What are the symptoms and treatment options for a hip labrum tear diagnosed on MRI?

Hip Labral Tears: Symptoms and Diagnostic Findings on MRI

Hip labral tears diagnosed on MRI typically present with anterior hip or groin pain, mechanical symptoms such as clicking or locking, and a positive anterior hip impingement test.

Clinical Presentation

Common Symptoms

• Anterior hip or groin pain (most common presentation)
• Mechanical symptoms:
  • Clicking or popping sensations
  • Locking of the hip joint
  • Giving way or instability
• Less commonly, buttock pain
• Pain that worsens with:
  • Prolonged sitting
  • Walking
  • Pivoting on the affected leg
  • Getting in and out of a car

Physical Examination Findings

• Positive anterior hip impingement test (FADIR - flexion, adduction, internal rotation) is the most consistent finding 1
• Limited range of motion, particularly with internal rotation
• Pain with hip flexion activities
• Possible tenderness in the anterior hip region

MRI Findings

Diagnostic Imaging

• MR arthrography is the gold standard for diagnosing labral tears 1, 2
  • Direct MR arthrography with intra-articular gadolinium provides the most reliable visualization of acetabular labral tears
  • Sensitivity ranges from 90-95% for labral pathology
• High-resolution 3T MRI may improve visualization without requiring contrast in some cases 2

Common MRI Findings

• Linear high signal intensity extending into the labrum
• Detachment of the labrum from the acetabular rim
• Labral degeneration or fraying
• Associated findings may include:
  • Paralabral cysts
  • Chondral damage
  • Bony morphological abnormalities (cam or pincer lesions)

Associated Conditions

Common Etiologies

1. Femoroacetabular impingement (FAI) - most common cause 3, 4
2. Trauma or sports injuries
3. Hip dysplasia and/or instability 1
4. Capsular laxity/hip hypermobility
5. Degeneration (age-related)
6. Psoas impingement (especially in young female athletes) 5

Diagnostic Algorithm

1. Initial evaluation with plain radiographs:

   • AP pelvis and lateral femoral head-neck views 1
   • Assess for underlying structural abnormalities (dysplasia, FAI, etc.)

2. Advanced imaging when labral pathology is suspected:

   • MR arthrography is preferred for definitive diagnosis 1, 2
   • CT arthrography may be an alternative when MRI is contraindicated 1

3. Diagnostic injection:

   • Intra-articular anesthetic injection can be both diagnostic and therapeutic 1, 2
   • Relief of symptoms following injection supports intra-articular pathology

Treatment Options

Conservative Management

• Relative rest and activity modification
• Non-steroidal anti-inflammatory medications
• Physical therapy (though controversial in isolated labral tears) 3
• Intra-articular corticosteroid injections 1, 2

Surgical Management

• Indicated when conservative management fails to provide adequate symptom relief 2
• Arthroscopic options:
  • Labral repair (preferred when tissue quality permits) 2
  • Labral debridement (for irreparable tears)
  • Treatment of associated pathology (FAI, chondral lesions)

Clinical Pearls and Pitfalls

Pearls

• Labral tears are more common in women than men 6
• The diagnosis often requires a high index of suspicion due to nonspecific symptoms
• Early diagnosis and treatment may prevent progression to osteoarthritis 3

Pitfalls

• Incidental labral tears are common in asymptomatic individuals and should be managed with appropriate clinical sensitivity 1
• Diagnosis should never be made on imaging alone but combined with clinical symptoms and examination findings 1
• Hip pain can be referred from the spine or knee, requiring thorough evaluation to identify the true source

Remember that early identification and appropriate management of labral tears may help prevent the development of secondary osteoarthritis and preserve hip function.