What Is A Labral Tear?
Are you confused about hip pain, shoulder pain, and labral tears? Or, maybe you know someone who has experienced a labral tear and wants to know more. What is a labrum anyway, and why would it tear? In this article, we’ll take a closer look at that important but often glossed-over structure in the hip and shoulder, the labrum. I’ll review some anatomy, explore labral function, and share some ideas about when and why a labrum might tear. Read on to learn more!
What is a labrum?
A labrum is a piece of fibrocartilaginous tissue that connects the cartilage that lines the socket of our hip and shoulder joints. The labra attach to the articular cartilage and form a rim around the socket. Labrum comes from Latin and means “lip.” The hip and shoulder labra are structures that support these two ball-and-socket joints.
What is a labral tear?
A labral tear of either the hip or shoulder labrum occurs when there is a tear to the labrum itself or when it is torn away from part of its location of attachment. Specific tears are described by their location, their particular morphology, and/or their cause.
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Hip labrum
Functions
The hip labrum is also called the acetabular labrum. The hip labrum supports multiple functions at this important joint. By providing a lip of extra fibrocartilagenous tissue around the socket, it deepens the socket of the hip joint.
The labrum completes a vacuum seal around the hip joint and helps maintain joint lubrication by contributing to the distribution of synovial fluid in the joint. It adds to the stability and shock absorption at the hip joint. It contributes to necessary load distribution at the hip joint and helps resist too much translation of the femoral head, which could lead to dysfunctions like dislocation. Finally, the hip labrum distributes contact between the head of the femur and the cartilage of the acetabulum, reducing premature wear at the interface of those two structures.
Hip labral tears
Tears of the acetabular labrum can be the result of multiple causes. Those might include (but aren’t limited to):
- Acute accidents (car accident, slip and fall, sports-related collision)
- Repetitive motion actions with frequent external rotation and/or twisting through the hip joint (e.g., dance, sports)
- A result of hip dysfunction or degeneration, for example, hip dysplasia, hypermobility, or femoroacetabular impingement
- Age-related wear and tear with or without other risk factors
The specific relationship between hip labral tears and damage to the articular cartilage that lines the joint is unclear. The two issues are often found together, especially in older patients, but whether one causes the other is not certain.
Symptoms of a hip labral tear
Symptoms of a hip labral tear are variable. Some people report anterior hip or groin pain. Others report pain that continues into the buttock, thigh, or even the knee. People may report that movement activities, including simple standing and walking, but especially twisting, make the pain worse. Sometimes people also report mechanical-type symptoms, like clicking, locking, catching, or feelings of instability in their hip joint. Long-term effects may include possible hip instability, increased risk of osteoarthritis, and the potential for reduced shock absorption at the joint.
Shoulder labrum
Functions
The shoulder labrum is also called the glenoid labrum. Remember that the glenoid fossa is the depression in the scapula that the head of the humerus fits into to create the shoulder joint. The shoulder labrum is a rim of fibrocartilagenous tissue that forms a rim on the articular cartilage that lines the glenoid fossa.
You might also remember that the socket of the shoulder joint is much shallower compared to our deep hip socket. One important function of the labrum is to provide tissue that essentially deepens this socket, making for a more stable connection between the humerus and scapula. Like the labrum in the hip joint, the shoulder labrum helps resist too much translation of the humeral head within the shoulder socket. That helps maintain movement within a healthy range and helps prevent dysfunction like dislocation. It also helps provide shock absorption when we do abrupt motions at the shoulder joint, like throwing, for example.
Shoulder labral tears
As with the hip joint, tears of the glenoid labrum can result from multiple causes. Those might include (but aren’t limited to):
- Acute accidents, like catching yourself with your arm in a fall
- Acute sports-related movements
- Repetitive motion actions (e.g., throwing sports, weightlifting)
- Age-related wear and tear (may be common, but asymptomatic in certain age ranges)
Symptoms of a shoulder labral tear
Often, asymptomatic and/or shoulder pain symptoms are not correlated with existing labral tears. One reference noted that between 55 and 72% of a group of asymptomatic adults aged 45-60 appeared to have a labral tear in the superior area of the labrum. However, there are also some symptoms that may be associated with labral tears. Those include shoulder pain, catching or grinding sensations when moving the shoulder, and feelings of shoulder weakness or instability.
Diagnosis and treatment of labral tears
Diagnostic tools and treatments are similar for hip and shoulder labral tears. Diagnostic imaging, including X-rays, MRI, and MRA, might be used, depending on each individual's situation. However, these imaging tools do not reliably show all labral tears. Arthroscopy and physical exams are also used to diagnose labral tears.
It’s important to note that many labral tears are asymptomatic, meaning they are present in the joint but aren’t associated with any pain or dysfunction. For that reason, not all labral tears may need treatment. If treatment is recommended, the first step in treatment is often simply resting from activities that are causing pain. In more problematic situations, physical therapy might be recommended. And, in more acute situations, surgery might ultimately be recommended.