Ortho Exam 2 - Labral Tears

What are the functions of the labrum?

- shock absorption

- joint lubrication

- pressure distribution

- aids in stability

- protects articular cartilage+bone !

Damage to the labrum is associated with ____

osteoarthritis

tears are precursor to chondral damage

Other populations at risk for labral tears

- athletes (extreme forces and ROM they place on bodies)

- hockey, golf, soccer, football, baseball

- those with a history of hip dysplagia (stress on anterior labrum - dancers and gymnasts)

Etiology of Labral Tears

- acute tears are rare, most insidious

- common w FAI

- 22-55% w hip or groin pain

- athletes undergoing arthroscopy

- capsular laxity/hypermobility

- hip dysplasia

- degeneration

common locations of labral tears

- most anterior (poor vascular supply, weaker tissue, region experiences higher forces)

- posterior due to discrete episodes of trauma

- superior/lateral

morphology of labral tears

1. radial flap (free margin of labrum)

2. radial fibrillated (frayed inside)

3. longitudinal peripheral (unattached from acetabulum)

Type 1 vs Type 2 labral tear

Type 1 --> detachment of labrum from articular cartilage surface

Type 2 --> one or more cleavage planes of variable depth within the substance of the labrum and extends perpendicular to the surface of the labrum

why is lower crossed syndrome a biomechanical predisposing factor for labral tears

tight hip flexors and erector spinae, inhibited glutes and abs

creates an imbalance as more weight is on anterior acetabulum and labrum

APT, increased hip flexion, lumbar hyperlordosis

clues in history for labral tear

- insidious

- anterior hip/groin pain, less common in buttock

- may radiate into knee, women may note pelvic floor pain

- many describe night pain

- constant, dull with episodes of sharp pain during certain movements

- aggravated with walking, pivoting, prolonged sitting, impact activities

- limping, need hand rail, limited ambulation distance and sitting tolerance

- clicking, locking, giving way

If a labral tear is a result of a traumatic MOI, what are the common circumstances?

- anterior dislocation

- usually hyperextension with femoral ER

- usually w hyper-rotation motion

test and measures for labral tear dx

- + clicking/snapping

- + antalgic gait

- decreased rotation, ADD, ABD, pain w hyperext

- not tender w palpation

- + ant/post labral test

- + SCOUR (compression)

- + Stinchfield

- + thomas test

- pain w WB IR activities

diagnostic imaging for labral tears

radiograph - A-P view of the pelvis or lateral view

can show abnormalities of the femur/acetabulum, developmental hip dysplagia, tumors, FAI

CT/MRI can now visualize, MRA (but booo radiation)

Differential Dx for Labral Tear

- contusion

- muscle strain

- athletic pubalgia

- osteitis pubis

- fracture/dislocation

- arthritis

- piriformis syndrome

- snapping hip

- bursitis

- AVN

- Legg-Calve Perthes

- referred P from L/S

- tumor

How do we treat labral tears?

Restore ROM

- soft tissue, flexibility, capsular mobility

- restore motion symmetry!

Reduce Joint Capsule Inflammation

- limit pivoting and other mvmnt patterns

- NSAIDs, injections, modailities

- grade I and II mobes!

Stregthen Hip Muscles that are Inhibited

- core strength

- rotational strength

Correct Biomechanics

- analyze gait, foot motion

- retrain if needed

Labral Debridement vs Labral Repair

Labral Debridement --> shaving, faster PT progression, more commonly used when there is lack of blood supply to labrum BUT can break down again

Labral Repair --> sewing, slower rehab but better down the line, used more when biomechanics must be restored

How is rehab after labral surgery conducted?

- pt presents w inflammation, pain, swelling, decreased joint mobility and strength, altered proprioception and endurance

- treat what pt presents w!

- debridement vs repair

- generally --> educate on joint protection, maintain proper alignment, promote tissue nutrition and wound healing, precent muscle inhibition, safe gait, and increase sitting tolerance