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Hip labral disorders are conditions affecting the acetabular labrum, a fibrous cartilage that lines the acetabulum (the socket of the hip joint). The labrum plays a crucial role in hip joint stability, shock absorption, and the distribution of pressure across the joint. Damage to the labrum, often caused by trauma, overuse, or structural abnormalities, can lead to pain, reduced mobility, and eventual joint degeneration.

Signs & Symptoms

Patients with hip labral disorders typically present with the following signs and symptoms:

  • Pain:
    • More than 90% of individuals experience pain in the anterior hip or groin.
    • Less commonly, pain is felt laterally or deep in the posterior buttocks.
    • Women may report concurrent pelvic floor pain.
    • The pain is often described as a constant dull ache with intermittent sharp episodes.
    • Night pain occurs in 71% of patients.
  • Mechanical Symptoms:
    • Clicking, locking, or catching sensations in the hip.
    • Feeling of instability or “giving way” in the joint.
  • Functional Limitations:
    • Limping in 89% of cases.
    • Difficulty climbing stairs (67% require support).
    • Walking distance and prolonged sitting are often limited.
    • Aggravation of symptoms with activities such as running, pivoting, or prolonged sitting.
  • Range of Motion (ROM) Restrictions:
    • Limited rotation is commonly noted during assessment.

Causes and Contributing Factors

Several factors can contribute to the development of hip labral disorders:

  1. Structural Abnormalities:
    • Femoroacetabular Impingement (FAI): Abnormal bone shapes in the hip joint can increase stress on the labrum.
    • Acetabular Dysplasia: A shallow hip socket reduces joint stability.
  2. Trauma:
    • High-impact injuries, such as those from contact sports or falls, can tear the labrum.
    • Dislocations or subluxations often damage the labrum.
  3. Capsular Laxity or Hypermobility:
    • Looseness in the joint capsule can lead to excessive movement and strain on the labrum.
  4. Degeneration:
    • Wear-and-tear from repetitive movements or ageing can weaken the labrum over time.
  5. Biomechanical Factors:
    • Gait abnormalities, poor foot alignment, or pelvic instability can increase hip joint stress.

Diagnosis

Accurate diagnosis of hip labral disorders is essential for effective treatment. The most reliable diagnostic methods include:

  • Clinical Assessment:
    • Thorough history and physical examination to identify signs and symptoms consistent with labral tears.
  • Imaging:
    • Magnetic Resonance Imaging (MRI): A 3-Tesla (3-T) MRI provides the highest sensitivity for detecting labral tears.
    • Magnetic Resonance Arthrography (MRA): Combines MRI with the injection of contrast dye into the joint, offering superior accuracy in identifying labral abnormalities.
    • X-ray and CT Scan: Useful for assessing structural abnormalities like FAI or acetabular dysplasia but less effective in visualising soft tissue.
  • Hip Arthroscopy:
    • Considered the gold standard for diagnosis and treatment, arthroscopy allows direct visualisation of the labrum but is reserved for cases where other diagnostic methods are inconclusive.

Grading of Labral Tears

Labral tears can be classified by their location, morphology, or cause:

  • By Location:
    • Anterior tears: Most common due to poor vascular supply and high mechanical stress.
    • Posterior tears: Often associated with trauma or dislocation.
    • Superior/Lateral tears: Less common but occur under specific loading patterns.
  • By Morphology:
    • Classified as radial, longitudinal, or degenerative based on the tear’s shape and extent.
  • By Cause:
    • Traumatic, degenerative, or related to structural abnormalities.

Physiotherapy

Physiotherapy plays a central role in the conservative management of hip labral disorders. Goals of treatment include reducing pain, improving joint stability, and enhancing functional capacity. A comprehensive physiotherapy program typically includes:

1. Activity Modification:

  • Avoid pivoting, twisting, and other movements that increase stress on the labrum.
  • Educate patients on ergonomic movements and proper biomechanics during daily activities.

2. Strengthening Exercises:

  • Focus on the hip, core, and lower limb muscles to stabilise the joint.
  • Gradually progress from non-weight-bearing exercises (e.g., bridges) to weight-bearing exercises (e.g., squats or lunges).
  • Functional training specific to the patient’s goals, such as running or stair climbing.

3. Mobility and Flexibility:

  • Stretch tight hip flexors, hamstrings, and pelvic muscles.
  • Joint mobilisation to improve hip, pelvis, and lumbar spine movement.

4. Gait Training:

  • Correct abnormal walking patterns.
  • Incorporate orthotics, taping, or shoe modifications to improve foot mechanics.

5. Proprioception and Balance:

  • Use balance boards, foam surfaces, or dynamic exercises to enhance joint awareness and stability.

6. Pain Management:

  • Techniques such as heat, ice, or manual therapy may be used to manage pain during treatment.

Physiotherapy is typically recommended for 12-24 weeks before considering surgical options.

Surgical Management

Surgery is considered when conservative treatments fail to alleviate symptoms or if functional limitations persist. Common procedures include:

  • Labral Repair:
    • The torn portion of the labrum is sutured back into place to restore joint stability.
  • Labral Debridement:
    • Damaged or frayed parts of the labrum are trimmed away.
  • Hip Arthroscopy:
    • A minimally invasive procedure used for both diagnostic and therapeutic purposes.
  • Addressing Underlying Causes:
    • Procedures to correct FAI or acetabular dysplasia may be performed alongside labral repair.

Prognosis

The prognosis for hip labral disorders varies based on the severity of the tear and the treatment approach. Key findings include:

  • Mild to Moderate Tears:
    • Respond well to physiotherapy, with significant improvements in pain and function.
  • Severe Tears:
    • May not show substantial improvement with conservative management alone.
    • Surgical intervention may be necessary for symptom relief and functional recovery.

Long-term untreated labral tears are associated with an increased risk of early-onset osteoarthritis (OA) due to joint instability and increased cartilage stress.

Information is provided for education purposes only. Always consult your physiotherapist or other health professional.