Hip Labral Tears

The labrum is a ring of firm cartilage around the rim of the hip socket that deepens the socket, helps hold the joint in place, and seals the lubricating fluid inside. A hip labral tear is a split or fraying of that ring. Because the labrum has a limited blood supply, it does not heal on its own. Torn tissue can catch between the ball and socket, producing the clicking or locking many patients describe. The most common cause is hip impingement (FAI). A tear cannot be reversed, but the pain it causes can usually be managed.

Common symptoms include:

• A deep, dull ache in the groin or front of the hip that sharpens with certain movements
• Pain with pivoting, deep squatting, or getting in and out of a car
• A clicking, catching, or locking sensation inside the joint
• A deep ache after prolonged sitting in a low seat that eases when you stand
• Stiffness at the extremes of hip rotation

Diagnosis starts with a history and a focused physical examination, checking whether specific positions reproduce your symptoms. Standard X-rays look for bony changes related to hip impingement and early arthritis. MR arthrography, an MRI taken after contrast is injected into the joint, is the most sensitive way to detect a labral tear, as the dye seeps into the tear and outlines it.

Most labral tears are managed without surgery, at least initially:

• Activity changes to limit deep squatting, extreme rotation, and prolonged sitting
• Physical therapy to strengthen the deep hip stabilizers and core
• Anti-inflammatory medication to reduce inflammation around the tear
• A corticosteroid injection to calm a flare and help confirm the hip is the source of pain

Surgery is considered when mechanical symptoms such as true locking are present, imaging shows a clear tear, and nonsurgical care has not relieved the pain. The procedure is a hip arthroscopy, repairing or trimming the labrum and reshaping any contributing bone from FAI at the same time.

For a fuller explanation, including anatomy, diagnosis, and the full range of treatment:

• Hip Arthroscopy — AAOS OrthoInfo