Diagnosing Hip Labral Tears

A hip labral tear is an injury to the ring of soft elastic tissue, called the labrum, that surrounds the hip joint. The hip joint is a “ball-and-socket” joint composed of the rounded top of the thigh bone, called the femoral head, and a bowl-shaped indentation in the pelvis, called the acetabulum. The labrum is located on the outer rim of the joint, where the two bones meet. It forms a tight seal around the joint and helps keep the “ball” part of the femur in place.

If the labrum is torn or detached from the joint, the hip may lose stability and lubrication. In some people, a hip labral tear may not cause any symptoms; in others, a torn labrum results in sharp pain in the groin or a painful clicking or locking sensation in the hip when walking, climbing stairs, or bending forward. Doctors at the NYU Langone’s Joint Preservation and Arthritis Center are specially trained to diagnose injuries of the hip joint and determine the underlying cause of a torn labrum.

Causes of Hip Labral Tears

Hip labral tears affect people of all ages and may often develop because of structural abnormalities in the bones of the hip joint. These include hip impingement syndrome, hip dysplasia, and Legg-Calvé-Perthes disease, among others. All three conditions cause changes to the shape of the femoral head or the acetabulum. If these bones don’t fit together smoothly, part of a bone may pinch the labrum during movement and cause it to tear.

A hip labral tear may also occur because of repeated twisting or pivoting motion in the hip that, over time, wears down the labrum. Some athletic activities, such as baseball, ballet, hockey, and golf, often involve these hip motions. People who frequently participate in these activities may have an increased risk of a labral tear even if there is no abnormality in the bones of the hip.

Less commonly, a labral tear may be caused by a traumatic injury—for example, a fall, dislocation, or a car accident—that puts excessive force on the hip joint, damaging the labrum.

Without treatment, a hip labral tear may lead to the erosion of other soft tissues in the hip joint, including cartilage, a smooth material that lines the ends of bones. Too much cartilage erosion may lead to a condition called hip osteoarthritis, which results in bones rubbing directly against each other, damaging the joint. Our doctors can determine whether there is damage to cartilage in the hip joint during diagnosis.

Medical History

In order to confirm that a hip labral tear is causing your symptoms—such as a deep pain in the groin or hip that increases with movement, a clicking or locking sensation in the joint, or decreased range of motion in the hip—your NYU Langone doctor may ask when you first noticed pain, stiffness, or dysfunction; where the pain is located; what movements are most painful; and how much these symptoms interfere with your daily activities.

In addition, your doctor may ask whether you have any medical conditions that currently require treatment or medication. He or she also wants to know whether you’ve had a previous hip surgery or injury to the hip, or if anyone else in your family has been diagnosed with hip problems. These and other details help your doctor to assess the possible causes of the labral tear.

Physical Exam

Your NYU Langone doctor examines your hip to determine if any physical signs suggest a hip labral tear. He or she may gently move your hip and position your leg in different ways in order to assess range of motion, impingement, and instability. You may be asked to walk back and forth, so your doctor can see if there are any changes in your gait, such as a limp. Your doctor may also gently press the skin outside of the hip joint to check for tenderness.

Imaging Tests

Our doctors frequently recommend one or more diagnostic imaging tests to confirm the presence of a hip labral tear or other joint damage. These tests are painless and take place at NYU Langone.

X-rays

X-rays are two-dimensional images created by high-energy beams of light that are absorbed by bones. Doctors at NYU Langone use specific types of hip X-rays to obtain a detailed view of the components of the hip joint. You may be asked to rotate your hip in different ways, so that images of the hip joint can be taken from several angles. These X-rays may reveal structural abnormalities in the joint, including any changes in the shape of the bones of the hip, which include the femur and acetabulum.

MRI Scans

MRI scans use radio waves and electromagnetic fields to create computer-generated images of the inside of the body. In particular, MRI scans provide detailed pictures of soft tissue, including cartilage and the labrum. Doctors and radiologists at NYU Langone use three-dimensional MRI technology, which provides images of the hip joint from every angle and can reveal even the subtlest injury in the labrum or surrounding structures.

MRI Scans of Cartilage

Doctors and radiologists at NYU Langone use new MRI technologies designed specifically to detect cartilage breakdown in joints, including the labrum. These enhanced techniques can be used during a regular MRI scan. For example, doctors may modify the sequence of electromagnetic pulses generated during the MRI to create images of cartilage within the joint. These enhanced images allow doctors to see areas in which cartilage has broken down.

Another technique uses a contrast dye, called gadolinium, which is injected into the bloodstream or into the hip joint before the MRI scan is performed. This dye enhances the visualization of cartilage in the hip. A doctor then examines the images to determine if there is extensive cartilage breakdown.

CT Scans

CT scans use X-rays to create a series of detailed two- and three-dimensional images of bony structures within the body. Computers combine these images into one three-dimensional image that can be examined from a variety of angles. Our doctors use advanced CT technology that requires the least amount of radiation possible to get a better look at the anatomy of the hip joint.

Diagnostic Injection

Occasionally, your doctor may recommend injecting an anesthetic, typically ropivacaine, directly into the hip joint to confirm that hip pain is caused by a problem in the joint. Hip pain has many causes, and symptoms that seem to indicate a hip labral tear may also be signs of a different condition. If the anesthetic injected into the joint relieves your pain, this indicates that a problem in the hip joint is the likely cause of your symptoms.

Doctors use live ultrasound guidance—an imaging technique that uses high-frequency sound waves to create images of the inside of the body—or X-rays to ensure that anesthetic is injected precisely into the hip joint space. If you have a labral tear, pain relief is often immediate. This diagnostic test is done in the doctor’s office or radiology suite and takes less than an hour.

After leaving the doctor’s office, you are asked to monitor your body’s response to this diagnostic injection for several hours after the test. Our doctors suggest that you stand and walk every 30 minutes and write down whether the pain feels better, worse, or the same. This information helps our doctors to confirm the diagnosis.