Hip Labral Tear

What the hip labrum does

The hip is a ball-and-socket joint. The labrum is a firm ring of fibrocartilage attached to the edge of the socket (acetabulum). It deepens the socket, keeps the joint fluid sealed inside like a suction cup, and spreads load across the cartilage. It has nerve endings, so a tear can be painful, but it has a poor blood supply, so it heals slowly by itself.

Most tears occur at the front-top (anterosuperior) part of the labrum, where load and pinching forces are highest.

Hip labral tear symptoms

• Groin pain: deep, aching pain in the front of the hip or groin is the most common symptom. Some people point to the side of the hip with the thumb and fingers forming a "C" shape around it (the C-sign).
• Mechanical symptoms: clicking, locking, catching or a feeling that the hip gives way.
• Pain with specific positions: sitting for long periods, getting out of a car, putting on socks, deep squats, twisting or pivoting on the leg.
• Stiffness: reduced hip rotation.
• Pain after activity: running, kicking, dancing or hockey often bring it on.

Some tears cause no symptoms at all and are found by chance on MRI, especially after age 35.

Causes and risk factors

Femoroacetabular impingement (FAI)

The most common cause. Extra bone on the ball (cam) or the socket rim (pincer) makes them pinch the labrum during bending and rotation. Over years this frays and peels the labrum from the bone. FAI is more common in young athletes who played high-impact sports during growth.

Hip dysplasia

A shallow socket puts more load on the rim, so the labrum is overloaded and tears. See hip dysplasia.

Other causes

• repetitive twisting and deep flexion in soccer, hockey, ballet, golf, martial arts and running
• an acute injury such as a fall, car accident or hip dislocation
• joint hypermobility
• early osteoarthritis, where tears are part of wider joint wear

Labral tear vs other causes of hip and groin pain

How a hip labral tear is diagnosed

Examination. A doctor or physical therapist moves the hip into positions that pinch the labrum. The FADIR test (flexion, adduction, internal rotation) is the most used: the hip is bent to 90 degrees, then brought across the body and rotated inward. Reproducing your usual groin pain makes a labral problem or impingement more likely, though the test is not specific.

X-rays. These show bone shape: cam or pincer impingement, a shallow socket, and arthritis. They do not show the labrum.

MRI or MR arthrogram. An MR arthrogram, in which dye is injected into the joint before the scan, has long been the standard for seeing labral tears. Modern 3-tesla MRI without dye can work nearly as well.

Diagnostic injection. Numbing medicine injected into the joint under imaging guidance. If the pain goes away for a few hours, the pain is coming from inside the joint.

Hip labral tear treatment

Treatment without surgery

Most people start here, and many improve enough to avoid surgery.

• Activity changes: avoid deep squats, long sitting with the knees above the hips, and pivoting sports while symptoms settle.
• Physical therapy: usually 6 to 12 weeks, focusing on core and hip strength (especially gluteal muscles), control of pelvic position and gradual return to sport.
• Pain relief: NSAIDs such as ibuprofen or naproxen for short periods, at the label dose, if safe for you.
• Steroid injection into the joint for short-term relief, which also helps confirm the source of pain.

Hip arthroscopy

Keyhole surgery through 2 or 3 small incisions is considered when pain and function are not improving after about 3 months of good rehabilitation. The surgeon can:

• repair the labrum by stitching it back to the bone with small anchors
• trim (debride) a frayed tear that cannot be repaired
• reconstruct a severely damaged labrum with a tissue graft
• shave the extra bone that caused impingement, which is key to stopping re-tearing

Trials comparing arthroscopy for FAI with physical therapy have found modestly better results with surgery for selected patients. Results are poorer when there is significant arthritis, and in that case a hip replacement may be a better long-term option.

Recovery time

Outlook

Untreated tears do not usually heal fully, but many become painless with strengthening. Ongoing impingement and dysplasia increase the long-term risk of hip osteoarthritis, which is one reason doctors look closely at bone shape.

Frequently asked questions

What does a hip labral tear feel like?

It typically feels like a deep ache in the groin or front of the hip, with clicking, catching or a locking sensation. Pain often comes on with sitting, getting out of a car, pivoting or deep squatting, and the hip may feel stiff or unstable.

Can a hip labral tear heal without surgery?

The labrum has a poor blood supply, so tears rarely heal completely. Even so, many people become pain-free with physical therapy, activity changes and sometimes an injection. Surgery is considered when symptoms still limit you after about 3 months of good rehab.

How is a labral tear in the hip tested?

A clinician uses hip tests such as FADIR, which reproduce pain by pinching the labrum. X-rays check bone shape, and an MR arthrogram or high-quality MRI shows the tear. A numbing injection into the joint can confirm the pain comes from inside the hip.

Is walking good for a hip labral tear?

Walking on flat ground is usually fine and helps keep you active. Long walks uphill, very long strides and walking that causes sharp pain or catching should be reduced while symptoms settle. A physical therapist can set a safe walking and strength plan.

How long does recovery take after hip labral tear surgery?

Most people use crutches for 2 to 6 weeks, return to desk work within 1 to 3 weeks, start running at about 3 to 4 months and return to full sport around 4 to 6 months. Full improvement can take up to a year.