Dr. Greene explains Labral Tears diagnosis & treatment options

ShoreOrtho Sports Performance & Injury Prevention Tips

A Monthly Blog Series
presented by:
Damon A. Greene, MD
Board Certified Orthopaedic Surgeon
Shore Orthopaedic University Associates
October 2020

LABRAL TEARS
ANATOMY
The hip acts as foundation and pivot point for the entire body joining the upper and lower halves. It is just as important for walking as it is for core strength and supporting the upper body.

The hip is a ball and socket joint. The head of the ball (femoral head) fits into the socket (the acetabulum). If you imagine a cup the labrum is a thick ring of cartilaginous tissue that surrounds the top of the cup. The labrum has many functions from shock absorber but is two main functions are to confer increased stability to the cup and provide semi airtight seal that helps to keep the synovial fluid in the joint which provides lubrication between the femoral head and acetabulum. The labrum has also been shown to have a collection of nerves and sensory organs which can signal pain if the labrum is damaged. The blood supply to the labrum is very limited which unfortunately limits its ability to heal.

SYMPTOMS
Labral tears are difficult to diagnose, partially because of the many muscles and other structures that are near the hip joint. They are often misdiagnosed as common groin strains and it is not uncommon for the diagnosis to be missed for many months after the labrum is torn

Labral tears are common in athletes and occur when the collagen rips. There are many symptoms of a labral tear. The main symptoms are hip and groin pain. However other symptoms include:

1. Pain
2. “Catching” feeling in the hip
3. Decreased strength
4. Decreased range of motion
5. Locking of the hip
6. Stiffness

DIAGNOSIS
Since the diagnosis is difficult a clinical exam by a sports medicine physician or an orthopedic surgeon is the first step. Once the exam is complete the physician may order the following imaging tests:

1. X-Rays: X-rays show if there are any problems with the bones such as femeroacetabuluar impingement or osteoarthritis.
2. MRI Arthrogram: This test better evaluates the soft tissues around the hip including the labrum. 

NONSURGICAL TREATMENT
Hip labral tears can sometimes be treated with nonsurgical treatments. Below are some of the most common.

• Rest. Limited activity is advised to control discomfort, including the activities that bring on hip pain.
• NSAIDs. Taking non-steroidal anti-inflammatory drugs, such as aspirin or ibuprofen, for a limited period may reduce inflammation and pain in the hip area.
• Injections. A doctor may recommend local anesthetic fluid injections directly into the hip joint, called an intra-articular injection. A corticosteroid may be added to the injection depending upon the level of hip pain and any other existing hip problems.
• Physical Therapy. The plan may focus on strengthening the buttocks, thigh, and back, while also improving hip stability. Individuals should consult their doctor before beginning any physical therapy regimen

SURGICAL TREATMENT
If nonsurgical treatments are not recommended, or if they have been tried and do not relieve the hip pain, surgery may be suggested. The type of procedure that will be performed is dependent upon the severity of the tear.

Most surgical options for labral repair are minimally invasive, using a tool called an arthroscope. The arthroscope is about the size of a pencil and equipped with a tiny television camera, allowing the surgeon to view and repair the damaged labrum without having to make a large incision.

• Arthroscopic labral debridement. This technique involves trimming or smoothing the area of the labrum that is torn. This procedure may be recommended if the surgeon believes that a frayed labrum is causing symptoms or could cause future symptoms.
• Arthroscopic hip labral repair. This may be recommended when the labrum has separated from the bone. During a labral repair, the doctor will reattach the torn labrum to the hip’s socket (acetabulum) using small anchors.

Arthroscopic hip labral replacement. Labral replacement, sometimes called labral reconstruction, may be recommended when the labrum is too damaged to repair.

 

Dr. Greene is a Sports Medicine Fellowship-Trained, Board Certified Orthopaedic Surgeon. He specializes in; acute and chronic ligament, tendon, or cartilage injuries to all major joints; primarily shoulders, elbows, knees and hips. He treats fractures surgically when necessary, but performs casting, bracing, and other non-operative treatments such as specialized injection therapies.

The purpose of this blog series is to promote a broad understanding and knowledge of various health topics. It is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician with any questions you may have regarding a medical condition or treatment.

New knees, new hips–to go

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Our 2nd Annual Innovation Issue!
Same-day Joint Replacement Steps Up
Lola Butcher

Stephen J. Zabinski, MD
Shore Orthopaedic University

New knees, new hips–to go
Bundled payment is pushing providers to look for ways to control the cost of joint replacements. Is joint replacement going to become outpatient surgery?
If you want a hip or knee replaced by Stephen Zabinski, MD, a surgeon at Shore Orthopedics Associates in Somers Point, N.J., you’re in for some homework.
If you’re a smoker, that’s got to stop; there will be no surgery if you’re aren’t nicotine-free for at least six weeks. Patients with diabetes must get their HbA1c level under control. Those with sleep apnea must document they are using the CPAP machine as per doctor’s orders. Patients with a body mass index of 45 or more must take off some weight; Zabinski’s threshold is 40 if a patient has certain comorbidities. You may need to do strength and mobility training—so-called prehab—before surgery.

Shore Orthopedics offers support for all the to-do items, but the surgeon is not going to let you off the hook. Patients must sign a contract agreeing to comply with the practice’s “total joint pathway,” and they must designate a “total joint companion” who will help them recover but also hold them accountable for following the rules. In return, Zabinski promises to get them home quickly and avoid detours to a rehab facility. He operates on Medicare patients at Shore Medical Center; some get a same-day discharge while others stay 24 to 48 hours. Most patients younger than 65 never set foot in an inpatient facility.

Hip Mobility and the Golf Swing

By Christopher C. Hanson, PT, MPT, DMT, OCS, FAAOMPT

 

Most golfers are weekend warriors and if there is extra time in anyone’s schedule for golf activities, more times than not this is allocated to swing training.  As the last few articles have discussed, physical fitness is equally important.  In order to have a world class swing, the function of one’s musculoskeletal system also needs to be equipped. Golf is a sport that requires strength, power, coordination and mobility; no one of these is more important than the other. This weekly dive into the physical care of a golfer’s body will discuss the importance of hip mobility and stability in all golfers.

In the golf community the importance of spinal mobility and strength is well documented. There have been numerous social media campaigns since the start of this golf season showing new creative ways to improve spinal mobility and strength.  However, absent from these posts have been ways to improve hip strength and mobility; negating altogether the connection between the hip and the spine.

The hip and the spine are intricately related. If one has movement issues in one area, it can transmit increased forces along the kinetic (movement) chain.  In the presence of hip mobility issues the body increases motion in other joints.  The body is almost too good at this compensation and creating more (too much) movement in order to allow someone to function in a way that seems correct.  In the presence of limited hip mobility there may be an excessive forces through the lumbar spine. This can happen at different points in the swing.  Limited hip mobility can create issues in the back swing, during the initiation of swing and during the follow through. This also relates to other sporting activities as well.

Hip and Knee replacements move to outpatient-style mode

By BRIAN IANIERI
Staff Writer | Posted: Monday, September 1, 2014 

Hip and knee replacements have come a long way in Dr. Stephen Zabinski’s career as an orthopedic surgeon.

But one advancement is something unheard of 20 years ago — patients getting hip replacements in an ambulatory surgical center in the morning and returning home early in the afternoon.

This approach avoids possible days-long recoveries in a hospital and rehabilitation center, ultimately making it more cost effective for health care reform, he said.

Zabinski, vice president of Shore Orthopaedic University Associates, has performed these types of surgeries for more than three years and has been doing them at the Jersey Shore Ambulatory Surgical Center in Somers Point for about six months on certain patients.

“It really achieves all the goals we want to provide better care to patients in a safe way that’s more cost effective,” said Zabinski, who is the director of the Division of Orthopedic Surgery at Shore Medical Center and President of the Jersey Shore Ambulatory Surgical Center.

Gregory has become a trusted authority on hip replacement among family and friends!

Gregory Gregory, Somers Point, NJ
Hip Replacement
Physician: Stephen J. Zabinski, MD

Gregory’s Story: Update
Gregory has become a trusted authority on hip replacement among family and friends. He has few limitations and continues to enjoy “Stand Up” fishing, recently catching a 168 lb. tuna, hiking, deer hunting that involves climbing trees and spending lots of time with his three very active grandchildren, all under 10 years old.

Gregory’s first experience with Shore Orthopaedic University Associates was about six years ago when his nephew who played football for Mainland Regional High School went in for a hip flexor and he thought maybe that’s what he had. So he scheduled an appointment for himself, Dr. Zabinski took one look at Gregory’s X-ray and told him he needed a complete hip replacement. The doctor went on to show Gregory what a good and bad hip looked like. It was recommended to have the procedure done as soon as possible.