Case Study – Hip Labral Tear (Impingement)

March 22, 2014 | By | Reply READ MORE...

– Dr. Niriksha Khasgiwala

CASE:

40 year old Swati Mehta (name changed) was referred to Physio Rehab by a friend because she had complaints of

  • Sudden onset of pain in the right groin radiating to the right front thigh and marked limping since 1 month (Oct 2013)
  • No associated history of fall/trauma. Was out on a vacation while walking one morning the pain started)
  • Right leg felt heavy (because of lack of strength)
  • Pain was pulling in nature
  • At rest intensity 0/10 on activity 5/10
  • Had to give up regular walks completely due to severe pain
  • Attempt to sit cross leg used to give sudden shooting pain in the groin (due to restriction of motion as well)

Hip Labral Tear (Impingement)

 

Hip Labral Tear (Impingement)

 

AGGRAVATING FACTORS:

  • Walking 15 minutes
  • Rotatory movement at the hip
  • Jerky movement of hip or knee
  • Crossed leg sitting
  • Squatting

RELIEVING FACTORS:

  • Rest

LIFESTYLE:

  • An architect by profession and a very fitness conscious person.
  • Yoga thrice/week and weight training in the gym the other three days.
  • Loves Walking everyday.

EVALUATION:

  • Thin/lean built lady with slightly prominent hip bone
  • Sway back posture
  • On palpation tender in the groin area and the right hip joint
  • Right hip joint contour slightly more bulging
  • Inward rotation of the hip painful
  • Outward rotation of the hip restricted and painful
  • Lower limb strength reduced Right weaker than left
  • Difficulty in balancing on the right leg when stands on right leg
  • Squatting painful
  • Walks with a waddle

VIST TO ORTHOPAEDIC:

  • She visited a Orthopaedic who asked her to do an X-Ray and MRI scan which revealed Labral tear
  • She was advised Conservative Management and Physiotherapy

INVESTIGATIONS:

  • Xray: Revealed Pincer and Cam (Bony outgrowths or spur from the socket and head respectively)

Hip Labral Tear (Impingement)
Hip Labral Tear (Impingement)

 

  • MRI: Anterior (Front) Labral Tear (Labrum: Ring of cartilage that surrounds the socket of the hip joint. Its function is to deepen the socket & prevent the head of the femur (thigh bone) to slip out of socket)

Hip Labral Tear (Impingement)

 

 

After a thorough evaluation we created a tailor made Rehab programme for her.

PLAN OF CARE:

  • Pain Management with Ultrasound and cold pack to reduce inflammation
  • Hip Intrinsic training(small muscles around the ball and socket Hip joint similar to rotator cuff around the shoulder joint) + Gluteus (Buttock muscle) Strengthening

– Hip Intrinsic work
Hip Labral Tear (Impingement)
– Buttock muscle + Lower leg strengthening
Hip Labral Tear (Impingement)
– Short lever exercises to start with
Hip Labral Tear (Impingement)
– Graduated Long lever lower limb strengthening
Hip Labral Tear (Impingement)
– Progress with resisted exercises and in standing
Hip Labral Tear (Impingement)
– Balance training on floor & unstable surfaces to challenge
Hip Labral Tear (Impingement)
– Gradual return to walking
Hip Labral Tear (Impingement)
– Core and Oblique muscle strengthening
Hip Labral Tear (Impingement)

 

  • We started the Rehab in end of November 2013 twice/week for 2 weeks within which her pain subsided marginally except for jerky movements and then just once per week for 4 weeks for strengthening.
  • Now she comes once in 15-20 days for revision under supervision and progression of exercises and is doing almost all her activities as earlier.
  • Was apprehensive about crossed leg sitting as it still gave some discomfort but in mid February 2014 she achieved this final goal too.
  • Return to crossed leg sitting and Yoga

PATIENT SPEAK:
“I was surprised when I could sit cross legged without pain as I had lost hopes because of the shooting pain which I went through and was always worried about the tear!”

PHYSIO SPEAK:

“Hip Injuries and Labral tears are very common but tha fact is that they are very commonly missed during the diagnosis as well. People who are more prone to these hip conditions are dancers, hyper-flexible people like yoga teachers, footballers and various other sports people who are involved in high impact activities. It is important to treat these hip injuries in the initial stage to prevent hip movements from getting restricted by working on the muscle imbalances and thus making the joint more stable.”

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Category: Case Studies

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