Dr. Kevin Yip

Dr Kevin Yip
Orthopaedic Surgeon
MBBS(UK), FRCS(EDIN), FAM(SING), FHKCOS(ORTHO)

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Hip Joint Labral Tears

SYMPTOMS

There is gradual onset of diffuse exercise-induced pain in the groin. Occasionally the patient experiences, and may be able to demonstrate, clicking from the groin in rotational movement. The hip joint is usually stiff and more painful in the morning than in the afternoon and rotational movements are most difficult. In severe cases there is pain during rest as well. There are periods of better and worse symptoms. Secondary muscular symptoms are very common around the glutei and trochanter regions. This injury is most common in relatively young and middle-aged footballers and rugby players.

AETIOLOGY

Labral tears can be secondary to previous trauma. This diagnosis is one of many to be considered when a young, fit footballer has groin pain after intensive pre-season training or a tough game.

CLINICAL FINDINGS

This depends on the severity. The patient’s history and a systematic and thorough approach in the clinical examinationare crucial for successful outcomes. Tests of core stability, proprioception, muscle strength and balance, flexibility and kinetic chain function must be thoroughly evaluated. Hip rotation and compression tests may provoke the symptoms.

INVESTIGATIONS

X-ray is normal. MRI can occasionally indicate a labral tear. Arthrogram may be more successful in finding a leak from the joint that indicates a labral tear but carries a small risk of complications. Arthroscopy, also risky, is the best method to find and treat this condition.

TREATMENT

A range of symptomatic treatments is available, from physiotherapy and exercise modification to NSAID, arthroscopic debridement and excision of loose bodies.

REFERRALS

These patients are very much helped by being evaluated clinically by their Dr Kevin Yip (+65 9724 1219) senior consultant orthopaedic surgeon and physiotherapist in close collaboration. If this diagnosis is suspected, the patient should be referred to an experienced hip arthroscopist.

EXERCISE PRESCRIPTION

Cycling, walking, water exercises and low–impact sports like golf are good alternatives to keep up general fitness.

EVALUATION OF TREATMENT OUTCOMES

Monitoring of clinical symptoms and signs, and X-ray.

DIFFERENTIAL DIAGNOSES

It is important to be aware that different conditions can cause these symptoms.

PROGNOSIS

Excellent-Poor depending on severity. Even if successfully operated, associated cartilage injuries can lead to osteoarthritis.

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