labral tear hip joint

introduction

tear of the labrum of the acetabulum is said to account for 20-50% of “idiopathic” hip pain where there is no obvious cause
diagnosis is often delayed by 2 years as the labrum is not well demonstrated on US, XRay, CT or MRI scans, although a MRA scan does have better sensitivity for detecting these tears.
arthroscopic debridement may be required for those who fail conservative Mx.

over half are of insidious onset whilst others are acute after a precipitant or have intermittent episodes
90% complain of anterior hip or groin pain (esp. if anterior labral tear)
some have anterior thigh, lateral hip or buttock pain (esp. of posterior labral tear) and may radiate to knee
women may also have concomitant pelvic-floor pain
may also have clicking, locking or catching, or giving way and develop hip instability
walking, pivoting, prolonged sitting, and impact activities, such as running, often aggravate symptoms
most have night pain
most commonly reported ROM limitation was in rotation, but hip flexion, adduction, and abduction ROM limitations also have been reported
positive anterior hip-impingement test may be present
- performed with the patient supine with the hip and knee at 90° of flexion.
- hip is internally rotated while an adduction force is applied.
- positive test results in pain provocation in the anterolateral hip or groin
positive posterior hip impingement test may be present
- patient lies prone with hip and knee extended and the examiner passively extends, adducts, and externally rotates hip
- positive test reproduces anterior hip or posterior pelvic pain
physical exam findings remain inconsistent, likely because of the variable locations of labral tears

non-steroidal anti-inflammatory drugs (NSAIDs)
pain, analgesia and analgesics
physiotherapy
if fails to settle with conservative treatment, then referral for possible arthroscopic debridement is indicated