From the Guidelines
Conservative management should be the initial approach for a labral tear, with surgery considered only when these measures fail after 3-6 months or in cases of significant mechanical symptoms or large, unstable tears. When managing a labral tear conservatively, several strategies can be employed to facilitate healing and reduce symptoms. These include:
- Rest and activity modification to avoid exacerbating the injury
- Physical therapy to strengthen surrounding muscles, improve range of motion, and enhance joint stability, typically lasting 6-12 weeks
- Anti-inflammatory medications like ibuprofen (400-800mg three times daily) or naproxen (250-500mg twice daily) to manage pain and inflammation
- Possibly, corticosteroid injections for temporary relief The decision to proceed with surgery is influenced by factors such as the failure of conservative measures, the presence of significant mechanical symptoms (like catching, locking, or giving way), the size and stability of the tear, and specific patient needs, such as those of high-level athletes 1. It's also important to consider the location of the labral tear, as the response to conservative care can vary; for instance, acetabular (hip) labral tears may respond better to conservative management than glenoid (shoulder) labral tears. Ultimately, the success of conservative management hinges on patient compliance with the rehabilitation program and appropriate activity modifications to prevent further damage while the body attempts to heal the injured tissue.
From the Research
Conservative Management Options
- Relative rest and non-steroid anti-inflammatory agents can be used as initial conservative management for labral tears 2, 3
- Physical therapy (PT) is a controversial but potentially beneficial treatment option for labral tears, with some studies showing marked improvements in pain, strength, and function 4
- Intra-articular injection of corticosteroids can be used for diagnostic purposes and pain relief, and may be combined with physical therapy for improved outcomes 4
- Modification of activities and pain medications can also be used as part of conservative management 3
Indications for Surgical Intervention
- Surgical treatment is often necessary when conservative management fails, and may involve arthroscopic debridement of labral tears and surgical repair of associated structural problems 2, 3
- Labral debridement, labral repair, and labral reconstruction are common surgical procedures for labral tears 3
- Arthroscopy is considered the gold standard for diagnosis and treatment of labral tears, and can be used to confirm the diagnosis and guide surgical treatment 2, 5
- Factors associated with failure of conservative management and indication for surgical intervention include older age, participation in overhead sports, traumatic injury, and presence of concomitant injuries such as rotator cuff injury 6
Diagnostic Considerations
- Magnetic resonance arthrography (MRA) is a reliable radiographic examination for diagnosing labral tears, with arthroscopy being the gold standard 2, 3
- Plain radiographs can be used to assess for dysplasia, degeneration, and other causes of pain, but are not reliable for diagnosing labral tears 2
- Physical examination findings, such as a positive anterior hip impingement test, can be used to support the diagnosis of a labral tear 2, 3