Hip labral tears & impingement

The labrum is a rim of cartilage that deepens the hip socket, contributes to the joint's seal and helps distribute load. Isolated traumatic tears occur, but most labral tears in active adults arise because of the underlying shape of the joint.

In femoroacetabular impingement, extra bone on the femoral head-neck junction (cam morphology), over-coverage by the socket (pincer morphology), or a combination causes abutment during hip flexion and rotation. The labrum and the adjacent cartilage take that repeated contact, which is why treating the tear without addressing the mechanics often falls short.

Symptoms are usually felt in the front of the hip or groin rather than in the buttock, and are provoked by positions that flex and rotate the joint.

Most labral tears in active adults develop because of the underlying shape of the joint — cam or pincer morphology that develops during skeletal maturity, often in patients who played high-demand sport as adolescents. Direct trauma, hip dislocation and dysplasia account for a smaller group, and those require a different plan.

Groin pain that persists beyond several weeks, limits sitting or sport, or is accompanied by catching or locking is worth evaluating. Hip pain is frequently mislabelled as a groin strain or a back problem, and a targeted examination usually clarifies the source quickly.

Evaluation deliberately distinguishes the hip joint from the lumbar spine, the abdominal wall and core, and the peritrochanteric structures on the outside of the hip. Examination includes range of motion, impingement testing and assessment of hip and trunk strength.

X-rays in specific views characterize the bony morphology and screen for dysplasia and arthritis. MRI, sometimes with contrast, evaluates the labrum and cartilage. A diagnostic intra-articular injection can be useful when the source of pain is genuinely uncertain — if the pain is relieved temporarily, that localizes the problem inside the joint.

Structured physical therapy is the starting point for most patients: restoring hip mobility within a comfortable range, building gluteal and deep hip stabilizer strength, and correcting the trunk and pelvic control patterns that increase impingement.

Activity modification — reducing deep-flexion loading for a period — and judicious use of injections support that work. Many patients improve enough that surgery is not needed.

When symptoms persist despite a well-executed program and the imaging matches the examination, hip arthroscopy is considered. The labrum is repaired to restore its seal where the tissue allows, and the cam or pincer bone is reshaped so the joint clears through its arc of motion. Cartilage damage and the capsule are managed as part of the same procedure.

Patient selection matters: results are best in hips that still have healthy cartilage, and arthroscopy is not a treatment for established arthritis. That assessment is made openly before surgery is planned.

The early phase protects the repair with defined weight-bearing and motion limits while beginning gentle mobility work. Strengthening advances in stages, focusing on gluteal control and progressive loading, and return to running and sport follows objective criteria.

Written protocols are provided so your therapist and the surgical plan stay aligned throughout.

Dr. Horner is a board-certified orthopedic surgeon with fellowship training in sports medicine at Rush University Medical Center and has presented hip preservation research internationally. Non-operative care is given a genuine trial, and arthroscopy is recommended only where the imaging, examination and cartilage status support it.

Patients are seen at Oak Brook on Mondays, Little Village on Wednesdays and St. Charles on Thursdays.