REPORT: MB #3071
BACKGROUND: The labrum of the hip is a form of cartilage that lines the rim of the hip socket. Like in the shoulder, tears of this cartilage can cause chronic pain. Symptoms of a hip labral tear include sharp groin pain following physical activity and thigh pain. This type of tear can also cause episodes of deep clicking and the feeling that the hip is giving out.
Hip labral tears have recently come into the spotlight as an underdiagnosed cause of hip or groin pain in high school athletes, according to an article in the journal Physical Therapy. On average, patients experience symptoms for two years before a diagnosis, and studies show 22 percent of athletes with groin pain and 55 percent of patient with hip pain of unknown cause had a labral tear.
CAUSES: Trauma from car accidents or falls can cause labral tears, whether or not the hip is dislocated. Other causes include participation in soccer, hockey, golf and ballet, all sports that require frequent external rotation. A large percentage of tears aren't associated with any known specific event or cause. Experts speculate that repetitive microtrauma may cause these tears. Some factors put certain people at higher risk of labral tears, including hip dysplasia, a condition that causes the head of the femur to fit improperly in the socket, and aging.
DIAGNOSIS: As many as 60 percent of patients with labral tears of the hip are misdiagnosed, according to the National Athletic Trainers Association. While radiography, CT and MRI have not been helpful in identifying the injury, MRI combined with gadopentetate dimeglumine has been reported to have 90 percent sensitivity and 91 percent accuracy in diagnosing hip labral tears.
TREATMENT: Surgical treatment of hip labral tears may involve debridement, which is trimming or removal of tissue. In a technique called hip labral repair, surgeons use sutures to reattach the torn cartilage to the rim of the socket. One surgical approach to labral tear treatment is hip arthroscopy, which the North Carolina Sports Medicine Institute says has been available for many years but limited in use because of technical demands and the fact that it is much more difficult to perform than shoulder or knee arthroscopy. Despite its technical difficulty, according the American Academy of Family Physicians, the surgery is the "gold standard" for both diagnosing and treating labral tears of the hip. During the procedure, a special table, camera, light source and flexible tools are used in the hip joint to repair the problem area. In addition to general surgical risks like infection and bleeding, patients are at risk of damage to the sciatic nerve because of the stretching required to perform the procedure. Other risks include damage to blood vessels and cartilage, calcification of normal tissues and dead bone in the hip.
FOR MORE INFORMATION, PLEASE CONTACT:
Wake Forest University Baptist Medical Center
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