Labral tears are one of the more common causes of hip pain in younger and active patients, yet many people have never heard of the labrum before they’re diagnosed with a problem.
It’s a condition Mr Shah treats regularly, and importantly, not every case needs surgery – when it does, outcomes are excellent.
What is the labrum?
The labrum is a ring of firm, rubbery cartilage that lines the rim of the hip socket. Its job is to deepen the socket and create a better seal around the ball of the hip joint – a bit like a rubber washer that helps keep everything securely in place.
As well as improving stability, the labrum helps distribute load evenly across the joint and plays a role in maintaining the fluid environment that keeps the cartilage healthy. It’s a small structure, but an important one.
How does a labral tear happen?
Labral tears can occur in a number of ways. In younger and more active patients, the most common cause is femoroacetabular impingement – more commonly known as FAI or hip impingement. This is where a subtle abnormality in the shape of the hip joint causes the bones to pinch against each other during certain movements, gradually damaging the labrum over time.
Other causes include:
- Repetitive movements in sport, particularly in activities involving rotation or deep flexion of the hip such as football, golf, cycling and dance
- A single traumatic injury, such as a fall or sudden twist
- Structural abnormalities present from birth, such as hip dysplasia
- General wear and tear, particularly in older patients with early arthritis
In some cases, no obvious cause can be identified.
What does a labral tear feel like?
Symptoms vary from person to person, and a labral tear can sometimes be present for months or even years before it’s diagnosed. Common signs include:
- A deep aching pain in the groin, particularly during or after activity
- A catching, clicking or locking sensation in the hip
- Stiffness or reduced range of motion, especially when bending or rotating the leg
- Discomfort when sitting for long periods or getting up from a chair
The groin pain associated with labral tears is often mistaken for a muscle strain or referred pain from the lower back, which can delay diagnosis. If you’ve been experiencing persistent groin or hip pain that hasn’t responded to rest or physiotherapy, it’s worth seeking a specialist assessment.
How is it diagnosed?
A labral tear can’t be confirmed from symptoms alone. Mr Shah will typically carry out a thorough physical examination, looking at range of motion and testing for specific signs of impingement or instability. If a labral tear is suspected, an MRI scan – often with a contrast dye injected into the joint – provides the most detailed view of the labrum and surrounding structures.
X-rays are also useful for assessing the overall shape of the hip joint and identifying any bony abnormalities that may be contributing to the problem.
Does a labral tear always need surgery?
Not necessarily. Many patients with labral tears respond well to non-surgical treatment, particularly in the early stages or where the tear is small and symptoms are manageable.
Conservative options include:
Physiotherapy. A structured programme focusing on hip strength, stability and movement can significantly reduce symptoms and help protect the joint from further damage. This is often the first line of treatment.
Activity modification. Reducing or temporarily avoiding the activities that aggravate symptoms can allow inflammation to settle and give the joint time to recover.
Cortisone injections. An injection into the hip joint can provide effective short-term relief from pain and inflammation and can also help confirm that the hip is indeed the source of the problem.
The decision to move towards surgery depends on several factors – the size and location of the tear, whether there is an underlying bony abnormality causing impingement, how much the symptoms are affecting daily life and how well the patient has responded to conservative treatment.
When is surgery recommended?
If symptoms persist despite a thorough course of conservative treatment, or if there is a significant structural problem – such as FAI – that is unlikely to resolve without intervention, surgery may be the most appropriate next step.
The procedure Mr Shah performs in these cases is hip arthroscopy – keyhole surgery carried out through small incisions using a camera and fine instruments. During the procedure, he can repair or trim the torn labrum, reshape any bony abnormalities causing impingement and address any other damage within the joint.
Hip arthroscopy is performed under spinal anaesthesia and is usually carried out as a day case. Recovery varies depending on the extent of the work carried out, but most patients are back to everyday activities within a few weeks and return to sport within three to six months.
Addressing a labral tear and any underlying impingement at the right time can also help slow the progression of arthritis in the hip – making it a worthwhile intervention for the right patient.
What happens if a labral tear is left untreated?
This depends on the individual. Some people live with a labral tear for years with minimal symptoms, particularly if they modify their activity levels and keep the surrounding muscles strong. However, if there is an underlying structural problem such as FAI, leaving it untreated can accelerate cartilage wear and increase the risk of developing arthritis earlier than might otherwise have been the case.
This is why getting an accurate diagnosis matters – not to rush into surgery, but to understand what’s going on and make an informed decision about the best course of action.
Getting the right advice
With the right assessment and a tailored treatment plan, most patients make an excellent recovery, whether or not surgery is involved.
Mr Nirav Shah is a consultant orthopaedic surgeon based in West Sussex with extensive experience in hip conditions, including labral tears and hip impingement. If you’re experiencing hip or groin pain that hasn’t been properly explained, he’d be happy to help.
