to pinching and / or tearing of the labrum. Occasionally, a traumatic injury that causes a labral tear may be trivial and forgotten by the time of the diagnosis. However, 70 – 80% of adults (18 – 55 years of age) who have no hip pain, have labral pathology seen on MRIs.  Thus, not all labral tears cause pain.

SYMPTOMS OF LABRAL TEARS

  • There may be no pain or symptoms

  • A locking, clicking or “catching” sensation within the joint

  • Stiffness in the joint

  • Little-to-no-pain during normal daily activities

EVALUATION

Your doctor will ask about your hip (your symptoms and how the pain started, for how long, etc) and perform an examination. Your doctor will move your hips and legs in different positions to assess your range of motion and evaluate the positions where your hip hurts. 

To confirm a diagnosis of a hip labral tear, you may undergo a special type of magnetic resonance imaging (MRI) called magnetic resonance (MR) arthrography. Even though you may have an MRI or MRA already, properly performed XRays are important in the evaluation of your hip pain, and provide information the MRI or MRA does not.

Magnetic resonance arthrography (MRA) is a noninvasive, non-irradiating imaging technique that uses a magnetic field and radio waves to evaluate your hip.  While X-Rays show bones well, the MRI is particularly good at showing the non-bony structures of the body, such as the labrum.  Further, while X-Rays are like looking at shadows, the MRI allows evaluation of the tissues around the hip in slices (like slices of bread as opposed to seeing the whole loaf without what is inside) and allows viewing from different angles. During magnetic resonance (MR) arthrography, dye (contrast material) is injected into the joint space to help make images more clear.  Frequently, local anesthetic (numbing medicine) is added to the contrast material to help determine if the pain is coming from inside the joint.

TREATMENT

The labrum does not have a blood supply to it’s substance that allows healing, but sometimes people with a torn labrum do not have any symptoms.  Thus, for those with symptoms that are the result of a labral tear the initial treatment involves rehabilitation and those that have symptoms that persist, arthroscopic surgery may be indicated.  The long term sequelae (recurrence) of labral tears is not known though it is assumed they can lead to arthritic progression. If the tear is the result of abnormal bone formation about the hip, hip arthroscopy is recommended to remove the causative factor (the excessive bone) of the labral tear, in addition to removing the labral tear.

NON-OPERATIVE TREATMENT

A course of physical therapy may be initiated along with activity modification. This includes exercises to help with strengthening of the hip and sometimes to help stretch the muscles about the hip. Corticosteroid injections into the hip joint can help provide pain relief and reduce joint inflammation. These injections are performed under X-Ray or ultrasound guidance. 

ALTERNATE TREATMENT OPTIONS

  • Non-Steroidal Inflammatory Medications (NSAIDs)

  • Glucosamine and/or Chondrotin

  • Hyaluronic Acid Injections

OPERATIVE TREATMENT

Arthroscopic surgery to repair or remove the torn tissue is usually recommended when symptoms do not allow a continuation of desired activities. The procedure is done on an outpatient basis (go home the same day) and full recovery normally occurs by eight to 12 weeks.  If excessive bone is removed or if additional procedures need to be done at the same time, then rehabilitation and return to sports activities may be longer.

Commonly Asked Questions About Hip Labrum

  • Sedentary work can be resumed in one to two weeks. Labor intensive work maybe eight to 12 weeks.

  • Once you have good control of your leg and you are not taking any narcotic medications. This is usually 1-2 weeks

  • Yes, though the amount and duration depends on what is done for your hip.

  • Stationary bike and elliptical trainers are a part of the recovery process and may begin as soon as a day after surgery. However, you are not to go into a swimming pool or get the wounds wet until your sutures are removed (usually 10 – 14 days)

  • Yes but you don’t need to. Spinal anesthesia is possible but generally anesthesia is recommended as risks of complications are less with general anesthesia

  • Yes, though how long depends on what is done and your surgeon’s preference and experience. Your rehabilitation progress will determine the weaning process as well as the extent of the tear and/or associated problems.

  • Your surgeon may recommend a brace to limit motion about your hip if you have a labral repair or a labral reconstruction (replacement of labral tissue with a graft).

  • Yes. The ability to detect articular cartilage injury before surgery still is not perfected, even with MRI. As hip arthroscopy techniques become more refined the incidence and ability to treat cartilage problems are both increasing. The presence of cartilage lesions (articular cartilage) is identified at the time of surgery and is treated by debridement (cleaning it up) and/or microfracture (where we poke holes in the bone to stimulate growth of a scar cartilage to replace the lost articular cartilage.

  • No. Many people have labral tears and have no pain associated with it. At this time, there is no evidence that having surgery for a labral tear that does not cause pain contributes to any long term consequences to your hip.

  • Non-operative treatment is always an option. If you follow a conservative treatment plan of active relative rest, stretching and strengthening, the pain and swelling may go down. If however, you have a labral tear, these generally do not heal. Usually, the pain and swelling will return once you return to your chosen sporting activity.

  • Non-operative treatment is always an option. If you follow a conservative treatment plan of active relative rest, stretching and strengthening, the pain and swelling may go down. If however, you have a labral tear, these generally do not heal. Usually, the pain and swelling will return once you return to your chosen sporting activity.

  • Surgery is done to treat your symptoms, usually groin pain, as well as to reduce worsening of the tear. There is no guarantee that a recurrent tear will not occur. Recurrent tears are, however, unusual. Also, it is not known whether removing the torn cartilage will prevent further damage.

  • The pain may come and go, but likely would not decrease significantly or for an extended period of time, especially if you continue with sporting activity, without surgical intervention.

  • All activities, even rolling over in bed can cause hip stresses. The most important exercises are ones which create normal flexibility about your hip and normal, protective strength. In some situations, activities that require extremes in your range of motion of your hip, may increase stress to the torn labrum.

  • Feeling worse after surgery is always a possibility, however, the likelihood of that is very small.

  • Pain medications can be ordered but are not recommended prior to surgery. Non-steroidal anti-inflammatory medication (Advil, Aleve) and Tylenol mixed together are often better than either alone. However it is recommended that you not take anti-inflammatory medications for the 2 weeks prior to surgery.