Hip Labral tears
-What does the hip labrum do?
-What does it mean if it’s been torn?
-What are the symptoms to suggest a torn hip labrum?
-Why it matters whether you have a degenerative or acute traumatic Labral tear.
-When should you consider hip labrum surgery.
-When should you consider regenerative medicine treatment options.
Hip Labral tears
Hello, this is Siddharth Tambar, from Chicago arthritis and regenerative medicine. Welcome to our weekly live educational broadcast. It’s September 14th, 2020. Welcome everyone. I hope everyone is healthy and doing well. So on this weekly broadcast, I’d like to discuss common questions that either patients or my own staff has regarding things that we evaluate, treat and assist with here in the clinic. So in this office, we are focused on nonsurgical evaluation and management of arthritis, tendonitis, injuries, and back pain.
So a occasional question that I get is regarding hip labral tears. So I had a patient last week who specifically was asking regarding her hip pain, whether her MRI finding could account for her pain and whether she should consider surgery or not. So what is a hip labrum? So the hip labrum is a thickened connective tissue layer that extends from the cartilage of the hip joint. It surrounds a rim of the acetabulum. It extends a hip joint socket itself. It increases the surface area of the hip joint socket, which then in turn helps to strengthen the hip joint socket. So it’s a really important structure in the hip joint in that it offers stability and adds to the overall strength and function of the hip joint.
So in someone that has an injury to the labrum, what they will experience is pain in the front of the hip, classically in the groin area pain with range of motion and even a possible catching sensation. And certainly pain as a physician is moving your hip around sort of internally and externally rotating the hip.
So what do you do if you have a hip labral tear. There’s really two ways you want to think about this. Number one is, do you have a degenerative tear versus you have a traumatic acute tear? So MRI can tell the difference, certainly your history and description of your pain when it occurred, how it occurred, can help out as well. So if you have a degenerative tear, degenerative tear means an MRI, you can tell that there’s been some blunting or some degeneration of the labrum itself. It’s not an acute tear. It may not even be what’s causing your pain. It’s a finding that you can see in many people that have chronic degeneration of the labrum of the hip in particular hip arthritis, it’s part of the overall wear and tear and stress that you can see in hip arthritis. You don’t want to overreact to that finding on MRI, if it’s a degenerative tear. And the reason why is because as a part of the overall degenerative process, if you overreact to it and you think that’s what’s causing your pain, it may lead you down the wrong avenue in terms of treatment. There’s no evidence that surgically correcting or treating a degenerative hip labrum will help more than physical therapy alone. In addition, there’s no evidence that it will actually help prevent progression of hip arthritis.
So in a degenerative tear, the way you want to think about that, is it’s evidence that there’s chronic stress on the hip. So you want to ask yourself, why do you have stress on the hip? Is it because you have a prior injury, and there’s a little bit of instability from ligaments in the hip. Is it because you have some weakness around the muscles of the hip that’s causing more strain on the hip joint? Is it because you have some instability in the SI joint, which is in the back of the hip, in the buttock area. Or is it because you have a mild pinched nerve in the lower back that’s then causing some weakness in the muscles around the hip, which is then causing more stress in the hip joint and the hip labrum. All of those things can be treated. either through strengthening, such as physical therapy or regenerative medicine treatment, such as utilizing your own platelets or bone marrow stem cells to inject some of the ligaments to actually strengthen the ligaments. If there’s actually pain in the hip joint itself in the groin area, then actually injecting cells into the hip joint makes sense as well. If you have a mild pinched nerve in the lower back, then actually injecting platelets around that pinch nerve can make a difference as well. Those are all effective and appropriate ways to treat a degenerative labral injury.
Actually getting surgery to it does not make sense, and it’s not the right way to do it. The problem with surgery in this case, is if you cut out, soft tissue and tissue, that’s actually helping to protect the joint. You’ve now left that joint to be exposed to more or three changes longterm. So in a degenerative tear, absolutely avoid surgery, absolutely maximize physical therapy and absolutely consider a regenerative medicine treatment.
A traumatic tear is kind of an interesting and other kind of story. So let’s say you’re a 20 year old athletic individual. You injure your hip during a athletic activity, and now you have pain in the hip joint. And let’s say, you’re now told you have an acute traumatic tear of the labrum. Should you go for surgery? It’s kind of a controversial question. So the typical thing that’s done currently is hip labral surgery would be recommended. In some cases they can actually stitch that up back together, but frequently it’s actually shaving down where the tear is. Shaving down where the tear is then does put you at more risk for hip arthritis longterm. You need to be careful about that. It’s a risk and benefit kind of issue that you need to really think carefully about. If you’re a professional athlete that has a acute labral tear and your living at a very substantial level is based on being able to play for another few months to a year or a couple of years. You know, thinking about that kind of risk benefit in terms of dollars might make sense. If you’re a amateur athlete and your goal is to maintain a level of physical activity for more than a decade, I would say rethink whether surgery makes sense. Can you get by with not only physical therapy, but a regenerative medicine treatment to treat this in a nonsurgical fashion so that you don’t remove tissue, that’s really meant to help to protect that joint. If you can do that, you at least in theory, put yourself at a greater likelihood of protecting the hip joint from progressive arthritis by cutting out tissue. A lot of this is more theory and principle based because really we don’t have longterm results when it comes to what happens to a hip labral patient 10 years down the line, if they’ve had surgery versus if they’ve had a regenerative medicine treatment. But at least from a regenerative medicine principle standpoint, avoid surgery, if you can.
Another aspect to this is something that’s talked about a lot by hip surgeons nowadays is femoral acetabular impingement. It’s a concept that if you have a slight bony outgrowth on the femur part of the hip, that or bony outgrowth on the acetabular part of the hip, that can you be more prone to hip labral injuries because there’s a little anatomical defect. And so surgically they will come in the, like you shave down that bump. Does that make sense? In some cases it might, if you have catching. If you have the right kind of clinical scenario, a young person that’s presenting with this kind of issue. In a lot of people though, it gets diagnosed when they’re older and I’ve seen patients who are 35 plus 40 plus, who’ve been told that they may have femoroacetabular impingement. That doesn’t make quite as much sense. You need to be careful. That’s someone who’s likely had that anatomic defect on x-ray going on for decades. That’s not the cause of his hip pain. It’s more degenerative process in the hip. So in some people it may make sense to consider that surgery. Again, I would always caution if you’re thinking about surgery, ask if there’s nonsurgical methods, including regenerating medicine treatments that maybe significantly effective in keeping you active, that does not have the higher, longer term risk of surgically removing something. It’s important to understand that while surgery may be able to get you to x-ray picture that you’re looking for, it may not necessarily get you the pain relief and functional improvement that you desire longer-term. Those are different things. And the musculoskeletal system is not always just, how does it look on an X Ray? It really is very much how are you doing pain and function wise? So try to maintain your own anatomy if possible.
In my patient’s case, 35 year old woman, one pregnancy in the past, who’s had some SI joint instability symptoms, some pelvic pain in the past related to that as well while she does have some groin pain, on her MRI what’s being described is a degenerative tear of the meniscus, excuse me, of the labrum, which I believe is due to chronic stress on that part of her hip due to chronic instability in her SI joint. In addition, my recommendation for her was to avoid surgery. Note that she did not have significant pain while actually moving her hip on examination. And I think she’s someone who would do well with the regenerate medicine treatment. She does not have significant damage to her hip joint yet. And if we can avoid surgery in her case, she’ll be better off longterm.
Great. Well thank you for your time. I hope everyone stays well. As a reminder, we’re doing this live stream twice per week, Mondays and Wednesdays, open and interested in hearing your questions. In addition, I’m doing a webinar this Wednesday 5:00 PM central standard time. I’ll put a link down below on any social sites that this gets posted on, where I’ll be talking about the truth behind regenerate medicine. What are realistic expectations, what can be treated, what can not be treated? How do you know if you’re getting a good quality treatment and being treated by an appropriate physician and clinic and how to avoid people who don’t know what they’re doing. Until next time, have a good day and live well. Bye bye.
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***About this video***
In this video Siddharth Tambar MD from Chicago Arthritis and Regenerative Medicine discusses treatment for hip labral tears.