Labral tear of the Hip

Labral Tears

The hip labrum is a structure made up of fibrous cartilage which acts as a lip around the edge of the hip socket.  Labral tears occur either when the labrum comes away from the hip socket, or develops a tear within itself.  The labrum helps hold your hip joint in place and lets it move smoothly. Damage to it can result in ongoing pain or intermittent symptoms.

Labral tears can develop in different areas around the hip socket.  Most tears happen at the front of the hip (anterior), where the labrum is wider and thinner.  They can also occur at the posterior (back) side.  If you have a diagnosis of labral tear, request a referral to Dr Jason Ward for specialist management. 

What are the signs and symptoms of a labral tear in the hip?

Labral tears in the hip do not always have symptoms, especially if they are small and happen in a person who is not particularly active. They are sometimes found during investigations for another condition. 

When they do develop, symptoms of a hip labral tear can include:

  • Hip pain or stiffness – typically worsening as you bend, rotate, or otherwise move your hip. It may extend into your buttocks or toward your knee.
  • Limited ability to move your hip, especially due to a ‘stiff’ or ‘locked’ feeling
  • Snapping, clicking, or popping sounds and feelings in the hip
  • Dull pain in the hip, groin, or buttocks, which may worsen after activities like running, walking, or prolonged sitting
  • The hip feeling weak, or as though it may ‘give way’.

Given that these symptoms broadly overlap with symptoms of other conditions, including hip arthritis, tendonitis and bursitis, ask for a referral to Dr Ward for a thorough diagnosis.

What causes hip labral tears?

Femoroacetabular impingement (FAI) is the most common cause of hip labral tears. It occurs when the ball-shaped top of the thigh bone (the femoral head) pinches against the edge of the hip socket and damages the labrum, causing it to weaken and tear over time. It can affect people of any age and may increase the risk of hip arthritis.

Other causes of hip labral tears include:

  • Trauma – High-impact events that result in dislocation or hip fractures can particularly cause labral tears, especially hip dislocation. This can result from a fall or tackle in sports or a motor vehicle accident.
  • Repetitive motions – back-and-forth or twisting movements of the hip, like those in football, soccer, tennis and golf, can place extra pressure on the labrum and wear through it over time.
  • Hip dysplasia – having a shallow hip socket (dysplasia) that doesn't fully cover the femoral head (ball part of the hip) can put more stress on the labrum.
  • Arthritis and other degenerative bone conditions – as arthritis progresses, the labrum becomes more prone to tearing.

How are hip labral tears diagnosed?

Your Physio or GP will usually diagnose a labral tear from your history and a physical examination. This usually involves looking at and feeling your hip, seeing how well it moves, and whether it catches during movement.  They will ask about your sport and exercise history and the duration of your symptoms.

If your GP suspects a labral tear, they will usually ask for imaging tests to confirm. These tests may include:

X-rays – these do not directly identify labral tears as they do not show cartilage well, but an x-ray can help identify signs of arthritis, injury, or structural problems which are associated with labral tears.

MRI – modern scanners are highly effective at showing the anatomic detail around the hip.  They often can diagnose a labral tear and assess it’s size, position, and identify any pathology that may have caused the tear.

MR arthrogram – this test is used in conjunction with MRI to increase the accuracy of the diagnosis and identify a labral tear.  It involves an injection of contrast dye into the hip joint before the MRI is done.

Local Anaesthetic injection – your doctor may suggest injecting a local anaesthetic into the joint space as a diagnostic test to see if your symptoms are relieved for a short period.  This may be useful if there are several problems around the hip, to understand which symptoms are coming from the hip joint itself.

What treatment options are available for hip labral tears?

A hip labrum will not heal on its own, however if the tear is small and does not cause symptoms, the GP may recommend rest and the use of over-the-counter pain relief (such as Nurofen or Panadol) until the pain settles.  They may also refer you to a Physiotherapist who will recommend exercises to strengthen your hip muscles and help you modify your activities to avoid aggravating the tear in the future.

Labral tears which are severe or have ongoing symptoms may require surgical repair.  Dr Jason Ward is happy to discuss appropriate treatment for you.  Surgical treatment options may include:

  • Hip arthroscopy – A small fibre-optic camera is inserted into the hip joint, and the unstable or torn parts of the labrum can be repaired or debrided. If your labral tear is caused by femoroacetabular impingement, your surgeon can often correct it during the same procedure.
  • Labral repair – after cleaning up any scar tissue or rough areas of cartilage, your surgeon stitches the damaged parts of the labrum back against the bone.
  • Hip arthrotomy - sometimes a minimally invasive technique is required for more significant labral tears.
  • Hip replacement surgery – if your labral tear is associated with severe arthritis or other bone injury, a full hip replacement may be required to relieve ongoing pain.
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