> Acetabular Tear
What is the Acetabular Labrum?
Your acetabulum is the round
socket on the side of your pelvis that forms the hip
joint along with the head of the thighbone (femur).
The acetabular labrum is a horseshoe-shaped fibrocartilage
lip that attaches to the rim of the acetabulum and extends
the depth of the acetabular socket. The labrum stabilizes
the top of your thighbone in the hip joint and seals
off the fluids that lubricate the cartilage inside the
Labral tears are rare ruptures anywhere in the fibrocartilage
around the rim of your pelvis' acetabulum (socket).
As a result, your thighbone (femur) may lose stability
in the socket. The tear also can lead to friction in
your hip joint as the fluid that normally lubricates
hip cartilage can more easily escape from the joint.
Labral tears more commonly occur in the front and top
portions of the labrum. Acetabular labral tears often
accompany other injuries or conditions in the hip. For
example, hip fractures can tear your labrum and the
majority of patients with osteoarthritic hips also have
labral tears. Patients with acetabular dysplasia (an
abnormality during development that results in a misshapen
hip socket) often develop labral tears and osteoarthritis
of the hip.
Acetabular tears are most often caused
by sports that require excessive hip rotation, such
as hockey, ice skating, and golf. Activities that palce
severe, repetitivr strain on your hip joint, such as
jumping, can also lead to acetabular labral tears. Some
less stressful activities that involve bending your
body forward, like horseback riding, also may strain
your acetabular labrum. Traumatic hip injuries, like
falls or collisions, which may pop your thighbone out
of the acetabular socket, tend to put added strain on
the acetabular labrum. Osteoarthritis may weaken your
labrum, making you more vulnerable to suffer tears during
less stressful activities. Patients with a shallow pelvis
socket, a condition called hip dysplasia, may have less
bony support holding their thighbone in the hip joint.
Their thighbone may be more likely to strain the acetabular
labrum tissue and lead to tears.
If left untreated, acetabular labral
tears may become a mechanical irritant to the hip joint,
which can increase friction in the joint and speed the
progress of osteoarthritis in your hip. Physicians generally
recommend conservative treatment with medication, activity
modification, and physical therapy for about six months
before surgery is considered. Surgery typically is only
offered after a reasonable course of non-operative care
is given. Without surgery, symptoms may subside in younger
patients with minor labral tears. Patients who have
suffered labral tears in conjunction with other injuries,
who have other medical conditions contributing to tissue
degeneration in their hip, or who are over age 65 may
have surgery prescribed earlier. The use of an arthroscope
to treat a torn acetabular labrum is a relatively new
procedure, but is becoming more widely used. Because
your hip joint is deep within your body and surrounded
by many muscles and ligaments, it is less accessible
with an arthroscope than other body areas, like the
knee and elbow. The most common labral surgery requires
a larger incision to access your labrum.
There are three parts to an orthopedic
evaluation: medical history, a physical exam, and tests
that your physician may order.
Your doctor will likely ask you when
you noticed your hip pain, how it has been feeling since
the pain began, and if your hip has been previously
injured. Physicians also typically ask about other conditions,
such as diabetes and allergies, and medications currently
being taken. You may also be asked about your physical
and athletic goals – information that will help
the doctor decide what treatment might be best for you
in achieving those goals. You should let your doctor
know about any family history of arthritis, as it is
often associated with acetabular labral tears.
Your physician usually performs a
number of physical tests to check for pain while your
hip is in various positions:
– Your posture, stride, hip alignment, muscle
tone, and ability to move from a standing to sitting
position will be observed for abnormalities.
on your back – Your abdomen, lower back, pelvis,
and hip joint may be put through range of motion tests
where your physician moves your hips and legs in different
directions. A snapping sound may be heard when your
physician rotates your hip towards your body.
on your side – Your physician may press on your
ITB (iliotibial band) to check for any damage.
– your physician may test your muscle strength,
reflexes, and sensitivity to touch. Your physician may
also check your pulse in your hip.
The physical symptoms are sometimes
inconclusive and your physician may need to take a closer
look at your hip joint. MRI
(magnetic resonance imaging) usually provides the best
images of your labrum. Small labral tears may not be
visible on MRI scans. Physicians may also order an arthrogram,
where dye is injected into the bloodstream so physicians
can inspect images for dye uptake in your hip. The final
diagnosis may require the use of an arthroscope, a tiny
camera about three to four millimeters in diameter,
which can be inserted into your hip through a small