Hip Labral Tear

Hip pain can be miserable. It can make walking across the room almost impossible at times. What is a hip labrum? Are there other causes of hip pain down the leg besides a hip labral tear?

Does the presence of a hip labral tear with pain down your leg mean you need surgery? What are the treatment options for hip labrum tears? Let’s dig in.

What Is A Hip Labrum?

Types Of Hip Labral Tears

These are the common types of hip labral tears:

• Anterior (front) hip labral tears: The labrum is wider and thinner at the front. This is the most common area of labral tears and typically causes pain at the front of the hip and in the groin. Anterior superior (top) area tears cause the most pain. 
• Posterior (back) hip labral tears: The labrum is thicker at the back of the hip. Tears here are less common and when they do occur, they may cause more buttock area pain. 
• Superior lateral tears: These are tears on the top and outside part of the labrum. 

Tears can further be classified on form, shape and structure (morphology):

• Radial tears are most common and involve free margins of the labrum. 
• Longitudinal tears occur at the socket/bone labral junction. 
• Unstable tears can be anywhere and cause mechanical symptoms.

Hip Labral Tear Symptoms

A tear in the hip labrum can cause many different symptoms. The most common is anterior hip or groin pain, which may radiate down to the level of the knee (3). Pain develops gradually and typically is dull in character and made worse with walking, pivoting, running, and prolonged sitting.

Hip labral tears are easily seen on an MRI. Unfortunately, their importance as a source of pain must be questioned. Why? Research has demonstrated that many patients with no hip pain have labral tears showing on MRI (4,5). In one study, Duthon et al demonstrated that 69% of patients without hip pain had labral tears.

Butt Pain

Throwing this question out to the social-media masses is sure to bring out the cyber “comedians” among us, but the truth is when you really do have butt pain, it’s no laughing matter. So we’re glad you came here to ask because we actually do see many patients in our clinic with this problem. There are a number of issues that can cause butt pain, but the root causes we most often discover are hamstrings tendinopathy, a pinched low-back nerve, or sacroiliac joint syndrome. Let’s take a look at each of these individually. – Hamstrings Tendinopathy: The hamstrings are actually a collection of large muscles…

Read More About Butt Pain

Gluteus Medius Pain

The gluteus medius is one of the major muscles in your buttock and hip. There are three gluteal muscles you have probably heard about: They layer one upon the another much like a layer cake. The gluteus minimus is closest to the body followed by the gluteus medius and then the larger gluteus maximus.Gluteus Minimus – The gluteus minimus is the smallest of the three gluteal muscles. It is a small triangular muscle that lies underneath its bigger brother, the gluteus medius. It functions to stabilize the hip, rotate the thigh, and move the hip in an outward direction.Gluteus Medius -A powerful muscle that starts at the backside of your waist bone…

Read More About Gluteus Medius Pain

Hip Pain

There are many causes of hip pain. Most individuals who experience hip pain believe that it comes from the hip. As a pain physician, I encounter a significant number of patients who have hip pain and who have been told they need either minimally invasive hip surgery, hip resurfacing surgery, or total hip surgery. Unfortunately that this is not always the case. The term referred to pain is one most of us know through TV or the movies. The most common is an individual who presents to the ER with severe arm or jaw pain. They don’t need to see a dentist or a surgeon…

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Hip Pain that Radiates Down the Leg

Hip pain is miserable making walking across the room almost impossible at times. Hip labral tears are the most common cause, but there are more to consider. What is a hip labrum? Are there other causes of hip pain down the leg besides a hip labral tear? Does the presence of hip labral tear with pain down leg mean I need surgery? What are the treatment options for hip labrum tears? Given that labrum tears are present in patients without hip pain it is important to understand the other causes of anterior thigh and hip pain. SI Joint, muscles, irritation of low back nerves…

Read More About Hip Pain that Radiates Down the Leg

Common Causes and Risk Factors For Hip Labral Tears

Repetitive Hip Motions

Repetitive rotational sporting activities such as golf, ballet, etc can put more stress on the hip capsule and labrum.

Capsular Laxity/Hip Mobility

If the hip joint capsule is loose due to repetitive hip motions or repeated trauma, this leads to more stress on the labrum. Also, some genetic conditions like Ehlers Danlos Syndrome cause hip ligament laxity, increasing the risk of labral tears.

Traumatic Injuries

Injuries from trauma such as motor vehicle accidents or major falls can directly injure the labrum.

Degenerative Conditions

Labral tears can be associated with degeneration of the hip joint and cartilage, as seen with osteoarthritis.

Genetic Disorders/Structural Abnormalities

Abnormalities of the hip such as dysplasia, slipped capital epiphysis, and Legg-Calve-Perthes disease are associated with higher risk of labral tears.

Biomechanics

Like many musculoskeletal problems and injuries, a person’s posture, alignment, muscle symmetry, and strength make up their biomechanics and play a large role in preventing and causing injuries. 

Labral injuries are associated with tight hip flexors and lumbar erector spinae (feelings of tightness around the hips and the large spinal muscle), and with weak/inhibited glutes and abdominal muscles. 

This leads to anterior pelvic tilt, increased hip flexion, and excess lumbar lordosis (the inward curve of the spine above the buttocks) all causing more stress on the socket and labrum.

Common Treatment Options For Hip Labral Tears

Treatments will vary from patient to patient, based on the severity of the injury, pain level, level of disability, and findings on physical examination and MRI results. Treatment options include the following:

Conservative Medicine

Rest, activity modification, physical therapy, and safe anti-inflammatory medications such as fish oil and curcumin.

Injections

When conservative care fails, steroid injections into the hip joint are often recommended. Steroids like cortisone are powerful anti-inflammatory agents that may reduce inflammation but are very toxic to orthopedic tissue like cartilage (6). 

Research has shown that steroid injections increase the loss of normal cartilage in a joint. Also, if eventual hip surgery is needed, having a steroid injection prior increases the risks of complications such as infection. For these reasons, steroid injections should be avoided.

Surgery

Hip labrum surgery is major surgery. It involves the insertion of a narrow-gauge camera and operating instruments into the hip joint. This is called arthroscopy and allows the surgeon to visualize structures inside of the hip joint, including the labrum. 

Aside from hip replacement, hip arthroscopy is the most common hip surgery in America. In a four year period, the number of hip arthroscopies has increased by 600% (7). Complications can occur, with the most common complication of hip labrum surgery being nerve damage, with an incidence of 16.5% (8).  

Is surgery of hip labral tears successful? One of the largest high-level studies to date comparing hip arthroscopy to physical therapy demonstrated no difference between the outcomes of the two groups (9). Yes, that is correct. Hip labrum surgery outcomes were no different than those treated with physical therapy. 

Also, to perform a hip arthroscopic surgery, traction is applied to the hip joint to allow camera access, which itself can damage the hip capsular ligaments. Capsular ligament laxity is a risk factor for labral tears, so may be one reason arthroscopic hip surgeries are not highly successful.

Diagnosis For Labrum Tears

• Physical exam: A good thorough physical examination is very important in determining what is causing a patient’s hip pain and any associated problems. A good examination should include evaluation of the low back, nerves, hip, knee, and any special testing for the labrum.
• A diagnostic ultrasound: This can be used to see some parts of the labrum and look at the tendons and ligaments around the hip. 
• X-ray: An X-ray can be helpful in identifying bony abnormalities, fractures and joint arthritic changes. 
• MRI: This is useful to visualize the labrum, joint cartilage, and inside of the bone. Less powerful MRIs require contrast injection to visualize the labrum. Most newer, stronger MRIs can see the labrum without contrast. The MRI needs a magnetic strength of at least 1.5 Teslas.

Do Hip Labrum Tears Cause Pain To Radiate Down The Leg?

Does the combination of a hip labral tear with pain down the leg necessarily mean that the labral tear is causing the pain? Given that labrum tears are present in patients without hip pain, it is important to understand the other causes of anterior thigh and hip pain.

• Muscles: The quadriceps, hamstrings, and inner thigh muscles and tendons can be injured, causing anterior thigh and hip pain.
• Ligaments: Ligaments are thick bands of connective tissue that connect bone to bone. The hip joint has multiple ligaments which can be injured and cause anterior thigh and hip pain.
• Blood vessels: Blood clots in the upper leg can cause swelling and pain.
• Irritation of low back nerves: Disc protrusions, disc herniations, small joint overgrowth, and disc slippage can cause nerve irritation, resulting in anterior thigh and hip pain.

Can A Labral Tear Heal On Its Own? 

It is possible that hip labral tears can heal on their own or at least become asymptomatic (show no symptoms). Modifying some of your activities can help avoid making the labral tear worse. Studies have shown physical therapy can be just as effective as hip labral surgery for symptom improvement. 

Physical therapy should usually focus on reducing anterior pelvic tilt, activating and strengthening the core and glutes, and mobilizing the hip flexors. Correcting these and any other biomechanical issues can take stress off of the labrum and allow for healing.

If conservative care alone is not helping, then newer regenerative medicine techniques could help facilitate healing. 

Regenerative Medicine For Labrum Tears In The Hip

When conservative measures fail, surgery is not the only other option now. At the Centeno Schultz Clinic, we specialize in treating orthopedic problems such as labral tears with injections that help the body self-heal. We have invented many of these techniques.

The two most common treatments used for labral tears are platelet rich plasma (PRP) and bone marrow concentrate containing stem cells. 

• PRP (platelet rich plasma): This involves obtaining blood from a vein in a simple blood draw, centrifuging (spinning) that blood to separate the components, then isolating and concentrating the platelets.
  
  At the Centeno Schultz Clinic, we have specialized lab personnel to do this so we can concentrate more on platelets and customizing the treatment to each patient for better outcomes. PRP has growth factors that help stimulate soft tissue healing, similar to what happens when you heal from a cut on your skin. 
  
  PRP works well for mild to moderate labral tears when patients are younger and they do not have arthritis. 

• BMAC (bone marrow aspirate concentrate): BMAC contains stem cells that are obtained by taking bone marrow from the iliac crest (hip bone) in a safe and comfortable way. The bone marrow is processed similarly to PRP to concentrate the cells in the marrow. 
  
  Stem cells are the most powerful healing cells. BMAC is used for more severe labral tears, labral tears in conjunction with arthritis, and for symptomatic tears in older patients. 
  
  In addition to using PRP or BMAC to help heal labral tears, we will also look for associated injuries that can contribute to the overall dysfunction, such as the hip capsule, hip ligaments, and hip tendons. 
  
  We also treat any other areas such as the spine or knee that may be contributing to the hip dysfunction and pain, so we take a very comprehensive approach.

Patient’s Case Study – Using A Regenerative Treatment For Labrum Tears

JB is a 55 year old female who presented to Centeno-Schultz Clinic with a two-year history of left anterior thigh and groin pain that was progressive in nature, dull in character, and aggravated by sitting and prolonged standing.

The onset of pain was not associated with any trauma or activity. Treatment included physical therapy, stretching, oral NSAIDs (non-steroidal anti-inflammatory drugs), and a steroid injection. She was scheduled for hip labrum repair the following week and wanted a second opinion. 

Her examination was significant for a full range of motion of the hip, tenderness in the left low lumbar spine, and left SI joint. Her inner thigh muscles and pubic bone were painful to the touch.

Her low back X-ray was significant, showing disc injury at the lowest level. Ultrasound of the hip and groin demonstrated arthritis in the pelvis and inflammation of the inner thigh tendons. Her hip MRI and ultrasound showed very minor wear and tear of the labrum with NO tears.

If you are a hammer everything looks like a nail. Beware of the diagnosis of labrum tears and the need for surgery. Correct diagnosis is key, even if you have a hip labral tear with pain down your leg.

JB did not need hip labrum surgery for her right thigh and hip pain, as she had irritation of her low back nerves, inflammation of inner thigh muscles, and sacroiliac and pelvic joint dysfunction.

At the Centeno-Schultz Clinic, we are experts in the management and treatment of low back, hip, muscle, and ligament injuries. We use the SANS approach, which utilizes a comprehensive approach to common musculoskeletal injuries. 

Precise ultrasound and X-ray injections of PRP and bone marrow concentrate are effective nonsurgical options for many conditions. JB canceled her hip labrum surgery and has been scheduled for PRP injections.

Find Relief From Pain Caused By Hip Labral Tears

The hip is a complex ball and socket joint, and the labrum is the ring of fibrocartilage that provides stability for the hip joint. Labral tears can occur with anterior thigh and groin pain.

The significance of identifying hip labrum tears through MRI has been questioned, as patients with no hip pain have labral tears on their MRIs. There are many other causes of anterior thigh and groin pain, which include injury to muscles, tendons, ligaments, low back nerve irritation, and sacroiliac joint dysfunction. 

Treatment options include conservative care, steroid injections, and surgery. Steroids are toxic to cartilage and should be avoided. Hip labrum surgery outcomes are no different than physical therapy. 

If you are experiencing the issue of a hip labral tear with pain down the leg, beware of the recommendation for hip labrum surgery, as in many cases it is not indicated – as was the case with JB. 

Thus, PRP and bone marrow concentration are effective nonsurgical treatment options without the risk of surgery or extensive rehabilitation.

Find relief from chronic pain caused by hip labral tears. Learn more about our alternatives to hip surgery.

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Christopher J. Centeno, MD

Christopher J. Centeno, M.D. is an international expert and specialist in Interventional Orthopedics and the clinical use of bone marrow concentrate in orthopedics. He is board-certified in physical medicine and rehabilitation with a subspecialty of pain medicine through The American Board of Physical Medicine and Rehabilitation. Dr. Centeno is one of the few physicians in the world with extensive experience in the culture expansion of and clinical use of adult bone marrow concentrate to treat orthopedic injuries. His clinic incorporates a variety of revolutionary pain management techniques to bring its broad patient base relief and results. Dr. Centeno treats patients from all over the US who…

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John Schultz, MD

John R. Schultz M.D. is a national expert and specialist in Interventional Orthopedics and the clinical use of bone marrow concentrate for orthopedic injuries. He is board certified in Anesthesiology and Pain Medicine and underwent fellowship training in both. Dr. Schultz has extensive experience with same day as well as culture expanded bone marrow concentrate and sees patients at the CSC Broomfield, Colorado Clinic, as well the Regenexx Clinic in Grand Cayman. Dr. Schultz emphasis is on the evaluation and treatment of thoracic and cervical disc, facet, nerve, and ligament injuries including the non-surgical treatment of Craniocervical instability (CCI). Dr. Schultz trained at George Washington School of…

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John Pitts, M.D.

Dr. Pitts is originally from Chicago, IL but is a medical graduate of Vanderbilt School of Medicine in Nashville, TN. After Vanderbilt, he completed a residency in Physical Medicine and Rehabilitation (PM&R) at Emory University in Atlanta, GA. The focus of PM&R is the restoration of function and quality of life. In residency, he gained much experience in musculoskeletal medicine, rehabilitation, spine, and sports medicine along with some regenerative medicine. He also gained significant experience in fluoroscopically guided spinal procedures and peripheral injections. However, Dr. Pitts wanted to broaden his skills and treatment options beyond the current typical standards of care.

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Jason Markle, D.O.

Post-residency, Dr. Markle was selected to the Interventional Orthopedic Fellowship program at the Centeno-Schultz Clinic. During his fellowship, he gained significant experience in the new field of Interventional Orthopedics and regenerative medicine, honing his skills in advanced injection techniques into the spine and joints treating patients with autologous, bone marrow concentrate and platelet solutions. Dr. Markle then accepted a full-time attending physician position at the Centeno-Schultz Clinic, where he both treats patients and trains Interventional Orthopedics fellows. Dr. Markle is an active member of the Interventional Orthopedic Foundation and serves as a course instructor, where he trains physicians from around the world.

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Brandon T. Money, D.O., M.S.

Dr. Money is an Indiana native who now proudly calls Colorado home. He attended medical school at Kansas City University and then returned to Indiana to complete a Physical Medicine and Rehabilitation residency program at Indiana University, where he was trained on non-surgical methods to improve health and function as well as rehabilitative care following trauma, stroke, spinal cord injury, brain injury, etc. Dr. Money has been following the ideology behind Centeno-Schultz Clinic and Regenexx since he was in medical school, as he believed there had to be a better way to care for patients than the status quo. The human body has incredible healing capabilities…

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Other Resources for Hip Labral Tears

References:

1. Seldes RM, Tan V, Hunt J, Katz M, Winiarsky R, Fitzgerald RHJr. Anatomy, histologic features, and vascularity of the adult acetabular labrum. Clin Orthop Relat Res 2001;382:232–240.
2. Kelly B, Weiland D, Schenker M, Philippon MJ. Arthroscopic labral repair in the hip: surgical technique and review of the literature. Arthroscopy 2005;21:1496–1504. doi: 10.1016/j.arthro.2005.08.013.
3. Hunt D, Clohisy J, Prather H. Acetabular labral tears of the hip in women. Phys Med Rehabil Clin N Am 2007;18:497–520. doi: 10.1016/j.pmr.2007.05.007.
4. Kumar D, Wyatt CR, Lee S, et al. Association of cartilage defects, and other MRI findings with pain and function in individuals with mild-moderate radiographic hip osteoarthritis and controls. Osteoarthritis Cartilage. 2013;21(11):1685–1692. doi:10.1016/j.joca.2013.08.009.
5. Duthon VB, Charbonnier C, Kolo FC, Magnenat-Thalmann N, Becker CD, Bouvet C, Coppens E, Hoffmeyer P, Menetrey J. Correlation of clinical and magnetic resonance imaging findings in hips of elite female ballet dancers. Arthroscopy. 2013 Mar;29(3):411-9. doi: 10.1016/j.arthro.2012.10.012
6. McAlindon TE, LaValley MP, Harvey WF, et al. Effect of Intra-articular Triamcinolone vs Saline on Knee Cartilage Volume and Pain in Patients With Knee Osteoarthritis: A Randomized Clinical Trial. JAMA. 2017;317(19):1967–1975. doi:10.1001/jama.2017.5283.
7. Bozic KJ, Chan V, Valone FH, Feeley BT, Vail TP. Trends in hip arthroscopy utilization in the United States. J Arthroplasty. 2013;28(8 Suppl):140-3. DOI: 10.1016/j.arth.2013.02.039.
8. Larson CM, Clohisy JC, Beaulé PE, et al. Intraoperative and Early Postoperative Complications After Hip Arthroscopic Surgery: A Prospective Multicenter Trial Utilizing a Validated Grading Scheme. Am J Sports Med. 2016;44(9):2292-8.DOI: 10.1177/0363546516650885
9. Mansell NS, Rhon DI, Meyer J, Slevin JM, Marchant BG. Arthroscopic Surgery or Physical Therapy for Patients With Femoroacetabular Impingement Syndrome: A Randomized Controlled Trial With 2-Year Follow-up. Am J Sports Med. 2018 May;46(6):1306-1314. doi: 10.1177/0363546517751912.