Labral Tear (Hip) Treatment
CAUSES SYMPTOMS DIAGNOSIS TREATMENT PHYSIOTHERAPY MANAGEMENT SURGICAL TREATMENT
By: Dr Roshan Jha
INTRODUCTION The margins of socket part of hip joint are attached with a cartilaginous rim around it to deepen the socket known as labrum. The purpose of the cartilaginous rim is to provide greater stability to the joint. The labrum can get torn and produce pain and clicking sound.
CAUSES Labral tear can result from repetitive strain injury in activities that require frequent rotations at the hip like golf, ballet dancing or contact sports. Sudden fall or traumatic injury to hip Sports in which hip joint is taken to extreme ranges can cause labral tear. Note: Researches suggests approximately 22% of athletes who complain of groin pain have labral tear in the hip. However, almost 75% of cases acetabular labrum tear have no direct known cause.
SYMPTOMS Some patients with labral tear experiences no pain, while others complaint of groin pain or pain around the lateral hip region or deep in the buttock. Pain may or may not be accompanied with a clicking noise. Some patients may experience “a catch� with hip movements.
DIAGNOSIS An assumption can be made on the basis of patient’s signs and symptoms and on the basis of physical examination. But to confirm the diagnosis an MRI is needed most of the time.
PHYSIOTHERAPY MANAGEMENT STAGE I – PAIN RELEIF AND PROTECTION STAGE II – RESTORE FLEXIBILITY AND STRENGTH STAGE III – RETURN TO NORMAL ACTIVITY/ SPORTS
STAGE I – PAIN RELEIF AND PROTECTION Avoid activities that aggravate the symptoms. Rest the hip joint in a comfortable position. Various physiotherapy means can be implemented to reduce the pain. Patient with labral tear should avoid sitting: With knees lower than the hip joint. Crossed legs or hips in a rotated position. on the edge of the seat/ chair Brisk walking (excess hip extension)
STAGE II – RESTORE FLEXIBILITY AND STRENGTH
The physiotherapist work on following areas to further improve the condition of the patient, Restoration of limited joint range-of-motion. Restoration of the soft tissue muscle length and resting tension. Activation of deep stability muscles of the hip. Enhancement of the proprioception and joint position sense.
STAGE III – RETURN TO NORMAL ACTIVITY/ SPORTS Focus in on enhancement of functional activities of daily living (ADLs) A Graduated sport program that is specific to the needs of the ptient. Agility, speed, power, and sport-specific drills. Most of the labral tear cases can be managed by conservative treatment while some may need hip surgery.
SURGICAL TREATMENT The detached segment of the labrum can either be re-attached or be debrided depending upon the extend of the labral tear. Post-operative hip rehabilitation under the guidance of an expert physiotherapist is needed to facilitate safe return to sport.
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