A hip labral tear is a tear in the labrum, the rim of tough cartilage around the hip socket that helps seal and steady the joint. It usually causes pain deep in the GROIN, sometimes with clicking or catching.
Most people should start with physio, not surgery. Labral tears are very common on MRI in people with NO hip pain, so a tear on your scan may not be what’s hurting.
Keyhole hip surgery (hip arthroscopy) can help some younger people with a hip shape problem called impingement. The extra benefit over physio is modest. If you already have hip arthritis, it usually does poorly.
Symptoms
- Deep groin pain: often shown by cupping the front and side of the hip with a hand in a “C” shape
- Clicking, catching or locking as you move the hip
- Pain sitting for long periods, getting in and out of a car, or bringing the knee up toward your chest
- Pain with twisting, pivoting or deep squats
- A stiff hip that doesn’t turn in as far as the other one
Your MRI result, in context
- Labral tears are common in hips that don’t hurt. In one study of adults with no hip pain, about 7 in 10 had a labral tear on MRI
- Other studies found lower rates, but tears in pain-free hips turn up again and again, in young athletes and in older adults
- So your tear is a finding to interpret, not automatically the cause of your pain or a reason for surgery
- Pain can also come from nearby: the hip flexor tendons, the groin muscles, the back, or early arthritis
A labral tear on your scan tells you what the hip looks like. It doesn’t tell you what’s causing the pain.
Where impingement fits in
- Femoroacetabular impingement (FAI) means the ball or the socket of the hip has an extra bump of bone, so they pinch together when the hip bends and turns
- That pinching can wear the labrum, which is why tears and FAI often come together
- Many people have the bone shape without any pain. It only becomes FAI syndrome when it comes with symptoms and matching findings on examination
What helps
- A physio-led exercise program: strengthening the buttock, hip and trunk muscles over at least 12 weeks. This is the first-line treatment
- Change the positions that pinch: avoid deep squats, low seats and sitting with the knees higher than the hips for a while. A wedge cushion helps
- Keep active: walking, cycling with the seat raised, and swimming (go easy on breaststroke kick) are usually fine
- Pain relief: anti-inflammatory tablets for flares, if your doctor says they suit you
- An injection into the joint: sometimes used to confirm the pain is coming from inside the hip. Relief is usually short-term. See cortisone shot side effects
Do you need surgery?
The evidence is mixed. Trials comparing hip arthroscopy with physio for impingement found surgery gave somewhat better scores over the first year or two. The difference was modest, many people improved with physio alone, and it isn’t clear surgery protects the hip long term.
- Surgery is more likely to help if you’re younger, have clear impingement on X-ray, have little or no arthritis, and physio hasn’t worked after a proper try
- Surgery is less likely to help if you already have hip arthritis. In one large study of people with arthritis who had hip arthroscopy, about 2 in 3 went on to need a hip replacement within two years
- Recovery from arthroscopy usually means crutches for a few weeks and several months of rehab before sport
If your X-ray shows arthritis, the conversation is usually about managing arthritis, not fixing the labrum. See hip arthritis.
Questions to ask your surgeon
- Is the tear definitely causing my pain, or could it be something else?
- How much arthritis is in the joint?
- What would you do to the bone shape, not just the labrum?
- What if I do another three months of physio first?
Get seen today if
- You fell and can’t put weight on the leg, or the leg looks shorter or turned out
- The hip is hot and swollen and you have a fever or feel unwell
- A child or teenager has a new limp or hip, thigh or knee pain with no clear cause
Get it checked if
- The hip truly locks, and you have to wiggle it to free it
- Pain hasn’t improved after 12 weeks of a proper exercise program
- Pain wakes you at night whatever position you’re in, or you have unexplained weight loss
- You’re a runner or on steroids and have groin pain that’s worse when you put weight on the leg. It could be a stress fracture
A tear on MRI is common. Physio first, and surgery only if the hip still needs it.