Keywords: Acetabular Tear, Hip pain, Joint Capsule, Physiotherapy, Special tests, Differential Diagnosis, Physiotherapy Exercises, Surgical management.
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Acetabular Labral Tears
Clinically relevant Anatomy
The socket of the hip joint that the thigh bone sits in is called the acetabulum. This is lined by a ring ofcartilage called the labrum. The labrum supplies cushioning and support for the hip joint. A tear can occur in the labrum and is also known as a hip labral tear or acetabular labral tear.
Tears to the labrum are being diagnosed more and more now due to the improvements and wider availability of MRI scans. This is the only way to 100% diagnose a labral tear.
Characteristics and Clinical presentation
- Pain in the hip or groin.
- A clicking or locking of the hip joint.
- Stiffness and restricted moment of the hip.
- Symptoms may come on suddenly after an incident.
- Symptoms may also gradually develop and progressively degenerate.
- Trauma such as traffic accidents, collisions and bad falls.
- Falling on to the outside of the hip.
- Twisting on a hip that has a lot of weight on it.
- Repetitive strain on the hip for example in golfers.
- impingement of the labrum in activities such as cycling, horse riding and martial arts.
The key to differential diagnosis starts with the subjective Ax. An insidious onset of worsening pain in an older patient may be more likely to be hip OA. A history of trauma or sudden onset of pain may correlate with damage of a specific structure ie the labrum.
Healthcare professional or Physiotherapy management
- Treatment usually requires surgery known as debridement via an arthroscopy (key-hole surgery).
- The torn part of the labrum is removed.
- Generally results from this procedure are very good.
- A rehabilitation program should be followed after surgery to restore full strength and movement to the hip joint and prevent further injuries or instability.
- If left the injury could degenerate into a worn hip joint.
- Improve biomechanics of the hip through strengthening.
- Address muscles weakness to reduce excessive movement within the joint
- Education and ? activity modification until surgery ( if already not self limiting to reduce risk of secondary OA
- Physiotherapy is also important post operatively to regain strength and normal biomechanics
- Pain in groin or hip region
- Secondary spasm in the piriformis.
- Soft tissue mobilisations
- Manual therapy
- Muscle Energy techniques
- Strengthening exercises.
- Hip Distraction
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VIDEO PRESENTATION: Non-Surgical Treatment of Acetabular Labrum Tears: A Case Series, Mark Shepherd, PT, DPT, OCS, Evidence in Motion OMPT Fellowship 2013