North Wales – Sports Injury – Hip Pain

Hip Labrum Tear Injury and Treatment in Conwy, Gwynedd and Anglesey Explained

One particular cause of hip pain is the sports injury hip labrum tear. In recent years, advances in the medical knowledge of hip injuries have highlighted the problem of a torn Acetabular Labrum. This owes much to the pioneering work of Cambridge based orthopaedic surgeon Richard Villar. In the past, it had been said that “the hip was impossible to arthroscope”, because of its anatomical structure, but this only served to stiffen Villar’s resolve to prove this statement wrong. By developing specially adapted surgical equipment and devising a totally new surgical procedure, Villar carried out the first hip Arthroscopy. Arthroscopy refers to the technique used by surgeons whereby they insert a very small (2mm diameter) camera into the body. It is a minimally invasive surgical procedure, commonly known as keyhole surgery. It allows the surgeon to look directly inside the locality of the patient’s problem and determine exactly what is wrong. By developing specially adapted surgical equipment and devising a totally new surgical procedure, Viller carried out the first arthroscopy in the late 1980’s.


By visualising the hip joint using an arthroscope, orthopaedic surgeons have been able to document hip injuries in much more detail. Research has noted the incidence of a torn Acetabular Labrum is much higher than previously thought. For instance, there is no recorded research that even mentions this injury in soccer until the late 1990’s. In the past, these injuries would have gone undiagnosed but now the diagnosis can be confirmed and, in many cases, repaired arthroscopically.

Hip Labrum Tear Signs & Symptoms

It’s vital to rule out the possibility of other structures mimicking a hip sports injury. Injuries such as disc herniation, pulled muscles, spinal joint damage and sciatica may manifest similarly to a hip injury.

A history of twisting on a weight bearing hip during sport is common. The onset of pain is immediate and is usually located at the front of the hip joint. As with all hip problems, the pain may become diffuse and difficult to pinpoint. It is not possible to see swelling, although the inflamed joint may become larger in volume because of an ‘effusion’ due to trauma. If the front of the hip joint is affected there may be a pinching sensation when the person flexes the hip by bringing the knee up to the chest. The pain may be reproduced in sport during activities that require weight bearing and twisting – i.e. kicking a football or playing Golf.

It may be possible to see the injury using a CT or MRI Arthrogram. These scans are done after a contrast medium has been injected into the joint to highlight the damaged Labrum. The injury is not always visible on a straightforward MRI scan or CT scan.

Hip Labrum Tear Treatment

Help is now at hand with more and more surgeons learning the arthroscopic technique for the hip, a procedure that can be performed on an outpatient basis. Although a general anaesthetic is used, a stay in hospital is not usually necessary. A tear in the Labrum can be seen and trimmed using the arthroscope, with the whole procedure taking less than an hour.

Following surgery, the patient will be taught how to use crutches and will remain on these for four or five days. This is purely precautionary because of the load bearing nature of the hip joint.

Rehabilitation

Once the ‘portals’ where the arthroscope is inserted have healed, the patient can begin rehabilitation. Unfortunately many patients are still exposed to the dated form of rehabilitation involving stretchy band exercises.  The fundamental flaw with this approach being of course patients’ compliance – the exercises are boring and people just don’t do them!

So what do we do at The North Wales Spine Clinic that’s different?

Firstly, we have to ask why the hip sports injury happened in the first place.  Aside from severe direct trauma research now suggests that errors in control of movement on a repetitive basis causes gradual damage to our soft tissues (hip labrum).  We need to re-educate this movement control problem otherwise we see relapse.

Secondly, we need to get the joint moving in a safe but effective way. Using specific and effective evidence based neuromobilisation procedures we see not only motion increase in the hip joint but also motor or muscular control improve.

Thirdly, by putting progressive, carefully taught exercises that continually challenge the stability and mobility of the hip joint our overall control improves.  The aim here is to train the whole body to coordinate movement as one unit, not as a series of parts. When moving the human body is a chain – a system that works together.

In summary, diagnosis of hip pain is vital.  Often the mode of onset is a factor in the early diagnosis. Once a working diagnosis is established imaging as described above may be used to identify the damaged tissue.  If surgical intervention is deemed necessary correct rehabilitation is vital to long term resolution.  Dated forms of rehabilitation are now often found wanting when looking long term for good outcomes for the patient with a sports injury such as hip labrum tear.

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