Before diagnosing a hip labral tear, a physician must eliminate the possibility that another hip condition is causing the symptoms. This process can be challenging and time consuming because many other hip conditions cause similar symptoms—in fact, research suggests it takes many people more than 2 years to get an accurate diagnosis. 1 Groh MM, Herrera J. A comprehensive review of hip labral tears. Curr Rev Musculoskelet Med. 2009;2(2):105-17.
Getting an accurate diagnosis will begin with an in-office doctor evaluation.
A doctor will ask questions about the patient’s medical history and physical activities and perform a physical examination, including specific orthopedic tests to determine the presence of a hip labral tear.
- Patient History. The patient should be prepared to provide the doctor with an accurate description of symptoms, including when they started, what movements cause pain, and where the pain is located, as well as past injuries and surgeries.
- Physical Examination. During a physical exam, the doctor will evaluate the hip joint’s strength and range of motion and check for symptoms such as swelling and redness. The doctor will also attempt to trigger the pain the patient experiences in day-to-day activities. A common test used to diagnose a hip labral tear is called the FABER test. 2 Martin RL, Enseki KR, Draovitch P, Trapuzzano T, Philippon MJ. Acetabular labral tears of the hip: examination and diagnostic challenges. J Orthop Sports Phys Ther. 2006;36(7):503-15.
- The FABER test. The FABER (Flexion, Abduction, and External Rotation) test is a provocation test that is useful for the anterior hip and groin pain that is associated with most labral tears.
- The person who has hip pain lies on his or her back with legs straight.
- The doctor places the tested leg in a “figure-4” position, with the knee bent and the ankle placed on top of the opposite knee.
- The doctor then applies a gentle downward force against the knee of the bent leg, pushing it towards the examination table.
Groin pain on the side of the bent leg is a sign that there is a problem in the hip joint. Other exams, such as the Scour or resisted straight leg test, may also be performed.
A physical exam cannot conclusively diagnose a hip labral tear and additional diagnostic testing may be ordered.
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Diagnostic testing for a hip labral tear can include medical imaging, injections, and—occasionally—arthroscopic surgery.
- MRI (magnetic resonance imaging) and MRI arthrogram. This type of diagnostic imaging shows a detailed view of the soft tissues surrounding the hip joint. Research suggests that an MRI arthrogram, which uses an injected contrast fluid, provides doctors a better image for diagnosing labral tears and related problems, such as damage to hip cartilage. 1 Groh MM, Herrera J. A comprehensive review of hip labral tears. Curr Rev Musculoskelet Med. 2009;2(2):105-17.
- Diagnostic hip injections. If a diagnosis remains unclear after an MRI or MRI arthrogram, the doctor may suggest injecting a numbing medicine (such as lidocaine) into the hip. Ultrasound or other medical imaging is used to help guide the injection to the precise location of the suspected tear. If pain relief is achieved, then the labrum is likely to be the source of pain.
- Arthroscopic hip surgery. This procedure allows the doctor to see and treat the suspected labral tear while making only 2 or 3 small incisions (about 5 mm each). A pencil-sized tool called an arthroscope is equipped with a tiny TV camera and inserted through the small incision and guided inside of the hip joint. Being able to see within the hip joint lets the doctor confirm a labral tear and determine if there are any other underlying conditions that need to be addressed. If a labral tear is identified, the doctor can perform a surgical repair during the same procedure.
Arthroscopic surgery typically involves general anesthesia and is reserved only for cases in which a labral tear is strongly suspected.
Once the patient is diagnosed, a treatment can be recommended.