Acetabular Labral Tears of the Hip: Examination and Diagnostic Challenges

Abstract

The purpose of this clinical commentary is to provide an evidence-based review of the examination process and diagnostic challenges associated with acetabular labral tears of the hip. Once considered an uncommon entity, labral tears have recently received wider recognition as a source of symptoms and functional limitation. Information regarding acetabular labral tears and their association to capsular laxity, femoral acetabular impingement (FAI), dysplasia of the acetabulum, and chondral lesions is emerging. Physical therapists should understand the anatomical structures of the hip and recognize how the clinical presentation of labral tears is difficult to view isolated from other hip articular pathologies. Clinical examination should consider lumbopelvic and extra-articular pathologies in addition to intra-articular pathologies when assessing for the source of symptoms and functional limitation. If a labral tear is suspected, further diagnostic testing may be indicated. Although up-and-coming evidence suggests that information obtained from patient history and clinical examination can be useful, continued research is warranted to determine the diagnostic accuracy of our examination techniques.

Nonsurgical Treatment of Acetabular Labrum Tears: A Case Series

“…There is limited ability to accurately clinically diagnose a labral tear. 16,[22][23][24] In addition, even for patients with a confirmed labral tear on diagnostic imagining, it does not ensure that the pain arises from the tear. 23 Therefore, we chose to use the term "clinical evidence of a labral tear" for our patients.…”

“…Focal rotational instability is defined as localized laxity of select capsule-ligamentous structures that results from repetitive forceful hip rotation. 22,29,31 The most common injury mechanism is excessive hip external rotation, leading to iliofemoral ligament laxity. 22,31 Abnormal loading of the anterior-superior labrum can occur in the presence of instability.…”

“…22,29,31 The most common injury mechanism is excessive hip external rotation, leading to iliofemoral ligament laxity. 22,31 Abnormal loading of the anterior-superior labrum can occur in the presence of instability. 29 The labrum is important for joint stability and, therefore, capsule-ligamentous structures can come under additional stress when a labral tear occurs.…”

Treatment of an Individual With Piriformis Syndrome Focusing on Hip Muscle Strengthening and Movement Reeducation: A Case Report

“…The scour test, hip quadrant test, log roll test, FABER, and active straight leg test 23 were performed, and all were negative with respect to reproduction of the patient's symptoms. Clinical tests also were performed to assess for piriformis syndrome.…”

The Interrater Reliability of 4 Clinical Tests Used to Assess Individuals With Musculoskeletal Hip Pain

“…33 Details describing how to perform and interpret these tests have been previously reported. 4,20,21,30,31,33 The FABER test involves combining the motions of hip flexion, abduction, and external rotation. This commonly performed test is used as a screening maneuver and attempts to reproduce pain in the hip, lumbar spine, or sacroiliac region.…”