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Hip Labral / Labrum Tear

Hip pain is miserable making walking across the room almost impossible at times.  What is a hip labrum?  Are there other causes of hip pain down 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?  Let’s dig in.

What is Hip Labrum?

The hip is a complex ball and socket joint.  The top portion of the thigh bone is shaped like a ball that fits into a socket.  The socket is called the acetabulum. The hip labrum is a ring of fibrocartilage that is attached to the acetabulum.  It provides stability and deepens the joint.  The labrum increases the joint surface area by 22% (1).  The hip labrum is susceptible to injury and can tear.   Tears are thought to be from gradual wear and tear, trauma, congenital malformation (dysplasia), impingement and joint laxity (2).

Hip Labral Tear Symptoms

A tear in the hip labrum can cause a number of 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 made worse with walking, pivoting and running.  Hip labral tears are easily seen on MRI.  Unfortunately, it’s importance as a source of pain must be questioned.  Why?  Research has demonstrated that many patients with no hip pain have labral tears 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…

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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…

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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…

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What Causes Hip Pain that Radiates Down the Leg?

Does the combination of a hip labral tear with pain down 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.  The major causes include

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 the anterior thigh and hip pain.

Sacroiliac Joint

The sacroiliac joint (SI) is an important joint in the low back that is formed by your waist bone (iliac crest) and the base of your lumbar spine (sacrum).  It functions to transfer the forces of the upper body to the lower extremities. The joint is susceptible to injury with pain in the anterior thigh, groin, buttock and posterior thigh.

Treatment Options for Hip Labral Tears

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

Conservative Care

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

Injections

When conservative care fails, steroid injections into the hip joint are oftentimes 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 will increase the loss of normal cartilage in a joint.  Steroids 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 4 year period, the number of hip arthroscopes has increased by 600% (7).  Complications can occur.  The most common complication of hip labrum surgery is 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 PT.

Meet JB

JB is a 55 yr old female who presented to Centeno-Schultz Clinic last week with a 2-year history of left anterior thigh and groin pain that was progressive in nature, dull in character aggravated by sitting and prolonged standing.  The onset of pain was not associated with any trauma or activity.  Treatment had included physical therapy, stretching, oral NSAID 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.   Low back x-ray was significant for disc injury at the lowest level.  Ultrasound of the hip and groin demonstrated arthritis in pelvis and inflammation of the inner thigh tendons.  Hip MRI and ultrasound were significant for 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 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 is scheduled for PRP injections next week.

In Conclusion

The hip is a complex ball and socket joint.  The labrum is a ring of fibrocartilage that provides stability for the hip joint.  Labral tears can occur with anterior thigh and groin pain.  The significance of hip labrum tears on MRI has been questioned as patients with no hip pain have labral tears on MRI.  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 were 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.  PRP and bone marrow concentrate are effective nonsurgical treatment options without risk surgery or extensive rehabilitation.

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Doctors Who Treat Hip Labral Tears

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

My passion and specialization are in the evaluation and treatment of cervical disc, facet, ligament and nerve pain, including the non-surgical treatment of Craniocervical instability (CCI). I quit a successful career in anesthesia and traditional pain management to pursue and advance the use of PRP and bone marrow concentrate for common orthopedic conditions. I have been a patient with severe pain and know firsthand the limitations of traditional orthopedic surgery. I am a co-founder of the Centeno-Schultz Clinic which was established in 2005. Being active is a central part of my life as I enjoy time skiing, biking, hiking, sailing with my family and 9 grandchildren.

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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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Matthew William Hyzy, D.O.

Doctor Hyzy is Board Certified in Physical Medicine and Rehabilitation (Physiatry) and fellowship-trained in Interventional Orthopedics and Spine. Dr. Hyzy is also clinical faculty at the University of Colorado School of Medicine in the Department of Physical Medicine and Rehabilitation; In addition, Dr. Hyzy is an Adjunct Clinical Assistant Professor at The Rocky Vista University College of Osteopathic Medicine. Dr. Hyzy also maintains an active hospital-based practice at Swedish Medical Center and Sky Ridge Medical Center. He is also recognized and qualified as an expert physician witness for medical-legal cases and Life Care Planning. He is published in the use of autologous solutions including…

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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 Labrum Tears

  • Hip Labral Tear Recovery Without Surgery

    The hip labrum is a ring of fibrocartilage and connective tissue that provides important support to the hip and is susceptible to injury. Dr. Schultz discusses the importance of labral tears, nonsurgical options that include PRP and bone marrow-derived stem cells.


  • Hip Labral Tear Surgery Success Rate

    The hip labrum is important structure that provides support to the joint and is susceptible to injury. Dr. Schultz discusses the significance of labral tears, surgical repair results and non surgical treatment options.


  • Success Rate of Stem Cell Therapy for Hips?

    What’s the success rate of stem cell therapy for hips? You would be surprised that while we can help many problems with orthobiologics, there are some hip problems that can’t be helped. So let’s dig in to make sure you don’t get scammed. What Can Go Wrong in the Hips that Can Cause Pain? There … Continued


  • What You’re Getting with Hip Labrum Surgery

    Hip labrum surgery is a common procedure, and it typically is done for a labrum tear and hip impingement. It’s easy to assume that because a surgery is so common, there must be plenty of research backing it, so it must be the right solution for you. Unfortunately, however, with hip labrum surgery, supporting research … Continued



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.

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