Signs and Symptoms
Some labral tears cause no symptoms at all and are found by chance on imaging. When they do cause symptoms, common signs include:
- Deep pain in the groin or front of the hip, sometimes felt in the buttock
- Clicking, catching or locking in the hip
- Pain with deep bending, pivoting, sitting for a long time or getting in and out of a car
- Stiffness or reduced range of motion
- A feeling that the hip is unstable
What Causes It?
The labrum can tear from a single injury or from repeated stress over time:
- Femoroacetabular impingement (FAI), where extra bone on the ball or socket rim pinches the labrum when the hip bends. This is one of the most common causes.
- Hip dysplasia, a shallow socket that puts extra load on the labrum
- Repetitive twisting, pivoting and deep hip bending in sports such as soccer, hockey, golf, dance and running
- A fall, car accident or dislocation
- Wear and tear with age, often together with early hip arthritis
How We Diagnose It at POPB
Your physician will ask about your activities and how the pain started, then examine the hip with specific movement tests that can reproduce labral pain. The lower back and outer hip are checked too, because they can cause similar symptoms.
X-rays are taken on site to look at the shape of the hip, signs of impingement or dysplasia, and any arthritis. An MRI in our office can show the labrum in more detail. Sometimes an image-guided injection of numbing medicine into the hip joint is used to confirm that the pain is coming from inside the joint. Hip labral tears are treated by Dr. Press and Dr. Adelman.
Non-Surgical Treatment Options
Non-surgical treatment is usually the first step and helps many people:
- Physical therapy in our office to strengthen the hip, core and pelvic muscles and improve how the hip moves, with your therapist working from the same chart as your physician
- Avoiding positions that pinch the hip, such as deep squats and prolonged sitting in low chairs
- Anti-inflammatory medication, if safe for you
- An image-guided cortisone injection into the hip joint, using ultrasound or fluoroscopy (live X-ray) for accurate placement
- PRP (platelet-rich plasma, prepared from your own blood) may be discussed in some cases. Evidence is still developing, results vary, and insurance usually does not cover it.
Surgical Options
If pain and mechanical symptoms continue after a full course of therapy, your physician may discuss hip arthroscopy, a minimally invasive procedure through small incisions to repair or trim the torn labrum and, when needed, reshape bone that is causing impingement. It is generally more helpful for people without significant arthritis.
When a labral tear occurs along with advanced hip arthritis, arthroscopy is usually less helpful and the discussion may shift toward managing the arthritis, including hip replacement when appropriate. Your physician will explain which options fit your hip.
Recovery
With physical therapy, many people notice improvement within about 6 to 12 weeks. After hip arthroscopy, people typically use crutches for a period and follow a structured rehabilitation program, and a return to sports often takes several months. Timelines vary.
Insurance and Cost
Medicare and most commercial PPO plans generally cover office visits, X-rays, MRI, physical therapy, cortisone injections and medically necessary surgery, subject to your co-pay, co-insurance and deductible. Some plans require prior authorization for MRI.
PRP is usually not covered by insurance. HMO and managed-care plans require a referral from your primary care physician before your visit. Our staff verify your benefits when you call.
When to Be Seen
Call our office if groin or deep hip pain lasts more than a few weeks, or if your hip clicks, catches or locks with pain. If you have a fall or injury and cannot bear weight, or the leg looks deformed, go to the emergency room or call 911.
