Dr. Howard Liss treats disorders that cause pain and disability by providing consultative services and soft tissue and joint injections when needed. When medically appropriate, he makes specific referrals for diagnostic testing (lab work, imaging, electrodiagnosis), physical and occupational therapy, interventional procedures (epidurals and facet joint injections), and surgery.
Often compared to a cuff on a sleeve, the labrum is a rim of fibrous cartilage lining the socket of a ball and socket joint, providing stability and support. Labral tears can occur in the shoulder (glenoid labral tear) or hip (acetabular labral tear). While the labrum can tear as a result of an injury or fall, repeated movements (overuse) and degenerative conditions also play a role.
Consider the repetitive action of hitting a tennis ball or pitching a baseball. These overhead movements can result in a glenoid labral tear in the shoulder. In turn, imagine the twisting motion of swinging a golf club or intense pivoting during a basketball game, which can cause an acetabular labral tear in the hip. While these activities may produce a sudden tear, it must be noted that previous injuries as well as shoulder/hip dislocation, impingement syndrome, congenital disorders pertaining to the structure of the joint or arthritis can predispose individuals to a labral tear.
Depending on the extent of the tear, individuals experience varying degrees of pain, from mild to moderate discomfort to sharp, shooting pain. For instance, some report pain when getting out of the car or a clicking or catching sensation in their hip with certain movements. On the other hand, some report severe pain in the buttock area that extends to the low back and leg.
Understandably, due to the nature of pain experienced with a labral tear, some put off seeking orthopedic and sports injury treatment. However, it’s important to understand that while symptoms of a tear may be mild, the mechanics of the joint have been altered. This can impede function and performance and lead to early degeneration.
Treatment and Rehabilitation of Labral Tears
Treatment and rehabilitation of labral tears require special consideration of an individual’s health condition, lifestyle, the location and circumstance surrounding the injury, current symptoms and the precise pattern of their pain. A number of factors come into play when assessing hip or shoulder joints, including multiple body systems and conditions. Physiatrists are best positioned to identify and direct treatment and rehabilitation.
With a multifaceted approach, physiatrists bridge knowledge and expertise across many disciplines to determine the root causes of an individual’s pain. Physiatrists understand a wide variety of conditions that affect the brain, spinal cord, nerves, bones, joints, ligaments, muscles and tendons. Because they consult with other medical professionals such as physical and occupational therapists, and clinicians and interventionists when needed, patients benefit from comprehensive patient care.
Early treatment for labral tears consists of reducing pain (ice therapy) and protecting the labrum through active rest. Specifically for labral tears of the hip, or acetabular labral tears, patients shouldn’t sit with their knees positioned lower than their hips. Also they should not sit with their legs crossed, as this rotates and twists the hip. Once pain and inflammation have subsided, patients may undergo assessments of their biomechanics, with particular attention to joint and muscle function and range of motion. Under the direction of a physiatrist, physical therapists guide patients through assessing and improving soft tissue muscle length and resting tension. Exercises are often tailored to activate deep stability muscles as they help promote healing and injury prevention.
Physiatrists appreciate the connection between physiological health and psychological health. Patient education, awareness of posture positioning and joint position sense are a vital part of rehabilitation. This approach to therapy provides comfort to the patient through pain management, and it strengthens multiple body and muscle systems. It also equips patients to return to a specific sport or activity and helps patients take control of their future health with modifications to avoid injury.
As a trusted physiatrist in Englewood, Dr. Howard Liss, M.D. remains committed to empowering patients in their recovery from labral tears of the shoulder or hip. To discuss your pain and schedule an appointment with Dr. Liss, contact the Howard Liss, M.D. Rehabilitation Institute today.