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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 acetabu lar cartilage <ref>Smith, M., Panchal, H., Ruberte, R., & Sekiya, J. (2011). Effect of acetabular labrum tears on hip stability and labral strain in a joint compression model. The American Journal of Sports Medicine, 39, 103S-110S.</ref>. The most common labrum tears in Japan are in the posterior region, likely due to the customary practice of sitting on the floor <ref>Groh, M., & Herrera, J. (2009). A comprehensive review of hip labral tears. Current Reviews in Musculoskeletal Medicine, 2, 105-117.</ref>. 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 <ref>Groh, M., & Herrera, J. (2009). A comprehensive review of hip labral tears. Current Reviews in Musculoskeletal |
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 acetabu lar cartilage <ref>Smith, M., Panchal, H., Ruberte, R., & Sekiya, J. (2011). Effect of acetabular labrum tears on hip stability and labral strain in a joint compression model. The American Journal of Sports Medicine, 39, 103S-110S.</ref>. The most common labrum tears in Japan are in the posterior region, likely due to the customary practice of sitting on the floor <ref>Groh, M., & Herrera, J. (2009). A comprehensive review of hip labral tears. Current Reviews in Musculoskeletal Medicine, 2, 105-117.</ref>. 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 <ref>Groh, M., & Herrera, J. (2009). A comprehensive review of hip labral tears. Current Reviews in Musculoskeletal |
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Medicine, 2, 105-117.</ref>. |
Medicine, 2, 105-117.</ref>. |
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===Rehabilition=== |
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With physical therapy, there is only a small amount of evidence on rehabilitation techniques for the [[acetabular labrum]] <ref> Garrison, Craig J., Osler, Michael T., Singleton, Steven B. (2007). Rehabilitation after |
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Arthroscopy of an Acetabular Labral Tear. North American Journal of Sports Physical |
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Therapy. 2(4), 241-250. </ref> |
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It is even thought that physical therapy could be controversial due to there not being any evidence of a specific effective therapy routine <ref> Groh, Megan M. & Herrera, Joseph. (2009). A comprehensive review of hip labral tears. |
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Musculoskeletal Medicine. 2(2), 105-117. </ref> |
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There are, however, some studies that report physical therapy could benefit the patient by bringing them back to “sports-ready” capabilities <ref> Lewis, Cara L. & Sahrmann, Shirley A. (2006). Acetabular Labral Tears. Journal of the American |
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Physical Therapy Association. 86, 110-121. </ref> |
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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 <ref> Garrison, Craig J., Osler, Michael T., Singleton, Steven B. (2007). Rehabilitation after |
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Arthroscopy of an Acetabular Labral Tear. North American Journal of Sports Physical |
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Therapy. 2(4), 241-250. </ref> |
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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 <ref> Clohisy, John C. & McClure, Thomas. (2005). Treatment of Anterior Femoroacetabular |
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Impingement with Combined Hip Arthroscopy and Limited Anterior Decompression. |
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Iowa Orthopaedic Journal. 2, 164-171. </ref> |
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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+)” <ref> Garrison, Craig J., Osler, Michael T., Singleton, Steven B. (2007). Rehabilitation after |
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Arthroscopy of an Acetabular Labral Tear. North American Journal of Sports Physical |
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Therapy. 2(4), 241-250. </ref> |
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All physical therapy regimens should be individualized from person to person based on all adequate criteria <ref> Hunt, Devyani, Clohisy, John, Prather, Heidi. (2007). Acetabular Labral Tears of the Hip in |
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Women. Physical Medicine and Rehabilitation Clinics of North America. 18(3), 497-520. </ref> |
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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 laying on their side to strengthen the [[sartorius]] and tensor fasciate latae muscles to build support in the leg. |
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In phase “II” the physical therapist should be trying to promote more flexibility in the soft tissue. There should be more emphasis on the beginning aspects of [[strength training]] while adding some resistance over time. In order to progress to phase “III”, the patient should be able to demonstrate a normal gait pattern and minimal pain with exercises like the single leg bridging to help strengthen the hamstring muscles to help with leg equality. |
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In phase “III” the focus is to begin building functional strength. Movements should include single leg exercises to build the muscle and challenge the strength of the hip. |
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In order to progress to phase “IV” the flexibility of the patient should be adequate. Phase IV is the final stage in which the physical therapist would assess and prescribe any further exercise up until the patient is ready to return to the sport <ref> Garrison, Craig J., Osler, Michael T., Singleton, Steven B. (2007). Rehabilitation after |
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Arthroscopy of an Acetabular Labral Tear. North American Journal of Sports Physical |
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Therapy. 2(4), 241-250. <ref/> |
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Usually the therapist would start using complex movements like [[squatting]], kicking, and running. The therapist would look for symmetrical movements on both sides of the body without pain. If the patient demonstrates the symmetrical movements without pain, the physical therapist would use their discretion for the patient’s clearance. |
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Some things to avoid from while rehabilitating are sitting with “knees lower than the hips, legs crossed where hip is rotated, and sitting on the edge of the seat and contracting the hip flexor muscles <ref> Lewis, Cara L. & Sahrmann, Shirley A. (2006). Acetabular Labral Tears. Journal of the American |
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Physical Therapy Association. 86, 110-121. </ref> |
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[[File:Single Leg Bridge.jpg|thumb|Single Leg Bridge]] |
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[[File:Side Leg Raise.jpg|thumb|Side Leg Raise]] |
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[[File:Single Leg Balance.jpg|thumb|Single Leg Balance]] |
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=Etiology= |
=Etiology= |
Revision as of 22:57, 21 November 2013
Acetabular labrum | |
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Details | |
Identifiers | |
Latin | labrum acetabuli |
TA98 | A03.6.07.008 |
TA2 | 1880 |
FMA | 43521 |
Anatomical terminology |
The acetabular labrum (glenoidal labrum of the hip joint or cotyloid ligament in older texts) is a ring of cartilage that surrounds the acetabulum (the socket of the hip joint). The anterior portion of the labrum is most vulnerable when the labrum tears.
Its function is to deepen the acetabulum, making it more difficult for the head of the femur to slip out of place (subluxation of the femur).
Regional
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 acetabu lar cartilage [1]. The most common labrum tears in Japan are in the posterior region, likely due to the customary practice of sitting on the floor [2]. 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 [3].
Rehabilition
With physical therapy, there is only a small amount of evidence on rehabilitation techniques for the acetabular labrum [4] It is even thought that physical therapy could be controversial due to there not being any evidence of a specific effective therapy routine [5] There are, however, some studies that report physical therapy could benefit the patient by bringing them back to “sports-ready” capabilities [6] 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 [7] 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 [8]
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+)” [9] All physical therapy regimens should be individualized from person to person based on all adequate criteria [10]
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 laying on their side to strengthen the sartorius and tensor fasciate latae muscles to build support in the leg.
In phase “II” the physical therapist should be trying to promote more flexibility in the soft tissue. There should be more emphasis on the beginning aspects of strength training while adding some resistance over time. In order to progress to phase “III”, the patient should be able to demonstrate a normal gait pattern and minimal pain with exercises like the single leg bridging to help strengthen the hamstring muscles to help with leg equality.
In phase “III” the focus is to begin building functional strength. Movements should include single leg exercises to build the muscle and challenge the strength of the hip.
In order to progress to phase “IV” the flexibility of the patient should be adequate. Phase IV is the final stage in which the physical therapist would assess and prescribe any further exercise up until the patient is ready to return to the sport Cite error: A <ref>
tag is missing the closing </ref>
(see the help page).
Etiology
Traumatic injuries are most commonly seen in athletes who participate in contact or high impact sports like football, soccer, or golf [11]. 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 [12]. 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 [13]. And since bone density does not reach its peak until the age of 30, hip traumas could result in a fracture [14].
Anatomical modifications of the femur and or hip socket cause a slow build up of damage to the cartilage. Femur or acetabular dysplasia can lead to femoral acetabular impingement also known as FAI [15]. Impingement occurs when the femoral head rubs abnormally or its lacks a full range of motion in the acetabular socket [16]. There are 3 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 [17]. The second deformity is referred to as a pincer deformity and it is due to an excess growth of the acetabular socket [18]. The third type of FAI is a combination of the first two deformities. When either abnormality is present, it changes the position the femoral head sits 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 [19].
See also
Rehabilitation
There are four phases of rehab for Acetabular labrum phase I: initial, phase II: Intermediate, Phase III: Advanced, Phase IV: Sports Specific. Phase I: Initial stage lasts for about four to six weeks. It mainly focuses on not getting the repaired tissue damaged again; as well as controlling inflammation and pain and restoring the range of motion. In order to move on to the next phase there are basic requirements that needed to be met, such as weight bearing. In the initial phase the PT are more cautious with exercises since it is an early stage and pain occurs as well as damages may re-occur. There are recommended precautions that PT needs to pay close attention to such as avoiding hip flexors. The exercises that are done during this stage in Physical therapy are: upright bike riding, ankle pumps, towel slides, and lying quadruped rocking and standing IR/ER with chair [1] Physical therapy includes isometrics for the leg and hip examples are quad sets and hamstring sets, other kinds of exercises could be used as leg raises such as abduction, adduction and hip extension, side lying clamshells, double leg bridges, and leg press, that is done in the sixth week [2]
Phase II: Intermediate that starts during the fourth or the sixth week after surgery is done. The purpose of this stage is to protect the tissue that was repaired; and restore range of motion and gait pattern, as well as increasing muscle strength [3]. In this stage PT continue the same exercises from phase I, and adding some more exercises that would be helpful for rehab. The exercises are bilateral squats, side stepping, as well as ¼ lunges. There should be an awareness of putting a lot of load on the hip to limit that, the exercises are done within the frontal and the sagittal planes only. Manuel PT usually pays close attention on soft tissue management of anterior hip musculature. In this stage the patient might be able to exercise at home by summing Phase I and II exercises [4].
Phase III: advanced this stage focuses on muscle strengthening and cardiovascular endurance. This stage usually starts from week six to week eight and it is a continuing stage of the two previous stages. This stage includes hip flexion but it still depends on the patient degree of pain and healing. In this stage there are kinds of exercises that should be avoided such as:treadmill and contact sports. Exercises in this stage are: single leg exercises [5].
Phase IV: sports specific this is the final stage of rehab so the patient should be close to being able to go to normal activities with no complications. This is a continuing stage and final so high levels of exercises are present in this stage. This stage starts between the eighth and the sixteenth week. This stage includes hip flexion, it has less restrictions or actually no restriction depending on the status of the patients. This stage includes low level of plyometric such as multidirectional agility drills, circuit training, and jumping rope. After this stage the patient is discharged but he comes back to PT for follow up for about one month, the patient then reports that there is no pain. Patients by that time should be able to lift weight and no pain occurs. After that, there are four month follow up, if the patient is sure that they are free from any pain which doing their activities and there is nothing that restricts them from exercising. There is a test that is done in this last follow up to make sure that everything went to normal and hip flexion is not challenging [6].
- ^ Smith, M., Panchal, H., Ruberte, R., & Sekiya, J. (2011). Effect of acetabular labrum tears on hip stability and labral strain in a joint compression model. The American Journal of Sports Medicine, 39, 103S-110S.
- ^ Groh, M., & Herrera, J. (2009). A comprehensive review of hip labral tears. Current Reviews in Musculoskeletal Medicine, 2, 105-117.
- ^ Groh, M., & Herrera, J. (2009). A comprehensive review of hip labral tears. Current Reviews in Musculoskeletal Medicine, 2, 105-117.
- ^ Garrison, Craig J., Osler, Michael T., Singleton, Steven B. (2007). Rehabilitation after Arthroscopy of an Acetabular Labral Tear. North American Journal of Sports Physical Therapy. 2(4), 241-250.
- ^ Groh, Megan M. & Herrera, Joseph. (2009). A comprehensive review of hip labral tears. Musculoskeletal Medicine. 2(2), 105-117.
- ^ Lewis, Cara L. & Sahrmann, Shirley A. (2006). Acetabular Labral Tears. Journal of the American Physical Therapy Association. 86, 110-121.
- ^ Garrison, Craig J., Osler, Michael T., Singleton, Steven B. (2007). Rehabilitation after Arthroscopy of an Acetabular Labral Tear. North American Journal of Sports Physical Therapy. 2(4), 241-250.
- ^ Clohisy, John C. & McClure, Thomas. (2005). Treatment of Anterior Femoroacetabular Impingement with Combined Hip Arthroscopy and Limited Anterior Decompression. Iowa Orthopaedic Journal. 2, 164-171.
- ^ Garrison, Craig J., Osler, Michael T., Singleton, Steven B. (2007). Rehabilitation after Arthroscopy of an Acetabular Labral Tear. North American Journal of Sports Physical Therapy. 2(4), 241-250.
- ^ Hunt, Devyani, Clohisy, John, Prather, Heidi. (2007). Acetabular Labral Tears of the Hip in Women. Physical Medicine and Rehabilitation Clinics of North America. 18(3), 497-520.
- ^ Groh, Megan M., and Joseph Herrera. "A Comprehensive Review of Hip Labral Tears." Curr Rev Musculoskeletal Med. 2.2 (2009): 105-117. Web. 16 Oct. 2013
- ^ Mason, J. Bohannon MD. "Acetabular Labral Tears In The Athlete." Clinics In Sports Medicine. 20.4 (2001): 779-788. Web. 16 Oct. 2013.
- ^ Byrd, J.W. Thomas. "Lateral Impact Injury." Clinics In Sports Medicine. 20.4 (2001): 801-815. Web. 16 Oct. 2013
- ^ Byrd, J.W. Thomas. "Lateral Impact Injury." Clinics In Sports Medicine. 20.4 (2001): 801-815. Web. 16 Oct. 2013
- ^ Rahman, Abdel, Sathish Rajasekaran, and Haron Obaid. "MRI Morphometric Hip Comparison Analysis of Anterior Acetabular Labral Tears." Skeletal Radiol. (2013): 1246-1252. Web. 17 Oct. 2013
- ^ Rahman, Abdel, Sathish Rajasekaran, and Haron Obaid. "MRI Morphometric Hip Comparison Analysis of Anterior Acetabular Labral Tears." Skeletal Radiol. (2013): 1246-1252. Web. 17 Oct. 2013
- ^ Groh, Megan M., and Joseph Herrera. "A Comprehensive Review of Hip Labral Tears." Curr Rev Musculoskeletal Med. 2.2 (2009): 105-117. Web. 16 Oct. 2013
- ^ Groh, Megan M., and Joseph Herrera. "A Comprehensive Review of Hip Labral Tears." Curr Rev Musculoskeletal Med. 2.2 (2009): 105-117. Web. 16 Oct. 2013
- ^ Groh, Megan M., and Joseph Herrera. "A Comprehensive Review of Hip Labral Tears." Curr Rev Musculoskeletal Med. 2.2 (2009): 105-117. Web. 16 Oct. 2013