India-OrthCompiled by Dr Satyam Patel through Collaborative Authorship Program
Labral tears , one of the most important cause of persistent hip pain and often misdiagnosed or undiagnosed condition due to less awareness of this problem. Labral detachments and tears are most common in atheletes or due to abnormal hip conditions..As it’s a soft tissue condition , it is difficult to appreciate on an xray and that one requires a good mri especially with contrast material injected in the hip joint which can easily traverse through the tear and delineate it.The dilemma is that many a times abnormal picture of labrum is seen in asymptomatic people and that has to be clinically correlated.The other peculiar thing is that studies have found even absent labrum in normal people as well as appearance of sulcus at the anterosuperior acetabular junction, now the importance of these two conditions arises only if the subject is symptomatic otherwise not.
There occurs a big dilemma in evaluating patients with chronic persistent mechanical hip pain.There are wide possibilities such as common entities like osteoarthritis, fracture, and avascular necrosis, as well as less common entities including pigmented villonodularsynovitis, synovial osteochondromatosis, snapping hip syndrome, and hemorrhage into the ligamentumteres.[11] .Xrays in all above condition appear normal. To diagnose a cause of hip pain one needs good contrasted mri and one study revealed that patients had to suffer on an average for 2 years or so before the diagnosis got established[11].Also in one study patients in whom hip arthroscopy was done , 55% revelaed one or other form of labral tears or detachment as a caused of persistent mechanical hip pain.
The usefulness of M R Arthrography is outstanding as not only it reveals brilliantly labral tears but as well as other hip abnormalities of cartilage, synoviumetc.
Figure 3. showing mri normal anatomy
:Normal anatomy in a 40 year old man with chronic hip pain is depicted on T1-weighted MR images obtained with intraarticular contrast material Axial MR image demonstrates the normal triangular cross section of the anterior and posterior labrum (arrowheads), small perilabral sulci (short arrows), and cross section of ligamentum teres (long arrow).
Figure 4. showing MRI transverse ligament
Sagittal MR image along the medial joint includes the transverse ligament (arrowheads).
Figure 5. Normal coronal Mri hip image at midline level
Midline coronal MR image shows the long axis of the ligamentum teres (short arrow) and its insertion onto the transverse ligament (long arrow). A normal superior labrum (curved arrow) and the larger superior perilabral recess (arrowhead) are seen..
Figure 6. Normal posterior coronal mri image
On a more posterior coronal MR image, the circular fibers of the zona orbicularis (arrowheads) are evident, as are the longitudinal fibers of the iliofemoral ligament (short arrow). A cleft is seen where the transverse ligament and labrum start to merge (long arrow). [12]
Figure 7. ilipsoas bursitis
Hip pain of unknown cause in a 45-year-old active man. Fat-suppressed T1-weighted axial MR image obtained with intraarticular contrast material demonstrates filling of the iliopsoas bursa (arrows) both medial and lateral to the tendon (*). [13]
Figure 8. Torn labrum
Extensive labral tear in a 38-year-old woman who is an avid runner. T1-weighted axial MR image depicts contrast material throughout the labral substance. The labrum is enlarged and maintains its triangular shape (arrowheads). An extensive linear intralabral collection of contrast material is present (short arrow). Communication between the joint and the iliopsoas bursa is evident (long arrow).
