1. Labral Tears

2. Normal Anatomy
Labrum is fibrocartilaginous ring that surrounds the acetabulum
Present over the anterior, superior and posterior aspects of the acetabulum
Inferior it is completed by the transverse acetabular ligament
Blood supply to the outer 1/3 of the labrum
Labrum has various roles
Deepens the hip joint increasing joint stability
Acts as a shock absorber
Decreases the force transmitted to the articular cartilage by increasing the surface area of the acetabulum
Provides a seal for the joint to maintain synovial fluid and pressure
Hip Extension creates the most amount of contact pressure in the hip
Source of proprioceptive feedback
Contains nociceptors so can be a source of pain
Hip joint capsule supported by 3 extra articular ligaments
Pubofemoral
Ischiofemoral
iliofemoral

3. Pathology
a tearing of the fibrocartilage that surrounds the acetabulum
most commonly in an anterior and anterosuperior location of the inner aspect of the labrum

4. Mechanism of Injury Traumatic
Requires significant trauma such as subluxation, dislocation or acetabular fractures
shearing force from twisting, pivoting or falling
External rotation force in a hyperextended position

5. Mechanism of Injury Insidious
Microtrauma from repeated pivoting and twisting
Football, hockey, golf, ballet
Idiopathic
Femoroacetabular Impingement
Boney abnormality
Capsular laxity
Laxity of the capsule and ligaments decreases the ability to absorb stress
Therefore labrum exposed to more stress
Global Laxity
Systemtic connective tissue disease
Focal Rotational Laxity
Golf, hockey, basketball
Congenital
Hip Dysplasia
Shallow hip increases stress on labrum and capsule
Degenerative
Associated with degenerative changes within the hip joint

6. Classification Can be classified by location, etiology or morphology
Morphological classification listed below
Radial Flap
Most common
Disruption of the free margin of the labrum
Radial Fibrillated
Fraying of the free margin
Associated with degenerative joint disease
Longitudinal Peripheral
Longitudinal tear in the peripheral aspect of the labrum
Abnormally Mobile
Detached labrum
Similar to Bankart lesion in the shoulder

7. Associated Pathology Chondral lesions Osteoarthritis
Dysfunctional labrum increases contact pressure on chondral surfaces
Osteoarthritis
Dysfunctional labrum increases the pressure within the joint leading to early deterioration
Femoroactebular Impingement

8. Subjective Examination
Usually insidious with repeated microtrauma
Can be traumatic
Pain in the anterior groin
Worse with prolonged walking, pivoting or prolonged sitting
Painful inguinal clicking
May report Instability and giving way
May refer pain into the buttock, greater trochanter, thigh or medial knee

9. Objective Examination
Reduced hip extension during gait
Pain, restricted range of movement or clicking on passive range of movement testing
Painful hip flexion and adduction

10. Special Tests
FABER
Scour Test
Resisted Straight Leg Raise

11. Further Investigation
MRA
MRI
CT scan
Arthroscopy

12. Management
Conservative management attempted for 10 – 12 weeks initially
Surgery is often required

13. Conservative Reduce pain and inflammation
NSAID’s
Ice
Massage
Rest from aggravating activities for positions (end range extension, pivoting)
Restore Normal Range of Movement
Lumbar spine, Hip
Joint mobilisation
Joint manipulation
Stretches N.B stretches should not replicate clients symptoms

14. Conservative Restore Normal Muscle Activation
Hip Flexors
Hip Extensors and Abductors
Deep Hip Rotators
Restore Dynamic Stability
Proprioceptive Training
Sport Specific Training

15. Plan B
Surgery
Different types of surgery depending on arthroscopic findings and surgeon preference
Arthroscopic Debridement

16. References
Cheatham, S. W., K. R. Enseki and M. J. Kolber (2016). "The clinical presentation of individuals with femoral acetabular impingement and labral tears: A narrative review of the evidence." J Bodyw Mov Ther 20(2):
Groh, M. M. and J. Herrera (2009). "A comprehensive review of hip labral tears." Current Reviews in Musculoskeletal Medicine 2(2):
Martin, R. L., K. R. Enseki, P. Draovitch, T. Trapuzzano and M. J. Philippon (2006). "Acetabular labral tears of the hip: examination and diagnostic challenges." J Orthop Sports Phys Ther 36(7):
Reiman, M. P., R. C. Mather, 3rd, T. W. Hash, 2nd and C. E. Cook (2014). "Examination of acetabular labral tear: a continued diagnostic challenge." Br J Sports Med 48(4):
Tijssen, M., R. E. van Cingel, E. de Visser, P. Holmich and M. W. Nijhuis-van der Sanden (2016). "Hip joint pathology: relationship between patient history, physical tests, and arthroscopy findings in clinical practice." Scand J Med Sci Sports.