Labrum

Question 1

Labrum ring is completed by ___

Answer 1

Transverse Lig

Question 2

Anterior half collagen

Answer 2

Thin
Parallel fibers

Question 3

Posterior half collagen

Answer 3

Thick
Perpendicular fibers

Question 4

Vascularization

Answer 4

outer 3rd

Question 5

Functions of labrum

Answer 5

Increase joint depth
Stabilize
Increase congruency
Protect articular cartiliage

Question 6

How are labral tears classified?

Answer 6

Directional: A vs P
Physical Location: at articular cartilage vs within substance

Question 7

Labral tear at articular cartilage

Answer 7

Labrum detaches from articular surface.
Advanced tear = cartilage detaches from bone.

Question 8

Labral tear within substance

Answer 8

Perpendicular thru the plane of the labrum

Question 9

Risk factors for labrum tear

Answer 9

FAI
Trauma
Hypermobility/laxity
DDH
Degeneration

Question 10

What types of trauma increase risk of labrum tear?

Answer 10

Femoral head dislocation or subluxation

Question 11

Hypermobility & capsular laxity can result from what?

Answer 11

Underlying disorders, hormone influences.
Abnormal loading in ER - kicking/twisting sports.

Question 12

What is FAI?

Answer 12

Compression of anterior-superior labrum.
Compressed btwn acetabulum & anterior femoral neck.

Question 13

Causes of FAI

Answer 13

Congenital
Acquired from sport

Question 14

CAM FAI

Answer 14

Most common type of FAI.
Bony overgrowth of femoral neck.
Direct impingement of femoral head on labrum = shear force btwn labrum & articular cartilage.

Question 15

Pincer FAI

Answer 15

Overhang of anterior-superior rim of acetabulum

Question 16

Isolated traumatic MOI

Answer 16

HyperABD
Twisting
Falling
MVA
Dislocation

Question 17

Repetitive microtrauma MOI

Answer 17

Sports involving ER and hyperext (hockey, soccer, ballet, golf)

Question 18

Symptoms

Answer 18

C Sign
Clicking, catching, instability.
Pain: groin & anterior hip. Constant dull w/ episodes of sharp.
Aggs: sitting, STS, descending stairs.
Night pain: lying on affected side, or innominate rotation.

Question 19

Functional limitations

Answer 19

Antalgic gait
Stairs
Sitting or walking for extended time
Pivoting/rotation activities
Impact (running, jumping)

Question 20

Gait

Answer 20

Prolonged foot flattening
Decreased knee flex at heel strike
Hip hyperext & ER

Question 21

Posture

Answer 21

Swayback or Lower Crossed

Question 22

ROM

Answer 22

Limited ER/IR, flexion, add/ABD.
Pain at end-range FADIR.
Pain moving from flex to ext.

Question 23

MMT

Answer 23

Weak flexion & adduction

Question 24

Pt education: avoid what activities?

Answer 24

Crossing legs
Pelvic rotation during STS
Hyperextension during gait or exercise
High impact exercise

Question 25

Optimize biomechanical alignment by controlling...

Answer 25

Force from glutes (ext). Force from iliopsoas (flex).

Question 26

Other PT treatment options

Answer 26

PNF Aquatics (once wounds healed if post-op)

Question 27

Indications for surgery

Answer 27

FAI Conservative tx not improving s/s

Question 28

Contraindications for surgery

Answer 28

Significant OA Uncorrected DDH Asymptomatic

Question 29

Potential complications during surgery

Answer 29

Traction-related injury Portal placement Chondral/labral damage Instability Inadequate correction of FAI

Question 30

Potential complications post-op

Answer 30

Excess fluid Femoral neck fx AVN HO

Question 31

Surgical procedure options

Answer 31

Debridement Repair Reconstruction

Question 32

Debridement

Answer 32

Arthroscopic Part of labrum removed. Good for immediate relief but worst long-term outcomes. Increased risk of OA (like meniscectomy).

Question 33

Repair

Answer 33

Arthroscopic Performed if labral tissue is adequate. Better outcomes, prevents degeneration & maintains stability. Looped Repair (for small) or Labral Base Re-Fixation (for large).

Question 34

Reconstruction

Answer 34

Open or Arthroscopic Performed if repair too difficult or previous debridement cannot be repaired. Graft from ITB, Ligamentum Teres Capitis, Gracilis.

Question 35

Reconstruction: allograft vs autograft, which has better outcomes?

Answer 35

Allograft - less prone to fraying/swelling.

Question 36

Reconstruction: open vs arthroscopic, which has better outcomes?

Answer 36

Arthro - less scar, less risk of infect, less post-op pain.