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Hip Labral Tear

Labrum is a ring of strong fibrocartilaginous tissue lining around the socket of the hip joint. Labrum serves many functions where it acts as shock absorber, lubricates the joint, and distributes the pressure equally. It holds the head of the femur in place and prevents the lateral and vertical movement of the femur head with in the joint. It also deepens the acetabular cavity and offers stability against femoral head translation.

Labral tear may be caused by trauma, femoroacetabular impingement (FAI), hip hypermobility, dysplasia, and degeneration. It is one of the rare conditions and is common in athletes playing sports such as ice hockey, soccer, golf and ballet. Structural abnormalities may also cause hip labral tear. Patients may have hip pain, clicking and locking of joint and restricted range of motion. Patients may also experience dull pain on movement of hip joint that may not subside on rest. Hip labral tear is often diagnosed with symptoms, history, physical examination and radiological techniques. Magnetic resonance arthroscopy may be more appropriate for diagnosing hip labral tear.

Your doctor may start with conservative treatment prescribing non-steroidal anti-inflammatory drugs and advising you to rest. These methods may offer symptomatic relief while surgery is required to repair the torn labrum. Your doctor may perform arthroscopic surgery using fibre-optic camera and surgical instruments through the smaller incisions. Depending on the severity of tear, the damaged or torn labrum may be removed or may be sutured.

Hip Instability

The hip plays an important role in supporting the upper body weight while standing, walking and running, and hip stability is crucial for these functions. The femur (thigh bone) and acetabulum (hip bone) join to form the hip joint, while the labrum (tissue rim that seals the hip joint) and the ligaments lining the hip capsule maintain the stability of the hip. Injury or damage to these structures can lead to a condition called hip instability. Hip instability happens when the hip joint becomes unstable causing various symptoms.

Symptoms


The most common symptoms of hip instability include

  • Pain
  • Laxity
  • Giving away of the hip
  • Producing a clicking sound
  • Dislocation

Causes

Hip instability can be traumatic or atraumatic. Traumatic instability can be caused by injuries from sports or motor vehicle accidents. These injuries can damage the bony structures, labrum, and cartilage of the hip joint and can form loose bodies. It can range from severe dislocation to a simple subluxation (partial displacement) of the hip joint. Atraumatic instability can be caused by overuse or developmental/congenital abnormalities of the hip joint.

Conditions that can cause hip instability include:

  • Labral and ligament tears
  • Hip dysplasia (misaligned hip joint bones)
  • Femoro acetabular impingement (abnormally shaped hip joint bones)
  • Tears to the ligamentum teres

Diagnosis

Your doctor will diagnosis hip instability based on your medical history and physical examination. Imaging studies such as plain X-rays, MRI, and MRI arthography (use of a contrast agent) may also be ordered to confirm instability. Your doctor may also perform hip instability tests such as posterior impingement or dial test; both of which involve simple range of motion exercises.

Treatment

Your doctor may start you off on a conservative/non-operative treatment approach such as protected weight bearing (crutch, cane, or wheelchair) and referral to a physical therapist for exercises. A physical therapist will instruct on special exercises, focused on improving your strength, balance, and flexibility.

When conservative options fail to resolve your symptoms or if you have large fractures, you may be recommended to undergo surgical management. Surgery can be arthroscopic (minimally invasive) or open depending on your condition. Most of the common causes for hip instability, such as damage to the hip capsule and ligaments surrounding the joint, and labral tears can be rectified arthroscopically. Your doctor will be the best person to address your concerns and help you overcome your instability.

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