By Boyd W. Haynes, III, MD
A common cause of pain in the groin is a labral tear of the hip. The acetabular labrum is a ring of cartilage that surrounds the acetabulum (hip socket), and helps the head of the femur stay inside of the socket. There are two separate segments of the labrum, which is important to note when dealing with an injury. The extra-articular side is next to the joint capsule and has a good blood supply. The intra-articular area is next to the joint, but has a poor blood supply. When damage occurs, the extra-articular side will be more likely to heal on its own or have a faster recovery time after treatment. The intra-articular side will not heal well once damaged or respond as quickly to treatment methods. This area has continued ongoing research as this is still controversial.
What causes this?
Injury is a major cause of labral tears in the hip. Exercising with repetitive, pivoting movements can cause a tear. Another cause of this damage is a femoroacetabular impingement (FAI). In this condition, the structure of the hip is altered, which results in abnormal motion because of the slight misplacement of the femoral head in the hip socket. In simpler terms, the ball and socket just don’t quite fit together correctly. There are two types of this impingement: pincer and cam. Pincer impingement happens when the hip socket presses against the ball. Cam impingement is when the femoral head is not perfectly round and does not fit correctly. Other causes can be that the patient has a shallow hip socket, or because of arthritis taking its toll on the body.
What are the symptoms?
The main symptom of a labral tear is pain in the groin area. Patients may also experience the feeling of their hip catching or locking when moving. If severe, the pain may radiate to the buttocks, and down to the knee. The pain can cause patients to walk with a limp, and worsens with extended periods of walking, sitting or standing.
How will I be diagnosed?
After a physical examination and a discussion of the patient’s medical history, there are several tests I can perform to determine the cause of your groin pain. An impingement test will involve bending the hip to 90 degrees, turning it towards the inside of the body, and then moving the thigh towards the other hip. Depending on the body’s reaction to these movements and the level of pain that it creates, I may be able to determine if the cause is from a labral tear. An x-ray will show the entire structure of bones in an area, so that I can see if the hip position is out of place. An MRI (Magnetic Resonance Imaging) scan will create a clear image of the body’s soft tissues.
What are the treatment options?
Physical therapy will be the first step I suggest in most labral tear cases. A physical therapist can create a specific recovery plan for a patient by analyzing their movements, hip and knee strength, and body alignment. The exercises will help to strengthen the hips and ideally reduce hip and groin pain. Flexibility exercises will not necessarily change the structure of the bones, muscles, and tissues that are damaged, but can lengthen the muscles and reduce the chance for pinching between the femoral head and hip socket. A cortisone injection in the hip joint can reduce pain for an extended period of time and help with an uncertain diagnosis.
Arthroscopic surgery can be used to get a closer look at a torn labrum. An arthroscope is a thin tube that has a small camera attached at one end. The arthroscope is put inside of the joint and projects video onto a screen that I can use to see the damaged area and repair the torn labrum. One method is to get rid of the frayed and damaged tissue around the acetabular edge, and then attach the remaining labrum to the acetabular bone. The goal is to reattach the labrum as accurately as possible to the original position. Sometimes the damage is too much to perform this procedure, and the torn tissue has to be completely removed to prevent further damage to the joint.
What is the recovery process?
For conservative treatments, the patient should wait to resume physical activities until both hips have strengthened and no pain is felt during daily movements. Limiting extended periods of time standing or sitting in one place until the hip is pain free is also an important step to a full recovery. After surgical treatment, labral tears can take several months to recover. Following a rehabilitation plan and not jumping back into certain activities throughout this timeframe are important to an efficient and effective recovery.