The labrum is a ring of specialized fibrocartilage lining the socket of ball-and-socket joints, such as the shoulder and the hip. This tissue deepens the joint socket, enhancing stability and maintaining the joint’s fluid seal. A labral tear involves damage to this cartilage, often occurring from acute trauma, repetitive movements, or underlying structural issues. Diagnosing a labral tear requires a structured, multi-step process integrating a thorough physical evaluation with advanced imaging technology.
Initial Assessment and History Review
The diagnostic process begins with a comprehensive patient interview to establish the history of the problem. The physician inquires about the mechanism of injury, such as a fall, twisting motion, or abrupt force, which suggests a traumatic tear. They also seek details on the onset, location, and nature of the pain, including whether it is a deep ache, sharp pain, or accompanied by mechanical symptoms like clicking, locking, or a catching sensation.
This initial assessment includes a broad physical check, observing the joint for visible swelling or deformity. The physician gently palpates the area to identify tenderness and performs a general range of motion assessment. Checking active and passive movement patterns helps to gauge overall joint function and stability. This initial data helps distinguish a potential labral tear from other common joint conditions, such as tendonitis or bursitis, before moving to specific tests.
Specific Physical Examination Maneuvers
Following the general assessment, the clinician performs specific orthopedic tests designed to provoke symptoms when the labrum is compromised. These maneuvers place the joint in positions that apply stress or tension to the torn cartilage, which can elicit pain or a mechanical response. Since labral tears occur in both the shoulder and hip, the exam includes region-specific movements.
For the shoulder, the O’Brien Test (Active Compression Test) is commonly used to evaluate the superior labrum. The patient holds the arm straight out at 90 degrees, angled slightly across the body, with the thumb pointing down (internal rotation). The examiner applies a downward force while the patient resists. A positive result occurs if deep shoulder pain or clicking is felt. The test is then repeated with the palm facing up (external rotation); if the pain is significantly reduced or eliminated in this second position, it suggests a labral tear.
Another shoulder maneuver is the Biceps Load II Test, which isolates the superior labral area where the biceps tendon attaches. The patient’s arm is placed in 120 degrees of abduction and maximal external rotation. The patient contracts their biceps muscle against the examiner’s resistance. Reproduction of deep shoulder pain during this resisted contraction indicates possible involvement of the superior labrum-biceps tendon complex.
For the hip, the Flexion, Adduction, Internal Rotation (FADIR) test checks for tears in the acetabular labrum. The patient lies on their back while the examiner passively moves the affected hip into maximal flexion, followed by adduction and internal rotation. This motion stresses the anterior labrum, the most common location for a hip labral tear. A positive result is the reproduction of the patient’s groin or hip pain, suggesting anterior hip impingement often associated with a labral tear.
Diagnostic Imaging Procedures
While physical tests are suggestive, imaging procedures are necessary to visualize the joint’s internal structures. The first step is typically a standard X-ray, used to evaluate bony anatomy. Although X-rays cannot directly show the labral cartilage, they are important for ruling out other causes of joint pain, such as fractures, arthritis, or structural issues like femoroacetabular impingement (FAI).
To visualize soft tissues, Magnetic Resonance Imaging (MRI) is often utilized. An MRI uses magnetic fields and radio waves to create detailed cross-sectional images of non-bony structures, including the labrum, ligaments, and tendons. While a standard MRI can detect labral damage, its accuracy can be limited due to the labrum’s small size and deep location.
Magnetic Resonance Arthrography (MRA) is considered the superior non-surgical imaging method for labral tears. Before the scan, a contrast dye (usually containing gadolinium) is injected directly into the joint space under X-ray or ultrasound guidance. This dye seeps into any tears or defects, making the cartilage edges and injury extent much clearer on the resulting MRI images. MRA significantly improves the sensitivity and specificity for detecting labral pathology compared to a conventional MRI.
Confirmatory Diagnosis
The final and most definitive step is a surgical procedure known as arthroscopy. This minimally invasive technique is widely regarded as the “gold standard” for confirming a labral tear. During the procedure, the surgeon makes a few small incisions around the joint.
A pencil-sized instrument called an arthroscope, containing a camera and light source, is inserted into the joint. The camera transmits live, magnified video to a monitor, allowing the surgeon to directly visualize the labrum and surrounding structures. This direct visual inspection provides accurate confirmation of the tear’s presence, location, and severity, a level of detail unmatched by non-invasive imaging. Furthermore, arthroscopy often transitions from a diagnostic tool into a treatment, as the surgeon can repair or debride the torn labrum during the same procedure.