Acetabular Labral Tears of the Hip Joint
Like the shoulder, the hip has a fibrocartilaginous labrum or collar, and tears of this can be responsible for long lasting hip pain in the groin.
The main function of the acetabular labrum is to improve hip joint stability, by deepening the hip socket, providing it with extra structural support, and by sealing the joint to create a negative intra-articular pressure which counteracts any pulling-apart forces.
Often symptoms may follow a traumatic event or injury, but not always. People with this injury generally have a sharp groin pain on movement and frontal thigh pain that often becomes worse on bringing the thigh backwards. They can also have feelings of joint clicking and a feel that the hip is “giving way.” The problem can go on for many months!
Acetabular labrum tears are a common cause of time away from sport in athletes and particularly footballers. Up to 20% of groin pain in athletes is now thought to be the result of acetabular labrum tears.
Acetabular labrum injury can now be seen using magnetic resonance arthrography and diagnosed directly using hip arthroscopy
Hip arthroscopy is currently best for the diagnosis of acetabular labral tears.
Common causes of injury
The presentation of acetabular labral tears is not always the same but the most common complaint is a sharp groin pain after an injury in athletes like footballers. Pain is also often felt in the anterior thigh or buttock regions.
Examination of the hip is often normal with a normal range of movement. There are specific tests for a labral tear that your Osteopath may perform. The “Trapping” test (flexion, adduction and internal rotation of the hip joint) often produces pain or a clicking sensation when a tear is present at the front. Another test involving flexing both hips and then extending the affected hip (patients with a labral tear will feel a pinch). Passive hyperextension, abduction and external rotation bring on pain with a posterior tear.
Acetabular Labrum Tears Treatment
Treatment can be conservative or surgical. Conservative management involves rest followed by a graded increase in movement and activity. But there is no conclusive evidence as to whether the inner two-thirds of the labrum, which lack any blood supply, are able to heal with rest alone. So if your tear extends into this section, conservative treatment may not work! Surgical treatment is arthroscopic tidying up or repair.
A return to activity and sport is usually possible 3 to 4 months after the operation. Arthroscopic treatment is reported to improve symptoms in 65% to 90% of patients. particularly younger patients and those with no arthritis have a better outcome.
Other causes of groin pain include inguinal and femoral hernias, stress fractures of the femoral neck, adductor strains, avulsion fractures of the pelvis, osteitis pubis, intraabdominal disorders, nerve entrapment, and referred back pain.
Your Osteopath should be able to advise you on this.