Alexander Black Jill Bodak Jenn Bognar Justin Bodnarchuk ACETABULAR LABRAL TEARS
ANATOMY OF THE HIP
The Joint Capsule The joint capsule of the hip, the coxofemoral joint is large and loose It completely surrounds the joint, attaching to the labrum of the acetabular socket The labrum forms a seal around the joint with increased fluid pressure within the labrum contributing to lubrication of the joint The joint capsule also passes over a fat pad internally to join to the distal aspect of the femoral neck The capsular fibers attaching to the femoral neck are arranged in a circular fashion (zone orbicularis) and are an important contributor to hip stability
http://www.ithaca.edu/faculty/lahr/le2000/hip%20pi cs/8acetabularlig.jpg
http://www.aafp.org/afp/991015ap/1687.html
Labral Tear http://ajs.sagepub.com/content/33/6/864/f1/graphic-1.large.jpg
SIGNS AND SYMPTOMS
Clinical Findings Mechanism of injury most often associated with sudden pivoting or twisting Can also be associated with congenital abnormalities or degeneration Pain in anterior inguinal region, anterior thigh, and buttock (around greater trochanter) Active and passive ROM reproduces pain
Clinical Findings Cont d Audible/Palpable click (crepitus) Locking or Giving away of the hip joint Hip/Groin pain Decreased range of motion Snapping joint line pain Ligament laxity Snapping of the iliotibial band Refer for MRa to confirm clinical findings
TEST TO ASSESS HIP LABRAL INJURIES 1) McCarthy 2) FABER 3) Impingement
McCarthy Test The Test: The therapist has the patient lay in a supine position The therapist then has the patient flex both hips and then extend the affected hip If the patient feels a catch a labral tear is present and a positive test has occurred
FABER Test Also Known as the Patrick s Test The Test: The therapist has the patient lay in a supine position The therapist then takes the test leg and puts it on the opposite straight leg The motion is that of Flexion Abduction External Rotation The therapist then applies pressure to the anterior aspect of the knee lowering the test leg into further abduction If the leg can not be lowered parallel to the opposite leg or pain is produce a positive test has occurred The Faber test encourages anterior translation of the femoral head on to the anterior surface of the labrum, impinging on any suspected tear.
Impingement Test The Anterior Test: The therapist has the patient lay in a supine position The therapist then takes the patients leg into flexion, adduction, and slight internal rotation This test will compress the anterior surface of the labrum A positive test has occurred if pain has been reproduced and implies an anterior superior tear Other signs to look for would be crepitus, popping, clicking, etc. The Posterior Test: The therapist has the patient lay in a prone position The therapist then takes the patients leg into Passive hyperextension, abduction and external rotation If this motion elicits pain a positive test has occurred and there is the presents of a posterior tear
Other Diagnostic Tests Radiographs or X-rays Magnetic Resonance arthrography (MRa)
TREATMENT OF ACETABULAR LABRAL TEARS *Note: that the acetabular labrum DOES have a blood supply and that some labral tears are capable of healing on their own when coupled with proper physical treatment and pain management.
Change your lifestyle: to avoid further damage to the labrum, increase your level of low to moderate physical activity. focus on proper posture when sitting and standing, avoid activities that take the hip through full ROM or reproduce pain Use meds to control pain: Pain medications, as prescribed by a physician, along with NSAIDs Some patients also take glucosamines or cartilage supplements (trivial in research) Physical Therapy: ALL HIP LABRAL PATIENTS SHOULD EXERCISE. Strength/Stabilize hip: Lumbar and abdominal strengthening Postural correction Hip flexion and extension Hip abduction and adduction with minimal resistance Balance and proprioceptive activities * Monitor FREQUENCY, INTENSITY and TIME * Occasionally this allows the body to heal the labrum entirely on its own. Corticosteroid Injections: common treatment for joint pain, reduces inflammation and helps control pain. usually a temporary fix- must be accompanied by healthy lifestyle and P.A
THE LAST RESORT SURGICAL INTERVENTION 2 major types of acetabular labrum tears: Type I: Disengagement of the labrum at transition area to the articular hyaline cartilage. Type II: Intrasubstance splits with one or more cleavage planes Because current research shows nociceptors in the body of the acetabular labrum, prolonged pain and discomfort in the hip- regardless of therapy and pharmacological intervention results in the need for surgery. The modern method for repair is Hip Labral Arthroscopy: Reattach the labrum to the acetabular wall (anchor) Sew the tear in the labrum back together with bioabsorbable sutures Remove the labrum entirely Remove the torn or damaged section of the labrum ***Acetabular labral arthroscopy will not alleviate all symptoms in patients that have compounding hip conditions like arthritis or Femoral Acetabular Impingement (FAI)
Post-operative Care: After the surgery, the patient will be on crutches for two to six weeks (case-by-ase) Physical Therapy: improve the hip range of motion and muscle strength around the hip. return to play when symptom free- anywhere between two and six months, depending on the extent of the injury.
Patient prepped for arthroscopy http://www.youtube.com/watch?v=4j0su3vkrbm What a surgeon sees during Arthroscopy of Acetabular Labrum
Test Question 1. Which of the following is/are a mechanism of injury for a hip labrum tear A) sudden pivoting/twisting B) congenital abnormality C) Degeneration D) All The Above 2. A) 1-3 B) 2-4 C) 1,2,3 D) 4 Which of the following are included in the FABER test? 1) pressure is applied to the anterior aspect of the knee 2) therapist then takes the patients leg into flexion, adduction, and slight internal rotation 3) therapist then takes the test leg and puts it on the opposite straight leg 4) If the patient feels a catch a labral tear is present
Questions Con t What is the last resort for treatment of acetabular tears? A) Physical therapy B) Arthroscopy C) Medication D) Corticosteroids
Answers 1. D 2. A 3. B
REFERENCE Binningsely, D. (2003). Tear of the Acetabular Labrum in an Elite Athlete. British Journal of Sports Medicine. 37 p 84-88. http://www.mayoclinic.com/health/hip-labral tear/ds00920/dsection=symptoms http://www.sportsinjurybulletin.com/archive/acetabular-labrum-tears J. C. McCarthy, B. Busconi. Canadian Journal of Surgery. Hip Disease in Young Adults. Ottawa: Feb 1995. Vol. 38, Iss. 1, p. S13-7 (5 pp.) http://www.eorthopod.com/images/contentimages/hip/hip_anatomy/hip_anatomy_intro01.jpg http://biology.clc.uc.edu/graphics/bio105/pelvis.jpg (Picture on slide 2) http://www.eorthopod.com/images/contentimages/hip/hip_precautions/hip_artificial_precautions_anat02.jpg (picture on slide 4) http://www.eorthopod.com/images/contentimages/hip/hip_anatomy/hip_anatomy_ligaments01.jpg (picture on slide 6) Info from: foundations of athletic training and principles of human anatomy 10 th edition http://hiplabraltear.com/ https://healthlibrary.epnet.com/getcontent.aspx?token=a4c1f00b-d245-44f2-a90e-20b047f84a6a&chunkiid=432309 http://www.riversideonline.com/health_reference/disease-conditions/ds00920.cfm http://www.conquestchronicles.com/pages/the-labral-tear-hip