Mick spends most of his time doing clinical research. He is passionate about helping others to live healthy, happy lives.
Hip Labral Tear
A hip labral tear is a painful condition that may require surgery. The labrum is a rubbery cartilage that has several important functions. One of these important functions is to help keep the ball part of the joint (which is the top of the femur bone) in the socket (part of the pelvis bone). There are several causes of labral tears. Some causes are a result of trauma. However, there are also several non-traumatic causes. Traumatic tears of the labrum most commonly occur during high impact sports or exercise. On the other hand, non-traumatic tears are usually attributed to several biomechanical factors. The treatment for tears will depend on a number of variables, including the cause and severity. Arthroscopic surgery is the best option in some cases; but not all cases. This article outlines how these tears can occur, some alternatives to surgery, what happens during arthroscopic repairs, as well as the risks, and expected recovery time after surgery.
Hip Labrum - What Is It and What Does It Do?
The hip joint is a ball and socket joint that is encased in a dense soft tissue capsule. The ball part of the joint is at the end of the thigh bone and is called the head of the femur. The socket part of the joint is called the acetabulum. The acetabulum is part of the pelvis. The labrum is dense soft tissue (like a rubbery cartilage) that attaches to the outside of the acetabulum (outside part of the socket) on the pelvis side of the joint. It is perhaps the most important part of the soft tissue structures that envelope the ball to keep it the right place. Some people have described the labrum as forming part of the ‘suction cup’ that helps to keep the ball in the socket. There quite a wide range in the shape and thickness of the labrum (and other structures of the hip) that naturally occurs in a normal population. However the labrum is generally thicker at the back (posterior) portion of the joint and thinner and wider at the front (anterior) portion of the joint.
Causes of Hip Labrum Tears
Medical professionals and researchers believe there are at five primary causes of labral tears. These causes include trauma, impingement of the labrum between the acetabulum and the head of femur, laxity of the hip capsule, hip dysplasia and degeneration.
Labral tears due to trauma usually occur during high velocity and impact events (such as a car accident or sporting injury) and are often associated with dislocations (or subluxations). If the hip dislocates in the backward (posterior) direction than the labrum tear will often be on the back (posterior) portion of the labrum.
Impingement occurs when the labrum is being pinched between the ball and socket during certain kinds of movements. This may happen due to certain biomechanical factors (such as the shape of the acetabulum or head of femur). Unfortunately the underlying biomechanical factors (shape of the pelvis or thigh bones) that cause this to occur in some people can be difficult to change (without surgery).
Similarly to impingement, laxity of the hip capsule is another cause of labral tears that is not easy to change. You may recall that the capsule refers to the soft tissue structures that keep the ball in socket. Certain hormone levels or soft tissue disorders can cause some people to have an increased risk of capsule laxity leading to labrum tears. Laxity in the capsule can lead to additional strain on the capsule tissues (such as the labrum); particularly during rotational activities (such as tennis). Capsule laxity can cause the head of the femur to be unstable during movement and rides forward and up (anterior and superior) in the socket. This instability and additional strain on the front-upper (anterior-superior) portion of the labrum may cause it to tear.
Illustration of Hip Dysplasia
Hip dysplasia is a developmental condition characterised by misformed or misaligned joint. This may commonly include a shallow socket or misshapen femoral head. It can cause a range of problems including damage to the joint surface. Labral tears are also a problem that have been observed to occur among people with hip dysplasia.
Like many structures in the body, the soft tissues around the hip can experience degeneration with age. The labrum is not immune to this and may tear as a result of degeneration in older age. People who develop labral tears in young or middle ages are more likely to have one of the other four causes described above.
Symptoms of Hip Labral Tears
The most common symptom of a labrum tear is pain at the front of the hip (anterior hip pain) or in the groin area. While this is the cast in a vast majority of cases (more than 90%), sometimes people with labrum tears complain of pain deep in their buttock, or on the sides. It is believed that people who have a labrum tear and report pain at the front are more likely to have a tear in the anterior (front) portion of the labrum. This is also where the labrum is thinner and more likely to tear. In contrast, people who report pain deep in the buttock region are considered more likely to have a tear in the posterior region of the labrum.
Other symptoms of a labral tear at the joint include clicking, locking, catching, or giving way. Sometimes women with a labrum tear may also report a sensation that feels like pain in their pelvic floor area. It is also common for labrum tears to cause referred pain to the inside of the knee. In other words, it may feel like there is pain on the inside of knee, but this is being caused by the tear at the hip. Because there are many potential causes of pain around the hip, it is not uncommon for people with labrum tears to see several health professionals over a period of time (perhaps a couple of years) before it is correctly diagnosed.
Video of Arthroscopic Labral Tear Surgery
Non-Surgical Treatments for Tears (Conservative Management)
People with labral tears may be advised to try a conservative approach at first. This may include avoiding any aggravating activities (such as sport), anti-inflammatory medications, pain medications, and perhaps most importantly undertaking physical therapy for approximately 12 weeks. For many people, the symptoms may subside with this approach only to return once they begin undertaking their usual activities. Steroid injections may be considered but are generally not the first treatment option for young people who otherwise do not have degeneration at the joint.
Surgery for Hip Labral Tears
If conservative management has not resulted in a suitable reduction in symptoms, surgery is sometimes considered. The earlier surgical techniques would simply cut awat the damaged portion of the labrum. However, the removal of labrum may contribute to instability and earlier onset of arthritis. Therefore, contemporary surgical approaches most often include arthroscopic repair of the hip labrum. This involves making several small incisions (also colloquially known as 'keyholes') and inserting surgical instruments to access the joint with minimal invasiveness. Although, it is worth noting that even arthroscopic labrum repairs (as with all surgery) is still an invasive procedure. Once the instruments are in place, the surgeon can use several techniques to tidy up the area and repair structural abnormalities. The purpose of arthroscopic treatment is to relieve pain by eliminating the unstable flap tear that causes the discomfort. In some cases open surgery may be required, this involves the surgeon cutting through the skin and soft tissues to directly access the joint and repair the affected structures. Open procedures are generally more invasive, painful and have a longer recovery time. For this reason they are typically only used when arthroscopic surgery is not viable or likely to be successful (not common for tears these days).
Risks of Surgery
No surgery is risk free. Some risks that have been reported for surgical labrum repairs include:
- Blood clot, most notably deep vein thrombosis (DVT)
- Damage to the cartilage on the joint surface
- Accidental nerve or blood vessel injury
There are also other risks associated with going under a general anesthetic including (this is not a comprehensive list):
- Nausia and vomitting
- Allergic reaction to anaesthetic
- Death (this is unlikely, something like 1 in 100000)
As always, if you are considering any treatment including surgery, you should discuss the potential risks of treatment with your doctor. Risks are not equal for all patients. Your doctor will be able to provide you with specific advice and more comprehensive details of risks that may arise in your specific circumstance.
Recovery After Surgery - What to Expect.
The first few days after arthroscopic hip labrum repairs will be quite uncomfortable. It is important that an appropriate medication schedule is in place to manage post-operative pain at this time. Patients will often be seen by a physical therapist in the first day or two following surgery who will be able to provide instructions for a staged exercise plan that is approved or recommended by the surgeon. Depending on the precise surgery that has been performed, some people will not be permitted to put all their weight on the affected leg for several weeks. Other people may use a walking aid in the first few days for comfort only and will be able to return to normal walking quite quickly. Although the hospital stay will most likely be quite short (generally ranging from one day to a few days), the recovery period will usually last for 6-12 weeks depending on the severity of the injury and repair. Return to sport or other high impact activities will depend on several factors. Some of these factors include the cause of the injury (and likelihood of re-injury), the severity of injury and the nature of the surgical repair technique. The surgeon will generally be able to provide some advice in this regard prior to the surgery being undertaken.
Bharam, S. "Labral tears, extra-articular injuries, and hip arthroscopy in the athlete." Clinics in Sports Medicine. 2006 Apr; 25(2):279-92.
Groh, M., and Herrera, J. "A comprehensive review of hip labral tears." Current Reviews in Musculoskeletal Medicine. 2009 June; 2(2): 105–117.
McCarthy, JC. "The diagnosis and treatment of labral and chondral injuries." Instructional Course Lectures. 2004; 53:573-7.
This content is accurate and true to the best of the author’s knowledge and does not substitute for diagnosis, prognosis, treatment, prescription, and/or dietary advice from a licensed health professional. Drugs, supplements, and natural remedies may have dangerous side effects. If pregnant or nursing, consult with a qualified provider on an individual basis. Seek immediate help if you are experiencing a medical emergency.
Tell us about your story
Mickmc (author) on March 30, 2019:
Thanks for stopping by to leave a comment. I am sorry to hear about your trouble. It can often be a little tricky to diagnose the specific structure(s) that are causing pain to radiate into the hip region and down into the leg. Unfortunately, I am not able to give specific advice in this kind of forum. However, in a general sense, I believe it is usually good for people to keep an open dialogue with their family doctor / other local specialist health professional(s) who are able to take a complete history, view imaging, conduct physical examinations (etc) to form their clinical advice. It is often not a bad idea to to seek a second (or third) opinion if there is uncertainty about what may be the most appropriate way forward and when existing treatments have not yet delivered the desired results. I hope that your situation is improving!
Ethel Sullivan on February 23, 2019:
I have had groin pain since last summer. Gradually got so bad it hurt to drive to put foot on brake. Since then late October I have been out on short term disability. I cannt put my socks or shoes on by myself. Going upstairs kills then sitting on chairs stepping onbrake. (It’s my right leg). Getting on and off of. Toilet severe pains down leg
severe pains down my Put on Lyrica which is helping leg pain but nothing for groin buttock or hip pain. Bed ridden since oct. saw 2 ortho one said MRI showed tear not cause of pain he had no advice. Went to 2nd ortho he said he is confused try pt. I am 71 very active walk 15 miles a day work retail and on feet all day. I need help any advice would be appreciated. I can’t do this any longer its been 6 months. I can’t get around without severe pain. I’m. Desperate. And bed ridden since oct. please someone get me some help.
Mickmc (author) on January 28, 2019:
Hi Kathy, Thanks for leaving your comment. While I can't comment on specific cases in a forum such as this, here is some general information which may be helpful. First, damage to a range of soft tissues around the hip joint can occur with hip dislocations (whether or not hip replacement surgery has recently occurred). Dislocations after hip replacements are one of the more common complications. For this reasons, precautions to prevent dislocations are commonly recommended (e.g., https://hubpages.com/health/total-hip-replacement-... ). However, for dislocations that occur soon after hip replacement surgery, the treating clinical team may want to carefully consider the most likely cause(s), as not all can be solved by 'reducing' the hip back into the socket without surgical intervention. Here is a link to a journal article that talks about this issue. The article is written for health professionals, and so it may or may not be helpful to you and other interested readers: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC40941...
Kathy on January 25, 2019:
Is it possible that a Labral tear or other injuries to occur when 1 or 2 hours after hip replacement surgery the hip dislocated in Recovery and surgeons manually placed back in socket rather than open up incision and repair dislocation?
Mickmc (author) on November 27, 2018:
Hi Dave, Thanks for stopping by and leaving a comment. I am sorry to hear about the trouble you are having. Unfortunately I can't give advice on specific cases in this kind of forum. However, I can provide some general information and thoughts which may or may not be useful to you. The first is that hip labral tears are often associated with pain in the buttocks and this can refer into the leg, although typically more often into the groin / inside of the leg region than the shin. That being said, the nerves that innovate the shin area can be irritated at the spine, or anywhere along the path to your shin (which includes the buttocks/ hip area that they pass through). Regarding surgery... it is a little bit of a cliche, but it has been my experience that 'surgeons love to do surgery'... so anytime a surgeon says 'I don't want to do surgery' it makes me think that they have probably carefully considered the likelihood of benefits from surgical options, as well as the risks, before reaching that conclusion. As a general principle, when people are not sure what to do / whether the advice received by a treating clinical team is the best advice for them, a second opinion from an appropriately qualified Dr. who can conduct physical assessments, see your imaging findings etc. can often be helpful. It will either confirm the original advice (which hopefully brings peace of mind if nothing else) or discuss some alternative options (e.g., surgical options versus physical therapies (or something else)). I hope your situation improves Dave!
Dave on November 23, 2018:
I have been diagnosed w/labral hip tear. But dr does not want to do surgery. I have pain in my buttocks and at rest I have pain in my leg where my shin is. It gets so bad I have to take pain meds to sleep. I also have to bang on my shin area and bang on the muscle near my shin. Drs are very confused and can not diagnose the issue. I have had serval mri and tests done and they cannot see an issue. I even got cortisone shot in my back and hip. The shot in my back did not help the shot in my hip releaved it slightly buybuy not enough to get off these damn pain meds. Has anyone heard of this type of issue from a torn labral hip tear? It’s been years and I’m starting to go a little crazy from not being able to get decent sleep. And these damn drs and pharmacists are thinking I’m trying to get pain meds for the fun of it. Please any direction would be great. Btw this was originally a workers comp case and the employer did not have workers comp insurance. MY attorneys are trying to get Me treatment buy the state is not helping. I am currently using my own insurance. Now my own health insurance is starting to question why and how I got hurt. Please any direction would be helpful. A am in the state of California. Thank you.
Fintan Moore on April 16, 2015:
I have an overwhelming suspicion of a hip labral tear by a sports injury consultant. I am awaiting an MRI arthrogram radiology procedure to determine the extent and cause of the tear. I am in chronic pain at rest, during any hip movement such as walking or climbing stairs. The injury is already 4-5 months old and the hip movement and pain is progressively getting worse, I am beginning to fear a more serious tear in the labrum. I have completely refrained from all physical activity especially sports, during which I happened, I am unsure about what I should be doing until a complete diagnosis is carried out. Am I right in believing there to be a serious tear in the anterior labrum if not a full rupture? Any advice would be greatly appreciated.
Mickmc (author) on July 09, 2012:
Thanks for stopping by CyberShelley. I hope this information is helpful to your friend!
Shelley Watson on July 08, 2012:
Mickmc, A very interesting and educating hub. I will be sending your link to a friend, who will be greatly helped with this info in hand! Voted up, interesting.