Could Your Hip or Groin Pain Be a Labral Tear?
Labral tears within the hip are often an un-recognized source of hip and groin pain in otherwise-healthy young athletes, both men and women. The labrum is soft tissue that surrounds your hip socket (acetabulum) and provides a seal for the hip joint. According to Dr. Rick Bowles, an orthopedic surgeon at Summit Orthopedics, labral tears are often associated with a condition called femoroacetabular impingement (FAI).
FAI is a condition in which the ball (femoral head) doesn’t fit correctly into the hip socket (acetabulum). The abnormality may be subtle but even a small distortion can cause bones to bump up against each other and pinch the labrum between them. The pain people experience with a labral tear results from that pinching. Repetitive pinching can eventually tear the labrum, and FAI may contribute to arthritis over time.
Symptoms of a labral tear include deep pain in the groin or at the front of the hip. People often describe the location of the pain in a “C”-shaped region over the hip joint. You may also experience a sensation of locking or catching in the hip along with decreased range of motion. Certain athletes such as dancers, gymnasts, hockey players (especially goalkeepers), and those in combat sports like mixed martial arts may be more prone to labral tears because of the repetitive nature of their sport.
Dr. Bowles says FAI can be diagnosed through history, a physical exam and imaging. He starts by taking a thorough history and performing a comprehensive physical exam and recommends an X-ray to look at the bony structure and shape of the hip. Magnetic resonance imaging (MRI) may also be necessary to look at the soft tissues surrounding the hip, including the labrum. The MRI can confirm the presence of a labral tear and help rule out other conditions such as tendonitis (inflammation).
To treat a labral tear, your physician will most likely recommend nonsurgical options first, including physical therapy to improve hip/core strength and correct an abnormal gait (such as a limp due to pain), oral NSAIDs (such as Aleve® or Advil®) and possibly a hip injection to help localize and relieve pain, if necessary. Platelet rich plasma (PRP) injections may also help treat the symptoms in some cases. If conservative management doesn’t improve your symptoms, an orthopedic surgeon will most likely recommend surgery.
During surgery, repairing the hip labrum involves reattaching the torn labrum to the rim of the hip socket using tiny anchors and re-shaping the bone of either the hip ball (femoral head/neck) or socket (acetabulum) or both. This eliminates the bony impingement that caused the labral tear in the first place. Reconstructing the labrum is sometimes used in revision cases and involves removing the labrum and replacing it with a graft. A graft is tissue taken from the patient’s own body (autograft) or from a cadaver (allograft). The graft replaces the damaged labrum and is also held in place with small anchors. As the graft heals over time, it takes on the role of the original labrum that was removed. A debridement is reserved for cases in which the labrum cannot be repaired or reconstructed (or is likely to fail) and involves removing the torn or weakened sections of the labrum that are likely to get caught in the hip joint.
All three procedures can be done arthroscopically, a minimally invasive technique that involves inserting a miniature camera into tiny incisions in the hip joint. The camera transmits images of the surgical site to a full screen, which helps the surgeon better visualize the tear and perform the procedure precisely.
Bottom line: Dr. Bowles specializes in diagnosing and treating hip pain in athletes. Before completing his medical training, which included a Harvard internship in general surgery, a residency in orthopedic surgery at the University of Colorado, and a specialized fellowship in sports medicine at The Cleveland Clinic, Dr. Bowles worked as an engineer at two Fortune 100 companies. His background in engineering, medicine, and sports gives him a unique understanding of the biomechanics of the hip and how to restore it to full function for optimal performance.