Examination of Acetabular Labral Tear
Acetabular labrum tears (ALT) are present in 22–55% of individuals with hip or groin pain. Tears can occur as a result of trauma or degeneration and are markedly associated with femoral acetabular morphological variations. An ALT can lead to biomechanical deficiencies and a loss of stability to the coxafemoral joint due to the labrum serving as a stabilising structure of this joint. The diagnosis of ALT is complex and multidimensional. Although tremendous improvements in diagnostic utility for ALT have occurred in the past 25 years, there are few patient history, clinical examination and special test findings that are unique to the condition. Imaging methods such as MRI, CT and ultrasonography have demonstrated reasonable accuracy, but not at a level that allows use as a stand-alone measure. Outcomes measures that focus on functional limitation or that are used to measure recovery should envelop the complexities of the condition and be captured using both self-report and physical performance measures. Only when patient history, objective testing, clinical examination special testing and imaging are combined can a clinician fully elucidate the multidimensional diagnosis of ALT.
The reported prevalence of acetabular labral tears (ALT) in patients with hip or groin pain ranges from 22% to 55%. Differential diagnosis of the hip joint poses a diagnostic dilemma, particularly given that pain in the hip region is often difficult to localise to a specific pathological structure. With the evolution of improved diagnostic imaging and advanced surgical techniques, examination of the hip joint and periarticular structures as a primary pain source for hip-related pain/dysfunction has received a significant increase in attention. Although limited information exists in support of diagnostic utility, emphasis on patient history, clinical examination findings, MRI, MRI arthrography (MRA) CT arthrography and anaesthetic intra-articular injection pain response is currently advocated for determining the presence of intra-articular hip joint pathology. Clearly delineating the specific pathology in the hip can be difficult, since patients visit multiple healthcare providers over an extended period of time prior to diagnosis of ALT. Additionally confounding the diagnostic process of the hip joint is a lack of consensus regarding what elements of the examination are considered essential. The purpose of this paper was to examine the most current evidence and provide a systematic approach (based on this evidence) for examination of patients with a suggestion of ALT.
Abstract and Introduction
Abstract
Acetabular labrum tears (ALT) are present in 22–55% of individuals with hip or groin pain. Tears can occur as a result of trauma or degeneration and are markedly associated with femoral acetabular morphological variations. An ALT can lead to biomechanical deficiencies and a loss of stability to the coxafemoral joint due to the labrum serving as a stabilising structure of this joint. The diagnosis of ALT is complex and multidimensional. Although tremendous improvements in diagnostic utility for ALT have occurred in the past 25 years, there are few patient history, clinical examination and special test findings that are unique to the condition. Imaging methods such as MRI, CT and ultrasonography have demonstrated reasonable accuracy, but not at a level that allows use as a stand-alone measure. Outcomes measures that focus on functional limitation or that are used to measure recovery should envelop the complexities of the condition and be captured using both self-report and physical performance measures. Only when patient history, objective testing, clinical examination special testing and imaging are combined can a clinician fully elucidate the multidimensional diagnosis of ALT.
Introduction
The reported prevalence of acetabular labral tears (ALT) in patients with hip or groin pain ranges from 22% to 55%. Differential diagnosis of the hip joint poses a diagnostic dilemma, particularly given that pain in the hip region is often difficult to localise to a specific pathological structure. With the evolution of improved diagnostic imaging and advanced surgical techniques, examination of the hip joint and periarticular structures as a primary pain source for hip-related pain/dysfunction has received a significant increase in attention. Although limited information exists in support of diagnostic utility, emphasis on patient history, clinical examination findings, MRI, MRI arthrography (MRA) CT arthrography and anaesthetic intra-articular injection pain response is currently advocated for determining the presence of intra-articular hip joint pathology. Clearly delineating the specific pathology in the hip can be difficult, since patients visit multiple healthcare providers over an extended period of time prior to diagnosis of ALT. Additionally confounding the diagnostic process of the hip joint is a lack of consensus regarding what elements of the examination are considered essential. The purpose of this paper was to examine the most current evidence and provide a systematic approach (based on this evidence) for examination of patients with a suggestion of ALT.