Background and Etiology
The hip joint is one of the largest joints in the body. It is composed of one osseous (bony) joint. The hip is built for weight bearing and movement in several different planes. The stability of the hip joint comes from the capsule, ligaments, muscle and a cartilaginous tissue called the labrum.
The hip, like the shoulder, is a ball and socket joint. It is formed by the head of the femur (thigh bone), which sits in the acetabulum, a part of pelvis. The head of the femur (the ball) is large and the acetabulum (the socket) is shallow. This allows for a greater range of motion. The Labrum is a fibrocartilaginous structure that is located around the acetabulum (the socket.) It provides added depth and stability to the joint.
Labral Tear
Though labral injuries to the shoulder are more common, the labrum around the hip socket can be damaged or even torn. Labral tears are typically caused by either trauma, like that which would cause a hip dislocation, or degenerative wear and tear.
- Traumatic events, like car accidents, can result in a labral tear
- High contact sports like football or hockey where the player is hit and lands hard on his or her knee, forcing the hip out of alignment can possibly tear the labrum.
- Structural abnormalities of the hip, such as capsular laxity, femoroacetabular impingement, or hip dysplasia, can make someone more susceptible to a labral tear
- Wear and tear on the hip joint from repetitive strain can ultimately cause a labral tear.
Hip labral tears can present with limited symptoms, however in conjunction with a hip dislocation patients can experience severe pain and weakness in the hip joint. Symptoms of a labral tear include:
- Weakness of the affected hip joint
- A sensation of “catching,” “locking,” or “clicking” in the hip joint on the effected side.
- Stiffness or trouble moving the hip on the affected side
Treatment for a hip labral tear will vary depending on the severity of the injury, and any other conditions, like hip dislocation, that may occur at the same time.
- In more serious cases surgical treatment may be needed to repair the torn labrum.
- Debridement, a procedure to remove torn pieces of the labrum that are not suitable for a repair, may be recommended to reduce pain and increase function.
- Non-Steroidal Anti-Inflammatory Drugs (NSAIDS) to reduce inflammation and pain in the joint.
- Physical Therapy will be initiated once the physician has given clearance for weight bearing on the hip joint.
Treatment for a hip labral tear will focus on reduction of pain, progression of weight bearing, improving range of motion, hip strength and stability.
- Gait and weight bearing activities may be used to help the patient wean-off assistive devices and progress to full weight bearing
- Range of Motion: restore range of motion, avoiding the position of dislocation while the ligaments and muscles heal
- Strengthening: Improve strength of the affected hip musculature and total leg strength.
- Stabilization: Work on the primary hip stabilizers in weight bearing functional positions to improve dynamic stability of the hip joint.
- Function: Progression to functional activities including daily life (stairs, kneeling, squatting, getting in and out of the car, etc.), or returning to high-level functions like sport performance.
Common Physical Therapy interventions in the treatment of Hip Labral Tear include:
- Manual Therapeutic Technique (MTT): hands on care including soft tissue massage, stretching and joint mobilization by a physical therapist to improve alignment, mobility and range of motion of the hip. Use of mobilization techniques also help to modulate pain.
- Therapeutic Exercises (TE) including stretching and strengthening exercises to regain range of motion within safe parameters and strengthen muscles of the hip and lower extremity to support, stabilize and decrease the stress placed on the joint.
- Neuromuscular Reeducation (NMR) to restore stability, retrain the lower extremity and improve movement techniques and mechanics (for example, running, kneeling, squatting and jumping) of the involved lower extremity to reduce stress on the hip joint in daily activities.
- Modalities including the use of ultrasound, electrical stimulation, ice, cold laser and others to decrease pain and inflammation of the involved tendon and bursa.
- A home program that includes strengthening, stretching and stabilization exercises and instructions to help the person perform daily tasks and advance to the next functional level are an important part of physical therapy and eventual patient independence.
Prognosis
The prognosis for a full recovery from a hip labral tear depends on the severity of the injury. Any injury to the hip joint may be complicated by nerve damage, loss of blood supply to the femoral head (aseptic necrosis) or associated fracture. If a hip labral tear occurs in conjunction with a hip dislocation early reduction is important in limiting the chances of developing aseptic necrosis or neurological damage.
