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American Journal of Physical Medicine & Rehabilitation:
doi: 10.1097/PHM.0b013e31811623d5
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An Underestimated Culprit of Groin Pain: Acetabular Labrum Tear

Malas, Fevziye Ünsal MD; Kara, Murat MD; Kerimoğlu, Ülkü MD; Özçakar, Levent MD

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From the Departments of Physical Medicine and Rehabilitation (FÜM, MK, LÖ) and Radiology (ÜK), Hacettepe University Medical School, Ankara, Turkey.

All correspondence and requests for reprints should be addressed to Levent Özçakar, Yeni Ankara sokak 27/1, Cebeci, Ankara, Turkey.

A 41-yr-old woman was seen for her complaint of right groin pain that had persisted for 1 yr. She felt hip pain as she changed leg positions, and the pain radiated toward her knee when she stood for a long time. She did not have low-back pain, numbness, or tingling in her right lower limb. Her medical history was otherwise noncontributory.

On physical examination, she had painful, limited range of motion during external rotation of her right hip joint. Neurological examination of the lower extremities was unremarkable. Radiologic evaluation of the hip joints was inconclusive. Thereafter, magnetic resonance imaging of the right hip was performed, and it was consistent with a partial tear of the anterior labrum with a perilabral cyst (Fig. 1). She was then given analgesics and a home-based exercise regimen for strengthening the hip muscles. On a control visit after 2 mos, she was found to have improved.

Figure 1
Figure 1
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The clinical presentation of a labral tear of the acetabulum may be variable, and the diagnosis is often delayed; moreover, it has received little attention in the relevant literature. Patients usually suffer moderate to severe pain (86%), predominating in the groin region (92%), and the mean time from the onset of symptoms to diagnosis has been reported to be 21 mos.1 More importantly, these patients are seen by a mean of 3.3 healthcare providers before the definitive diagnosis, and even surgery on another anatomic site has been recommended in 17%.1 Magnetic resonance imaging seems to be the most accurate noninvasive method of depicting not only the labral tear but also concomitant pathologies—in our case, a paralabral cyst. We conclude that in patients with groin pain—with or without a history of trauma—hip labral pathologies should be considered, especially if dislocation of the hip, any sports injury, dysplastic hip, Legg–Calve–Perthes disease, or osteoarthritis are present.2

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REFERENCES

1. Burnett RS, Della Rocca GJ, Prather H, Curry M, Maloney WJ, Clohisy JC: Clinical presentation of patients with tears of the acetabular labrum. J Bone Joint Surg Am 2006;88:1448–57

2. Cotten A, Boutry N, Demondion X, et al: Acetabular labrum: MRI in asymptomatic volunteers. J Comput Assist Tomogr 1998;22:1–7

© 2007 Lippincott Williams & Wilkins, Inc.

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