Labral Tears: Symptoms, Causes and Diagnosis
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Key Takeaways
- The labrum cushions your hip or shoulder joints and enables them to move smoothly without grinding on each other. It is also the attachment point for ligaments in these joints.
- Labral tears can cause pain, stiffness, clicking or instability.Some people don’t experience any symptoms.
What is the Labrum?
The labrum is a protective fibro-cartilaginous tissue located at the hip and shoulder joints. The hip joint is where the thigh bone, or femur, connects to the hip bone, or pelvis. Meanwhile, the shoulder joint is where the head of the humerus (upper arm bone) connects to the shoulder blade (the scapula).
The labrum is important as it cushions the joints, preventing the bones from grinding against each other, while keeping them held together properly and allowing for smooth and stable movement. The ligaments that connect these bones together also attach to certain parts of the labrum.
Symptoms of a Labral Tear
A labral tear is an injury that occurs anywhere on the labrum. Even if it happens, symptoms aren’t always immediately apparent. You may experience:
- Pain around the joint area, even while seated
- A feeling of grinding at the affected joints
- Stiffness in the joints
- Unsteadiness when standing (hip labral tear)
- Instability of the joint
You may also experience pain in areas close to the affected joint, and this can inevitably cause changes to your posture and movement.
What Causes a Labral Tear?
Damage to the labrum can come from regular wear-and-tear from daily activities, sports injuries or even trauma due to a fracture or dislocated bone. When excessive pressure is applied to the labrum, it will cause the labrum to tear. In minor cases, the edges of the labrum may start to fray; in more severe cases, the labrum has detached from the bone.
Some other common causes include:
- Falls or other accidents that impact the joint
- Overuse of the joint, especially in sports or other rigorous activities
- Degenerative conditions like osteoarthritis
- Bone deformities
The difference in pain thresholds between people who have a labral tear can make it seem as though you might not have a tear if you’re not in occasional or constant pain. It’s always a good idea to get yourself checked to prevent further problems in the future.
Elderly people are especially at risk of labral tears, given their slower pace of recovery due to frailty or chronic health conditions. Treatment options for elderly people will also need to be carefully chosen – labral repair surgeries may not be successful as the labrum is likely to be degenerative and may not heal. Joint arthroplasty may be a better option in selected cases.
Can You Live with a Labral Tear?
You can, but only for low-grade tears that don’t cause you pain or adversely affect your movement or capabilities. Labral tears require surgery to repair, even for low-grade tears, as they can’t heal on their own. While you could continue with your life even with a low-grade tear, over time you do substantially increase your risk of degenerative bone conditions or a major labrum tear.
How Are Labral Tears Diagnosed?
While a doctor will start with a physical examination, it may not be accurate enough to find a labral tear, especially since the labrum is deep inside the shoulder or hip. Some tests may only pinpoint specific types of tears, but not others.
Twist Test
This looks out for a hip labral tear. You’ll be asked to stand with your legs apart, then flex your knees side to side in a windshield wiper motion. You may be asked to repeat the test twice while standing on one leg and holding your doctor’s hands for support. If you feel pain in either leg, it might suggest a positive hip labral tear.
Arlington Test
This test requires you to lie down on the examination table as your doctor internally and externally rotates your legs one by one. This aims to test your legs’ entire range of motion and identify any irritation or pain in the affected joint. Some studies have noted that the Arlington test is more sensitive (as in, more accurate) to detecting a hip labrum tear, though it’s common for doctors to combine the Arlington test with the twist test for better results.
O’Brien Test
Also called the active compression test, this test is used to look for shoulder labral tears. You'll be asked to raise your arms parallel to the floor and your elbows fully extended. You then direct your arms forwards till they reach around the centre of your body. From there, rotate your arms inward so the tops of your hands face one another and with your thumbs pointing down. The doctor will press down on your arms either from in front of or behind you and will ask you to resist as much as you can.
From there, you may then be asked to rotate your arms the other way so that your palms face the ceiling, and your elbows are pointing towards the floor. The doctor will repeat pressing down on your arms.
The physical examination is usually enough, but in some cases, additional tests may be ordered to see confirm the diagnosis, especially if physical tests are having a tough time confirming the result. It may also discover other complications that may be contributing to what you’re currently experiencing.
If need be, your doctor may suggest anaesthesia be injected into the joint space. If there is almost immediate pain relief after the injection, it could indicate a labral tear.
X-ray scans are generally sufficient to examine the affected joint and look for structural problems or other issues affecting the joint and its surroundings. A magnetic resonance imaging (MRI) test may also be ordered to get a closer look at the soft tissues surrounding the affected joint.
Orthopaedic Doctor for Labral Tears in Singapore
Dr. McGraw
M.B.Ch.B. | M.R.C.S. (Lon) | F.R.C.S. (Tr & Orth)
Dr. McGraw is a practising orthopaedic and trauma surgeon at Mount Elizabeth Novena Hospital and Parkway East Hospital.
His special interests and expertise include the management of all aspects of hip and knee conditions, in addition to general orthopaedic and trauma surgery.
Born and bred a Yorkshireman, Dr. McGraw studied Dental Surgery at Newcastle-Upon-Tyne in the United Kingdom. Upon qualifying, he worked as a Maxillofacial surgical trainee before undertaking his dental fellowship at The Royal College of Surgeons London and then commencing his studies in Medicine at Manchester University. He subsequently decided to change tack and completed his training as an Orthopaedic Surgeon in the northwest region of England. Dr. McGraw completed his training by undertaking two fellowships in hip and knee surgery at Wrightington Hospital in the UK. He was appointed as Consultant Orthopaedic Surgeon at Bury & North Manchester General Hospitals in 2012. Whilst at these hospitals, he kept up with the waiting list issues by dedicating his weekends to work in waiting list initiative lists at Wrightington Orthopaedic Hospital.
Frequently Asked Questions
It is a little frightening to think about it, especially since not everyone exhibits symptoms (like experiencing intermittent pain when walking or standing). It’s always a good idea to get yourself checked in case you’ve had a fall. Don’t delay as well: the sooner you can get examined, the better the odds of diagnosing the issue and addressing it.
Unfortunately, it is. Only low-grade tears don’t require surgery to treat, but there’s still a risk of the tear becoming worse off if something (a fall, for example) were to cause further damage to it. Grade 2 and 3 tears, however, will need surgical intervention to restore the joint’s function and range of motion.
You’ll need to discuss this in detail with your doctor. Ideally, it will take a few months before you’re in a condition where the doctor allows you to take part in your usual activities. They may also advise caution when doing certain activities, like sports, to prevent another tear from happening.
Related Conditions
Hip bursitis is a condition characterised by inflammation of the hip bursae, small, fluid-filled sacs that cushion the spaces around bones and other tissues during joint movement. The hip contains two major bursae that are at risk of bursitis: the trochanteric bursa and the iliopsoas bursa.
Hip instability, or loose hips, happens when weakened or damaged ligaments, muscles, or the labrum make the hip joint unstable. This causes excessive movement, pain, discomfort, and sometimes a feeling that the hip may “give out.”
