What is Labral Tear of the Hip Joint?
A labral tear of the hip is characterized by tearing of the connective tissue within the joint of hip called as the labrum.
The hip joint works on the principle of ball and socket movement. The ball is formed from the upper side of the femur. The thigh bone and the pelvis develop the socket. Labrum is the strong cartilage that is connected with the rim of the hip joint and is responsible for increasing the stability and depth of the socket of the hip joint. The labrum not only holds the ball just like a socket, but also maintains the ball present at the top of the thighbone in its place. Labrum acts like a cushion and shock absorber by absorbing the impact of the femur on the pelvis while performing weight bearing activities. The healthy labrum will be smooth and allows easy movement of the femur on the pelvis. Labral tear of the hip resulting from a trauma such as in sports in which sudden changes of direction and twisting movements are performed may tear or damage the smooth labrum forcing its surface to become tough and rough which also restricts its actual smooth functioning.
A labral tear of the hip is very common in individuals who participate in sports such as football, golf, ballet, soccer, ice hockey, snow skiing, basketball and netball. In some cases, structural abnormalities of the hip may also result in tearing of the hip labrum. A labral tear of the hip is associated with catching sensation and pain in the hip joint.
Initial treatment includes physical therapy and pain relievers. Arthroscopic techniques not only help in removing loose fragments from the joint, but also help in trimming or repairing the hip labral tear.
A labral tear of the hip may also occur while running or due to direct trauma such as heavy landing, motor vehicle accident and falls. In some rare cases gradual wearing and tearing associated with overuse which may involve weight bearing activity over time such as long distance running, excessive kicking such as football or martial arts and excessive twisting could also result in tearing of labrum. Degenerative changes in older individuals may also lead to labral tear of the hip, which may be caused even with relatively trivial movements.
Causes and Risk Factors of Labral Tear of the Hip Joint
- Trauma like collisions, bad falls and traffic accidents.
- Falling down on the outer side of the hip.
- Twisting on the hip with lot of weight on it.
- Repetitive strain on the hip such as in golfers.
- Labrum impingements in activities like horse riding, martial arts and cycling.
Other causes may include:
- Excessive and inappropriate activity and training.
- Insufficient recovery periods from injuries.
- Stiffness in the joints, specifically in the hip.
- Tightness in the muscles, specifically the hip flexor muscles and gluteals.
- Weakness in the muscles, specifically the gluteals.
- Improper running technique.
- Poor foot bio mechanics.
- Training on cambered, hard or uneven surfaces.
- Inappropriate footwear.
- Inadequate warm up.
- Inadequate rehabilitation followed by a previous lower limb or hip injury.
- Anatomical reasons.
- Discrepancy in the length of the leg.
- Poor core stability.
- Poor balance.
Signs and Symptoms of Labral Tear of the Hip Joint
- Pain is experienced in the groin and hip.
- Locking or clicking of the hip joint.
- Stiffness is experienced in the hip.
- Limited range of motion of the hip.
- Sudden appearance of symptoms after an incident is noticeable.
- Gradual development of symptoms with progressive degeneration.
Treatment for Labral Tear of the Hip Joint
Treatment options of labral tear of the hip joint usually depends upon the severity. Conservative treatments help some patients to recover in few weeks whereas others may be treated with arthroscopic surgery to remove or repair the torn area of the labrum.
Medications: Nonsteroidal anti-inflammatory drugs like naproxen and ibuprofen not only help in relieving pain but also decrease inflammation. Injecting corticosteroids directly into the joint also helps in controlling pain.
Surgical and Other Procedures: Surgery is performed when hip pain is experienced for more than 4 to 12 weeks in spite of physical therapy or in case of mechanical symptoms of locking of the hip.
The most common procedure is arthroscopic surgery, which is performed by inserting surgical tools and fiberoptic camera by making small incisions in the skin. Cutting out and removing the torn piece of labrum or repairing the torn tissue in order to sew it back together is usually depends upon the extent and cause of the tear. Several patients recover within four to six months after the surgery.
Physical Therapy: Physical therapy for labral tear of the hip joint is important in speeding up the healing process. Physical therapy also decreases the likelihood of recurrences in the future. Physical therapy may include:
- Soft tissue massage.
- Application of heat and ice.
- Electrotherapy like ultrasound.
- Joint mobilization.
- Dry needling.
- Using crutches.
- Biomechanical correction such as orthotics.
- Anti-inflammatory advice.
- Activity modification advice.
- Appropriate weight loss advice.
- Progressive exercises for improvement of flexibility, strength and balance.
- Clinical pilates.
- Appropriate plan for returning to sports and activity program.
Exercises for Labral Tear of the Hip Joint
Hip Flexion Exercise for Labral Tear of the Hip Joint:
This exercise is performed by lying down on back. Now gradually bring the knee towards the chest as far as possible until a mild to moderate pain free stretch is felt and return back to the initial position. Perform 10 to 20 times ensuring there is no exacerbation of symptoms.
Hip Abduction Exercise for Labral Tear of the Hip Joint:
This exercise is performed by lying down on back. By keeping the knee in a straight position move the leg sideways as far as possible until a mild to moderate pain free stretch is felt and return back to the initial position. Make sure that the toes and the knee cap is facing the ceiling while performing this exercise. Perform 10 to 20 times ensuring there is no exacerbation of symptoms.
Hip External Rotation Exercise for Labral Tear of the Hip Joint
This exercise is performed by lying down on the back with foot flat and knee bent. Now move the knee sideways as far as possible until a mild to moderate pain free stretch is felt and return back to the initial position. Perform 10 to 20 times ensuring there is no exacerbation of symptoms.
Tests to Diagnose Labral Tear of the Hip Joint
A complete objective and subjective examination is performed to diagnose labral tear of the hip joint. Other tests that help in assessing the severity and ruling out other injuries may include:
- Arthroscopy in rare cases.