What test is used to evaluate the hip for a labral (labrum) tear?

From the Guidelines

The most reliable test to evaluate a hip for a labral tear is magnetic resonance arthrography (MRA) of the hip, as it has the highest rating of 9 for detecting labral tears, according to the American College of Radiology appropriateness criteria 1. When evaluating a hip for a labral tear, it is essential to consider the patient's symptoms and physical examination findings. Patients with suspected labral tears often present with groin pain, clicking or catching sensations, and pain with certain movements. Clinical examination tests such as the FADIR test (flexion, adduction, internal rotation) and FABER test (flexion, abduction, external rotation) can help identify potential labral pathology. The McCarthy test, where the examiner rotates the flexed hip while applying axial loading, can also reproduce symptoms of a labral tear. Some key points to consider when evaluating a hip for a labral tear include:

• The American College of Radiology recommends MRA as the most appropriate test for detecting labral tears, with a rating of 9 1.
• MRI hip without IV contrast or CT arthrography may also be appropriate, but with lower ratings of 6 and 7, respectively 1.
• Radiographs of the pelvis and hip should be the first test ordered for the evaluation of patients with chronic hip pain, but if radiographs are negative, equivocal, or nondiagnostic, MRA or CT arthrography may be necessary 1.
• MRA provides detailed visualization of the labrum and can detect tears that might be missed on standard MRI, making it the gold standard for definitive diagnosis.

From the Research

Diagnostic Tests for Hip Labral Tears

• The diagnostic test of choice for evaluating hip labral tears is magnetic resonance arthrography (MRA) 2, 3, 4, 5.
• MRA has been shown to be more sensitive than conventional MRI in detecting labral tears, with a sensitivity of 92% compared to 8% for conventional MRI with a large field of view 3.
• Arthroscopy is considered the gold standard for diagnosing hip labral tears 2, 5.
• Plain radiographs may be used to assess for dysplasia, degeneration, and other causes of pain, but are not reliable for diagnosing labral tears 2.

Physical Examination Findings

• The most consistent physical examination finding for hip labral tears is a positive anterior hip impingement test 2, 5.
• Patients with labral tears may also present with mechanical symptoms such as clicking, locking, and giving way 2.

Imaging Modalities

• Magnetic resonance arthrography (MRA) is the preferred imaging modality for evaluating hip labral tears 3, 4.
• Conventional MRI may be used, but has limited sensitivity and specificity for detecting labral tears 3.
• Computed tomography scans are not reliable for diagnosing labral tears 2.