The acetabular labrum, a ring of soft connective tissue around the rim of the acetabulum, provides stability, flexibility, and motion to the joint as well as shock absorption, joint lubrication, and pressure distribution. It keeps the head of the femur (thighbone) inside the acetabulum.
Labral tears in general cause pain if the labrum is torn, frayed, or damaged. Many athletes experience a torn acetabular labrum, particularly active adults between the ages of 20 and 40 who practice ice hockey, soccer, football, golf, and ballet. Sports that require repeated twisting or pivoting motions (like those when swinging a golf club) can lead to higher risk of injury. Preexisting conditions or diseases of the hip, or within its joint, can also increase the possibility of a tear in the acetabular labrum.
Symptoms of the Tear
- A clicking or catching sensation in your hip
- Pain in your hip or groin
- Stiffness or limited hip joint movement
- Buttock pain (less common)
- A feeling of giving way within the hip.
Causes of Torn Hip Labrums
- Degenerative tear – Occurs from wear and tear, for example, repeated twisting and pivoting motions.
- Traumatic tear – The result of a sports injury, a fall, or an accident – and a major cause for labral tears.
- Structural abnormalities – A tear can also occur as a result of structural abnormalities in one’s hip. Wear and tear of the joint can accelerate the injury and cause a tear. Femoral acetabular impingement (FAI) is also an important cause of acetabular labral tears. Hip bones don’t fit together perfectly as they are abnormally shaped, and this results in these bones rubbing against each other and causing damage to the joint.
- Arthritis – When the labrum is damaged, it results in the joint’s fluid pressure degenerating and increases the risk of arthritis.
- Osteoarthritis – Osteoarthritis can also increase the likelihood of a labral tear.
Pain that lasts more than several days should be investigated. An acetabular labral tear is rarely isolated and usually results in other structures also sustaining injuries. Diagnostic tests can help determine exactly what’s going on inside your joint.
There are several ways your doctor can diagnose a torn acetabular labrum, namely:
- Imaging scans
- X-rays – these tests are used to eliminate the possibility of fractures, dysplasia, degeneration, or other structural abnormalities. Soft tissue cannot be seen on x-rays.
- Magnetic resonance imaging (MRI) scan – this type of scan can be used to evaluate the labrum, but it might not be clearly seen. If a contrast fluid is injected into the hip joint at the same time as the scan, a tear will be better defined.
- Magnetic arthrography scan – in this diagnostic test, a dye is injected into the joint to examine the soft tissue and assess an injury.
- Diagnostic injection – Many doctors will inject a local anesthetic into the hip joint using an x-ray monitor to make sure the needle is in the correct position, and if the pain is alleviated by the injection, then the likely cause was this joint. If the pain continues, then further diagnostic tests will need to be done.
- Arthroscopy – The best possible procedure to assess a damaged acetabular labrum. During surgery, a small camera is inserted into the hip’s ball-and-socket joint and gives the doctor a clear view of its inside.
Your treatment will depend on the severity of your symptoms and the characteristics of the tear. Some simple treatments include:
- Rest – It’s important to rest your hip in order to minimize the pain and inflammation. Avoid extending it excessively and avoid jarring motions. Also, avoid sitting with your knees lower than your hips, crossing your legs, and sitting on the edge of your seat.
- Medication – Anti-inflammatory medications are useful for the treatment of joint inflammation and for pain relief; their administration may result in the symptoms resolving themselves.
- Therapy – Physical therapy is used to strengthen and balance the muscles around the hip joint. The physical therapist can also help you avoid movements that put unnecessary stress on this joint. Aquatic therapy is beneficial and will help to improve hip function by allowing the patient to move more freely without the pressure of gravity.
- Cortisone injection – Relieves pain and can be administered at the same time as a diagnostic injection.
For more serious injuries, surgery may be required:
- Hip Arthroscopy Surgery – Sometimes surgery is required in cases where the pain associated with the acetabular labral tear continues for more than 4 to 12 weeks. During arthroscopy surgery (a relatively new type of surgery), the torn piece of labrum can be cut out and then repaired by sewing it back together (refixation), or the piece may be removed entirely (debridement). This is a minimally invasive technique, and recovery time is between 6 and 12 weeks. You will have to use crutches for up to 6 weeks after surgery.
The goal of the surgery is to regain normal hip flexion, range of motion and stability. Once your orthopedic surgeon has given you the go-ahead, you can begin light stretching and hip flexion exercises; for example, lie on your back and then raise your knee to your chest – stop if you feel pain or pinching. Repeat as per your therapist’s instructions.
Exercises in a hydrotherapy pool are particularly beneficial as you can increase mobility without putting stress on the joint. A Buoyancy Belt is very useful in that it allows you to run in the pool without touching the bottom.
Resistance Bands can be used for progressive strengthening exercises. Please consult your therapist on which rehabilitation exercises are suitable for you. Many athletes can return to sports within 4 to 6 months after surgery.
While little can really be done to prevent hip labrum tear, stretching before exercise is always helpful. An imbalance of muscles can lead to increased hip flexion, and weak gluteals increase joint pressure during hip extension. So in order to help prevent a labral tear in your hips, you’ll need to strengthen or stretch any muscles that might cause muscular imbalance. One exercise that helps strengthen the gluteus is called hip abduction. While lying on your side with your legs on top of each other, lift the upper leg while keeping your knee and hip straight.
To stretch a tight hip flexor, try the walking straight-leg kick and the swinging leg kick exercises. For the walking straight-leg kick, step forward with one foot and then kick forward with the other leg, keeping your knee straight, and continue until your leg is parallel with the floor. Then kick forward with the opposite leg. For the swinging leg kick, stand next to a pole and hold onto it. Stand on one leg and kick forward using the other leg. Kick as high as possible and then swing it behind you as far as possible. Keep your body straight. Do this ten times and then repeat with the other leg.