Physio Penrith Hip Labral Tear Treatment
Treatment of Hip Labral Tears at Sydney Muscle & Joint Physio Penrith
What is a hip labral tear?
The acetabular labrum is a fibrocartilaginous structure that lines the acetabular socket and has many functions, including shock absorption, joint lubrication, pressure distribution, and aiding in stability, with damage to the labrum associated with osteoarthritis. The etiology of labral tears includes trauma, femoroacetabular impingement (FAI), capsular laxity/hip hypermobility, dysplasia, and degeneration. The prevalence of labral tears in patients with hip or groin pain has been reported to be 22–55%.
Studies have shown that 22% of athletes with groin pain and 55% of patients with mechanical hip pain of unknown etiology were found to have a labral tear upon further evaluation.
What are the symptoms of a hip labral tear?
Hip labral tears present with anterior (front) hip or groin pain, and less commonly buttock pain. Frequently, there are also mechanical symptoms including clicking, locking, and giving way. An isolated labral tear was found more often in younger patients, whereas a labral tear in conjunction with chondral lesions was found more often in older patients, indicating that a labral tear may precede and possibly lead to articular changes (osteoarthritis).
Burnett and colleagues studied 66 patients found to have labral tears by arthroscopy and reported 92% had predominant localised groin pain, 52% had associated anterior thigh pain, 59% described lateral hip pain, and 38% reported associated buttock pain, while no patient presented with isolated buttock pain.
Many patients with labral tears describe a constant dull pain with intermittent episodes of sharp pain that worsens with activity. Walking, pivoting, prolonged sitting, and impact activities, such as running, often aggravate symptoms. Seventy-one percent of patients describe night pain. Functional limitations include, limping (89%), needing a banister to climb stairs (67%), limitation of walking distance (46%), and sitting limited to 30 min (25%).
When considering hip and groin pain, the differential diagnosis should include the following diagnoses: contusion, strain, osteitis pubis, inflammatory arthritis, hip osteoarthritis, piriformis syndrome, snapping hip syndrome, hip bursitis, femoral head avascular necrosis, fracture, hernia (inguinal or femoral), slipped femoral capital epiphysis, Legg-Calve-Perthes disease, or referred pain from the low back and sacroiliac joints.
How do you diagnose a hip labral tear?
The most consistent physical examination finding is a positive anterior hip impingement test. This is performed with the patient supine with the hip and knee at 90 of flexion. The hip is internally rotated while an adduction force is applied. A positive test results in pain provocation in the anterolateral hip or groin.
Several researchers have reported slight hip range of motion limitations. The most commonly reported range of motion limitation was in rotation, but hip flexion, adduction, and abduction range of motion limitations also have been reported.
Imaging can be utilised and usually begins with plain x-ray to assess for impingement, dysplasia, degeneration, and other causes of pain. While magnetic resonance imaging (MRI) and CT scans are unreliable for diagnosis, magnetic resonance arthrography (MRA) is the diagnostic test of choice, with arthroscopy being the gold standard.
What is guideline-based treatment of hip labral tears?
Typically, a trial of conservative management, including relative rest, anti-inflammatory medications, and pain medications as necessary, combined with a focused physiotherapy protocol for 10–12 weeks is recommended initially.
Physiotherapy-led exercise protocol for acetabular labral tears aims to optimise the alignment of the hip joint and the precision of joint motion by reducing anteriorly directed forces on the hip and addressing abnormal patterns of recruitment of muscles that control the hip. Assessing the impairments of joint stiffness and muscle weakness allows a better more targeted approach for the treatment of hip labral tears.
Activity limitation of pivoting motions and other movement patterns that increase forces across the labrum is of utmost importance because the acetabulum rotates on a loaded femur. Much of the focus is on strengthening muscles found in weak muscles. Assessing foot motion, especially through the subtalar joint, and correcting stiffness and/or restricted dorsiflexion are crucial in making corrections to gait patterns. The strengthening pattern is progressed over time to maintain long-term success in treatment.
With the train of thought that the labrum is a relatively avascular structure, it is thought that restricted range of motion causes lower rates of imbibition and compromised nutrition, therefore passive and active modalities aimed at restoring range of motion will also increase the rate of nutrient flow and may promote labral healing.
If long-term conservative treatment fails to reduce pain and restore function, some studies have report varied results after arthroscopic debridement. Burnett and colleagues reported 89% of patients with continued ‘‘improved’’ status at an average of 16.5 months after arthroscopic debridement of a labral tear.