Initial Management of Labral Tears
Most labral tears should initially be managed conservatively with physical therapy, NSAIDs, and activity modification for at least several weeks to months before considering surgery. 1
Location-Specific Approach
The initial management differs based on whether the labral tear is in the hip or shoulder:
Hip Labral Tears
Conservative management is the first-line treatment and includes rest, NSAIDs, activity modification, and physical therapy focused on hip stabilization exercises. 1
Initial Conservative Treatment Components:
- Physical therapy targeting hip stabilization and neuromuscular re-education to address kinesthetic deficits and muscle imbalances 2
- NSAIDs for pain control and inflammation reduction 1, 3
- Activity modification to avoid provocative movements, particularly those causing hip impingement 1, 3
- Rest from aggravating activities 1
Additional Conservative Options:
- Intra-articular corticosteroid injection (rated 5/9 - may be appropriate) can be considered for both diagnostic and therapeutic purposes, particularly when pain limits participation in physical therapy 1, 2
- Aspiration should be considered for painful, tense effusions following acute injury 4, 1
Duration of Conservative Trial:
Conservative management should be attempted for several weeks to months before considering surgical intervention. 1 In one case report, a patient showed marked improvements at 6-month follow-up with conservative management including injection and neuromuscular training. 2
Shoulder Labral Tears (SLAP Lesions)
Non-operative treatment with NSAIDs and physical therapy should be the initial approach. 1
Specific Physical Therapy Focus:
Evidence shows that successful nonoperative treatment of shoulder labral tears results in significant improvements in pain (VAS decreased from 4.5 to 2.1), function (ASES function improved from 30.8 to 45.0), and quality of life (EuroQol improved from 0.76 to 0.89). 5 However, approximately 51% of patients may ultimately require surgery. 5
Diagnostic Imaging During Initial Management
Hip Labral Tears:
- Plain radiographs first to evaluate for dysplasia, femoroacetabular impingement (FAI), joint space narrowing, and bony pathology 6, 1
- MR arthrography is the gold standard (rated 9/9 - usually appropriate) if surgical intervention is being considered 6, 4, 1
- Direct MR arthrography with intra-articular gadolinium provides superior visualization compared to standard MRI (rated only 6/9) 6, 1
Clinical Presentation to Recognize
Hip Labral Tears:
- Groin pain is the predominant complaint (92% of patients) 7
- Activity-related pain occurs in 91% of patients 7
- Night pain affects 71% of patients 7
- Positive anterior hip impingement test is the most consistent physical examination finding 3, 7
- Onset may be insidious (61% of cases), associated with low-energy acute injury (30%), or major trauma (9%) 7
Common Pitfalls to Avoid
- Do not rush to surgery without an adequate trial of conservative management, as many patients improve with non-operative treatment 1
- Do not rely on standard MRI alone for hip labral tears; MR arthrography provides superior diagnostic accuracy 6, 1
- Recognize that diagnosis is often delayed (mean time to diagnosis is 21 months) and patients may see multiple providers (average 3.3) before correct diagnosis 7
- Be aware that 17% of patients may have surgery on another anatomic site incorrectly recommended before the labral tear is diagnosed 7
When to Consider Surgical Referral
Surgical intervention should be considered when:
- Conservative management fails to provide adequate pain relief and functional improvement after several weeks to months 1, 3
- Untreated labral tears can lead to persistent pain, progressive cartilage damage, and osteoarthritis development 6, 4, 1
- For hip labral tears, arthroscopic labral repair with suture anchors is the preferred surgical technique over simple debridement, as it preserves the labral seal and load distribution function 6, 1, 8