Test Assess Hip Labral ODLICNO

8/3/2019 Test Assess Hip Labral ODLICNO

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ACETABULAR LABRAL TEARS

Alexander Black

Jill Bodak

Jenn Bognar

Justin Bodnarchuk



ANATOMY OF THE HIP



The Joint Capsule

The joint capsule of the hip, the coxofemoral joint is large and loose

It completely surrounds the joint, attaching to the labrum of theacetabular socket

The labrum forms a seal around the joint with increased fluid pressurewithin the labrum contributing to lubrication of the joint

The joint capsule also passes over a fat pad internally to join to the distal

aspect of the femoral neck The capsular fibers attaching to the femoral neck are arranged in a

circular fashion (zone orbicularis) and are an important contributor to hipstability





http://www.ithaca.edu/faculty/lahr/LE2000/hip%20pi

cs/8acetabularlig.jpg



http://www.aafp.org/afp/991015ap/1687.html



Labral Tear

http://ajs.sagepub.com/content/33/6/864/F1/graphic-1.large.jpg



SIGNS AND SYMPTOMS



Clinical Findings

Mechanism of injury most often associatedwith sudden pivoting or twisting

Can also be associated with congenitalabnormalities or degeneration

Pain in anterior inguinal region, anteriorthigh, and buttock (around greatertrochanter)

Active and passive ROM reproduces pain



Clinical Findings Cont’d

Audible/Palpable click (crepitus)

Locking or Giving away of the hip joint

Hip/Groin pain

Decreased range of motion

Snapping joint line pain

Ligament laxity Snapping of the iliotibial band

Refer for MRa to confirm clinical findings



TEST TO ASSESS HIP LABRAL

INJURIES

1) McCarthy

2) FABER

3) Impingement



McCarthy Test

The Test:

The therapist has the patient lay in a supine position

The therapist then has the patient flex both hips and then extend

the affected hip

If the patient feels a catch a labral tear is present and a positive test

has occurred



FABER Test

Also Known as the Patrick’s Test

The Test: The therapist has the patient lay in a supine position

The therapist then takes the test leg and puts it on the opposite straight leg

The motion is that of Flexion Abduction External Rotation

The therapist then applies pressure to the anterior aspect of the knee

lowering the test leg into further abduction If the leg can not be lowered parallel to the opposite leg or pain is produce a

positive test has occurred

The Faber test encourages anterior translation of the femoral head on to theanterior surface of the labrum, impinging on any suspected tear.



Impingement Test

The Anterior Test: The therapist has the patient lay in a supine position

The therapist then takes the patients leg into flexion, adduction, and slight internalrotation

This test will compress the anterior surface of the labrum

A positive test has occurred if pain has been reproduced and implies an anterior superiortear

Other signs to look for would be crepitus, popping, clicking, etc.

The Posterior Test: The therapist has the patient lay in a prone position

The therapist then takes the patients leg into Passive hyperextension, abduction andexternal rotation

If this motion elicits pain a positive test has occurred and there is the presents of a posteriortear



Other Diagnostic Tests

Radiographs or X-rays

Magnetic Resonance arthrography (MRa)



TREATMENT OF ACETABULAR LABRAL

TEARS

*Note: that the acetabular labrum DOES have ablood supply and that some labral tears arecapable of healing on their own when coupledwith proper physical treatment and painmanagement.



Change your lifestyle:

to avoid further damage to the labrum, increase your level of low to moderate physical activity.

focus on proper posture when sitting and standing, avoid activities that take the hip through fullROM or reproduce pain

Use meds to control pain:

Pain medications, as prescribed by a physician, along with NSAIDs

Some patients also take glucosamines or cartilage supplements (trivial in research)

Physical Therapy:

ALL HIP LABRAL PATIENTS SHOULD EXERCISE. Strength/Stabilize hip:

Lumbar and abdominal strengthening

Postural correction

Hip flexion and extension

Hip abduction and adduction with minimal resistance

Balance and proprioceptive activities

* Monitor FREQUENCY, INTENSITY and TIME

* Occasionally this allows the body to heal the labrum entirely on its own.

Corticosteroid Injections:

common treatment for joint pain, reduces inflammation and helps control pain.

usually a temporary fix- must be accompanied by healthy lifestyle and P.A



THE LAST RESORT

SURGICAL INTERVENTION2 major types of acetabular labrum tears:

Type I: Disengagement of the labrum at transition area to the articular hyalinecartilage.

Type II: Intrasubstance splits with one or more cleavage planes

Because current research shows nociceptors in the body of the acetabular

labrum, prolonged pain and discomfort in the hip- regardless of therapy andpharmacological intervention results in the need for surgery.

The modern method for repair is Hip Labral Arthroscopy:

Reattach the labrum to the acetabular wall (anchor)

Sew the tear in the labrum back together with bioabsorbable sutures

Remove the labrum entirely

Remove the torn or damaged section of the labrum

***Acetabular labral arthroscopy will not alleviate all symptoms in patients thathave compounding hip conditions like arthritis or Femoral AcetabularImpingement (FAI)



Post-operative Care:

After the surgery, the patient will be on crutches fortwo to six weeks (case-by-ase)

Physical Therapy: improve the hip range of motion

and muscle strength around the hip. return to play when symptom free- anywhere

between two and six months, depending on theextent of the injury.



Patient prepped for arthroscopy

What a surgeon sees during Arthroscopy of Acetabular Labrum

http://www.youtube.com/watch?v=4j0SU3vKrbM





Test Question

1. Which of the following is/are a mechanism of injury for a hip labrum tear

A) sudden pivoting/twisting

B) congenital abnormality

C) Degeneration

D) All The Above

2.

A) 1-3B) 2-4

C) 1,2,3

D) 4

Which of the following are included in the FABER test?

1) pressure is applied to the anterior aspect of the knee

2) therapist then takes the patients leg into flexion, adduction, andslight internal rotation

3) therapist then takes the test leg and puts it on the oppositestraight leg

4) If the patient feels a catch a labral tear is present



Questions Con’t

What is the last resort for treatment of acetabular tears?

A) Physical therapy

B) Arthroscopy

C) Medication

D) Corticosteroids



Answers

1. D

2. A

3. B



REFERENCE

Binningsely, D. (2003). Tear of the Acetabular Labrum in an Elite Athlete. British Journal of Sports Medicine. 37 p 84-88.

http://www.mayoclinic.com/health/hip-labral tear/DS00920/DSECTION=symptoms

http://www.sportsinjurybulletin.com/archive/acetabular-labrum-tears

J. C. McCarthy, B. Busconi. Canadian Journal of Surgery. Hip Disease in Young Adults. Ottawa: Feb 1995. Vol. 38, Iss. 1, p. S13-7 (5 pp.)

http://www.eorthopod.com/images/ContentImages/hip/hip_anatomy/hip_anatomy_intro01.jpg

http://biology.clc.uc.edu/graphics/bio105/pelvis.jpg (Picture on slide 2)

http://www.eorthopod.com/images/ContentImages/hip/hip_precautions/hip_artificial_precautions_anat02.jpg (picture onslide 4)

http://www.eorthopod.com/images/ContentImages/hip/hip_anatomy/hip_anatomy_ligaments01.jpg (picture on slide 6)Info from: foundations of athletic training and principles of human anatomy 10th edition

http://hiplabraltear.com/

https://healthlibrary.epnet.com/GetContent.aspx?token=a4c1f00b-d245-44f2-a90e-20b047f84a6a&chunkiid=432309

http://www.riversideonline.com/health_reference/Disease-Conditions/DS00920.cfm

http://www.conquestchronicles.com/pages/the-labral-tear-hip

http://www.eorthopod.com/images/ContentImages/hip/hip_anatomy/hip_anatomy_ligaments01.jpg

http://www.eorthopod.com/images/ContentImages/hip/hip_precautions/hip_artificial_precautions_anat02.jpg

http://biology.clc.uc.edu/graphics/bio105/pelvis.jpg

http://biology.clc.uc.edu/graphics/bio105/pelvis.jpg

Test Assess Hip Labral ODLICNO

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