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Labral Tear/Impingement

    • A labral tear is an injury to the labrum that lines the hip joint. The labrum is a soft thin rim of cartilage that protects and lubricates the socket to prevent the two bones from grinding against each other during movement. This lining helps keep the bones and joints moving smoothly.

    • Hip labral tears occur when something damages this cartilage. The damage can happen slowly over time through wear which results in fraying or small tears of the cartilage or may be the result of a trauma creating a more significant tear.

    • Patients typically report pain over the anterior hip and groin that has a gradual onset. This pain is generally a constant dull ache with occasional sharpness in certain positions. In some cases patients may also experience clicking, catching or locking in their hip.

    • Pain may worsen at night especially with certain movements including walking, pivoting, prolonged sitting, and running.

    • Diagnosis is based on detailed history, physical examination, and imaging. The patient will be put through various repetitive movements testing the hip, looking for symptom exacerbation. Certain physical tests may be utilized to reproduce symptoms at time of exam.

    • X-rays are often utilized to look for structural abnormalities and measure angles of the hip. Magnetic resonance imaging (MRI) and Magnetic resonance arthrography (MRA) are utilized in the diagnosis of labral pathology and integrity with MRAs having a higher sensitivity and accuracy rate due to the dye injected into the joint prior to imaging (Su et al, 2019).

    • Conservative Management
      • Initial treatment consists of rest, NSAIDs, activity modification and physical therapy. Nonsteroidal anti-inflammatory drugs (NSAIDs) are used for pain relief and physical therapy may be utilized to improve strength and function of the hip.

      • Intra-articular Injections
        • Intra-articular injections may be utilized for a diagnostic approach to determine whether the pain is stemming from a labral injury or other extra-articular pathology.

    • Surgical Intervention
      • If conservative treatment of the tear does not resolve pain surgery may be necessary to repair the damaged portion of the labrum. In some cases a debridement of the labrum may be used. If the torn labrum is stemming from bony structures impinging on the labrum, the bones may need to be shaved down as well.

Su T, Chen GX, Yang L. Diagnosis and treatment of labral tear. Chin Med J (Engl). 2019 Jan 20;132(2):211-219. doi: 10.1097/CM9.0000000000000020. PMID: 30614856; PMCID: PMC6365273.