Labral Tears

Labral Tears

Labrum is 2-3 mm thick and is dense type 1 collagen that outlines the acetabular socket and attached to the boney rim.  It is thinner in the anterior region of the hip and thicker in the posterior.  Labral disorders are any pathology of the labrum 

The labrum is considered mostly avascular with the outer third having a blood supply.  The labrum provides joint lubrication, and shock absorption to the hip while aiding in stability by deepening the socket. 

 

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Categories:


Location

-anterior/posterior/superior-lateral

Or by:

Morphology

-radial flap: Most common
-radial fibrillated: fraying secondary to degeneration
-longitudinal peripheral: Least common
-unstable: detached labrum

Most common in anterior, anterior superior or anterior superior due to thickness and MOI (External force into hyperextension)


Etiology


-On average occurs when people are in their 40’s
-women more likely than men
-22-55% of people complaining of hip/groin pain have some type of labral tear
-74% of labral tears cannot be attributed to a specific event

MOI

-Femoroacetabular impingement (FAI)
-Trauma
-Joint laxity
-Dysplasia
-Degeneration
FAI most common cause of labral tears

Type types:

Cam
- Larger femoral head causing impingement between femur and rim during flexion and IR
 -Anterior/superior tears

Pincer
- acetabular over coverage providing reinforcement to the femoral head into acetabulum
 -Posterior inferior tears

Diagnosis and examination


-Radiographs, Ct scans, and MRIs are ineffective
-MRa is the most effective diagnostic procedure
-90% of patients present with anterior hip pain.  Ipsilateral knee presents with a flexed knee gait to absorb shock with a shortened step length on the affected side.
Special Tests include:

McCarthy Test- + with painful click
Faber Test- articular pathology test – 88%
Anterior Labral Tear Test- + with catch or painful click
Posterior Labral Tear Test- + with catch or painful click
Impingement Test- .75 sensitivity
Fitzgerald Test- .98 sensitivity