Hip Joint Labral Tears

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Hip Joint Labral Tears

HIP JOINT LABRAL TEARS

Hip joint labral tears have gained increased attention in recent years as a possible source of hip joint pain and dysfunction.

Functional Anatomy: The acetabular labrum forms a ring around the peripheral aspect of the acetabulum.  It consists of both fibrocartilage and dense connective tissue.  While labral function is not fully understood, it is thought to increase the stability of the hip joint by deepening the acetabular fossa.  Labral tissue increases surface area within the joint resulting in improved load distribution and decreased contact stress.  Intact labral tissue also creates a seal within the joint which serves to keep synovial fluid within the articular cartilage, preventing contact between the femoral head and acetabulum.  (McCarthy et al., 2003).  Nerve endings and nerve end organs have been identified within acetabular labral tissue.  There presence would suggest this tissue is capable of sensing pain, pressure and deep sensation.

Disorders: Labral tears can result from both macrotrauma (i.e.: motor vehicle accidents, falls, slips, etc.) and repetitive microtrauma.  Activities and sports (i.e.: hockey, soccer, ballet, golf), requiring torsional movements of the hip under load, hyperabduction and frequent external rotation are believed to increase the potential for the development of labral problems.  Structural factors such as hip dysplasia, decreased femoral or acetabular anteversion and decreased femoral head – neck off set have also been shown to increase an individual’s risk of incurring labral damage.  Femoral head – neck off set is the distance between the highest aspect of the femoral head and the femoral neck. 

Clinical Implications: Labral tears are more commonly diagnosed in women than men.  This is possibly related to the increased prevalence of hip dysplasia in the female population.  The majority of clients affected by labral tears will complain of anterior hip pain or groin pain.  Lateral hip region pain or pain deep within the posterior buttocks is reported less frequently.  (Lewis and Sahrmann, 2006).  

·         Subjective: Clients often describe an insidious onset of hip pain and dysfunction with a gradual increase in symptom severity over time.  History may include complaints of joint clicking, locking, a catching sensation or actual giving way of the joint.  (Farjo et al., 1999).  

·         Objective: Variable limitations in hip joint range of motion and in some cases no limitation in range have been observed in the presence of labral tears.  Provocative tests vary widely which is likely owing to variations in labral tear location.

Labral tears can be very difficult to diagnose and are commonly more a diagnosis of exclusion.  Magnetic Resonance Arthrography has proven more effective in the diagnosis of labral tears than standard MRI.  The use of bone scans is as yet undetermined.  Gold standard diagnosis, currently, is arthroscopic surgery, which enables visualization of the labral tissue.

Conservative Management is comprised of decreased weight bearing and the use of NSAIDs.  Additional research is needed to support physical therapy treatment for this patient population.  It would stand to reason that measures to improve hip joint alignment by correcting movement patterns, muscle recruitment strategies and gait faults, would lessen abnormal forces acting on the hip joint and injured labral tissue. This would result in an overall decrease in hip joint pain and improved function.  

Surgical intervention most commonly involves labral debridement plus or minus joint resurfacing or cartilage growth stimulating procedures.  Good short- term improvement has been noted post surgical intervention but long-term outcomes are yet to be established.  (Lewis and Sahrmann, 2006).

For further information on the role of physiotherapy in recovering from a hip injury or surgery, please call or email us and ask to speak to one of our physiotherapists.

Gluteus Medius Weakness

Gluteus Medius Weakness

The Gluteus Medius

The gluteus medius is one of three gluteus muscles that originates on the posterior aspect of the pelvis and inserts into the lateral femur. It is know to abduct the hip and internally or externally rotate the femur depending on the position of the leg (1). More recently it has been shown to be an important muscle for stabilization, keeping the pelvis level and preventing internal rotation of the hip and the knee from buckling inward during weight-bearing.

This role as a muscle of stabilization has some important implications for injury prevention. Gluteus medius weakness has been linked to low back pain, patellofemoral pain syndrome, achilles tendonopathy and IT band syndrome(2,3). If a muscle of stabilization is weak or dysfunctional, it can lead to compensation from other muscles in the chain, leading to overuse injuries such as tendonitis.

A physical therapist can assess for gluteus medius weakness a number of ways, including testing the strength of abduction in side lying, testing internal rotation in sitting, or looking for a drop of the pelvis or Trandelenburg sign when an individual is standing on one leg. Once weakness in the muscle has been identified, the physical therapist can develop a specific exercise program to address the problem and prevent or rehabilitate an injury. Exercises may start with abduction or internal rotation in sitting or lying and progress to more functional activities in weight-bearing, including the activation of gluteus medius in combination with other muscles of the lower extremity as is typical of higher level activity such as sports.

For more information, please contact the clinic to speak with one of our experienced physical therapists.

References

1) Delp SLHess WEHungerford DSJones LCVariation of rotation moment arms with hip flexionJournal of Biomechanics 32 (1999) 493—501

2) Cooper NA1, Scavo KMStrickland KJTipayamongkol NNicholson JDBewyer DCSluka KAPrevalence of gluteus medius weakness in people with chronic low back pain compared to healthy controlsEur Spine J 2015 May 26

3) Fredericson, M, Cookingham CLChaudhari AMDowdell BCOestreicher NSahrmann SAHip abductor weakness in distance runners with iliotibial band syndromeClinical Journal Sport Med. 2000 Jul;10(3):169-75