Acetabular labrum

The acetabular labrum (glenoidal labrum of the hip joint or cotyloid ligament in older texts) is a ring of cartilage that surrounds the acetabulum of the hip. The anterior portion is most vulnerable when the labrum tears.Single Leg BridgeSide Leg RaiseSingle Leg BalanceIn A), Stretch of a right hip flexor, iliopsoas. Make sure your the weight bearing knee (left) does not go past your toes. You will want to lean forward for a good stretch and hold it for about 15 to 20 seconds.In B), this will be your starting position for the side lying hip abduction. You will want to be in a comfortable position. Slowly lift the top leg (right) straight up. Perform one set of 10 repetitions.This man is doing a body weight squat. There are no added weights to his body, allowing him to warm up his legs properly. This is a great way to induce 'creep' in the cartilage and muscles to prepare for intense exercise.Strain vs. Time graph for the three stages of creep. Strain slowly rises up and almost becomes constant from a constant stress on a viscoelastic material. Like your cartilage, it will deform or strain, from constant stress. The strain deformation is slow, but eventually too much stress will increase it. The acetabular labrum (glenoidal labrum of the hip joint or cotyloid ligament in older texts) is a ring of cartilage that surrounds the acetabulum of the hip. The anterior portion is most vulnerable when the labrum tears. It provides an articulating surface for the acetabulum, allowing the head of the femur to articulate with the pelvis. It is estimated that 75% of acetabular labrum tears have an unknown cause. Tears of the labrum have been credited to a variety of causes such as excessive force, hip dislocation, capsular hip hypermobility, hip dysplasia, and hip degeneration. A tight iliopsoas tendon has also been attributed to labrum tears by causing compression or traction injuries that eventually lead to a labrum tear. Most labrum tears are thought to be from gradual tear due to repetitive microtrauma. Incidents of labrum tears increase with age, suggesting that they may also be caused by deterioration through the aging process. Labrum tears in athletes can occur from a single event or recurring trauma. Running can cause labrum tears due to the labrum being used more for weight bearing and taking excessive forces while at the end-range motion of the leg: hyperabduction, hyperextension, hyperflexion, excessive external rotation. Sporting activities are likely causes, specifically those that require frequent lateral rotation or pivoting on a loaded femur as in hockey or ballet. Constant hip rotation places increased stress on the capsular tissue and damage to the iliofemoral ligament. This in turn causes hip rotational instability putting increased pressure on the labrum. Traumatic injuries are most commonly seen in athletes who participate in contact or high impact sports like football, soccer, or golf. The prevalence rate for traumatic hip injuries that causes a tear of the labrum is very low. Less than 25% of all patients can relate a specific incident to their torn labrum, however they are often a result of a dislocation or fracture. Falling on one’s side causes a blunt trauma to the greater trochanter of the femur. Since there is very little soft tissue to diminish the force between the impact and the greater trochanter, the entire blow is transferred to the surface of the hip joint. And since bone density does not reach its peak until the age of 30, hip traumas could result in a fracture. Tears of the hip labrum can be classified in a variety of ways, including morphology, etiology, location, or severity. Anatomical modifications of the femur and or hip socket cause a slow buildup of damage to the cartilage. Femur or acetabular dysplasia can lead to femoral acetabular impingement (FAI). Impingement occurs when the femoral head rubs abnormally or lacks a full range of motion in the acetabular socket. There are three different forms of FAI. The first form is caused by a cam-deformity where extra bone is present on the femoral head, which leads to the head being non-spherical. The second deformity is referred to as a pincer deformity and it is due to an excess growth of the acetabular socket. The third type of FAI is a combination of the first two deformities. When either abnormality is present, it changes the position that the femoral head occupies in the hip socket. The increased stresses that the femur and or acetabulum experience may lead to a fracture of the acetabular rim or a detachment of the overstressed labrum. In the United States acetabular labrum tears usually occur in the anterior or anterior-superior area, possibly due to a sudden change from labrum to acetabular cartilage. The most common labrum tears in Japan are in the posterior region, likely due to the customary practice of sitting on the floor. Posterior labrum tears in the Western world usually occur when a force drives the femoral head posteriorly which transfers shear and compressive forces to the posterior labrum. With physical therapy, there is only a small amount of evidence on rehabilitation techniques for the acetabular labrum.It is even thought that physical therapy could be controversial due to there not being any evidence of a specific effective therapy routine.There are, however, some studies that report physical therapy could benefit the patient by bringing them back to “sports-ready” capabilities.It is advised that physical therapists keep up on the new findings and stay in close contact with the orthopaedic surgeon so they have the best idea of how to approach their patient’s case.Following surgery, crutches will be used for up to six weeks and there should be no expectation to return to activities such as running for at least a period of six months. Some things to note when rehabilitation occurs is that it is important to know the size and placement of the tear. There are usually four phases in the rehabilitation process noted as: “Phase I – initial exercises (weeks 1-4), Phase II – intermediate exercises (weeks 5-7), Phase III – advanced exercises (weeks 8-12), and Phase IV – return to sports (weeks 12+)”.All physical therapy regimens should be individualized from person to person based on all adequate criteria In phase I of the rehabilitation process the first objective is to minimize the pain and inflammation. It is important to begin conducting small motion exercises that have up to 50% weight bearing capacity by the patient. A symmetrical gait pattern is imperative as not to create an imbalance in the muscles of the hip. Aquatic therapy is highly encouraged and looked upon due to its ability to help the patient move more freely without the pressure of gravity. To progress to phase “II” of the rehabilitation process patients should be able to complete straight leg raises while lying on their side to strengthen the sartorius and tensor fasciate latae muscles to build support in the leg.