The labrum is a ring of cartilage around the rim of the hip socket. A labral tear on an MRI or MR arthrogram report means that ring looks frayed, split or lifted. It is one of the commonest findings on hip scans, including hips that have never hurt, so the report on its own does not decide what is wrong or what should be done. Your symptoms, the examination and the rest of the report do that, and the trials comparing physiotherapy with surgery are more balanced than most people expect.
Assessing and treating hip pain at the Burlington clinic. Convenient for Waterdown, Oakville, Hamilton, Flamborough, and Carlisle residents.
When to see a doctor firstBroader Hip Pain GuideThe labrum. The socket of the hip has a rim of fibrous cartilage, the labrum, that deepens the socket and helps seal the joint fluid in. It can fray or tear with a twisting injury, with repeated pinching at the front of the hip, with the shape of the bones, or simply with age.
| On the report | What it means |
|---|---|
| Labral tear, fraying, degeneration | The rim looks split, roughened or worn. Degenerative means it looks worn rather than freshly torn. |
| Anterosuperior | At the front and top of the socket, where most tears sit and where the hip pinches in deep bending. |
| Paralabral cyst | A small pocket of joint fluid next to the tear. It usually confirms the tear rather than being a separate problem. |
| Cam morphology, alpha angle | Extra bone at the junction of the ball and neck of the thigh bone, measured by the alpha angle. Common in people without pain, especially athletes (Frank et al., 2015). |
| Pincer morphology, over-coverage, retroversion | A socket that covers the ball more than usual or faces slightly backward. Also common in painless hips. |
| Chondral or cartilage defect, delamination | Change in the smooth cartilage of the socket or ball. This matters more than the labral tear for what happens next, and it is much less common in painless hips (Heerey et al., 2018). |
| MR arthrogram | An MRI done after dye is injected into the joint. It shows the labrum more clearly. |
| Dysplasia, low centre-edge angle | A shallow socket. This is a different problem with a different plan, and worth raising with your doctor. |
| Gluteal tendinosis, trochanteric bursitis | Findings on the outside of the hip, covered by the gluteal tendinopathy page. |
Groin or hip pain with fever, feeling unwell, or a hot swollen joint
Same-day medical assessment to rule out infection, or go to emergency if you feel unwell.
Sudden hip or groin pain with an inability to put weight on the leg, especially after a fall or if you are over 60
Keep weight off the leg and get medical assessment today. A hip fracture needs to be ruled out.
Hip pain in a child or teenager, with or without a limp or knee pain
See your family doctor promptly. Hip problems in young people need a medical diagnosis before physiotherapy.
Deep hip pain with long-term steroid use, heavy alcohol use or sickle cell disease
See your family doctor; these raise the chance of osteonecrosis of the femoral head.
Pain at night that does not ease, unexplained weight loss, or a history of cancer
See your family doctor for a medical review before starting physiotherapy.
New numbness or weakness in the leg, or changes in bladder or bowel control
Urgent medical assessment; this points to the spine or nerves rather than the hip joint.
Labral tears are common in hips that do not hurt. In a prospective study of 45 volunteers with no hip pain, history of injury or surgery, 69 percent had a labral tear on MRI and 73 percent had some abnormality, more often with age (Register et al., 2012). Across 29 studies, labral tears were found in 54 percent of people without hip pain and 62 percent of people with it (Heerey et al., 2018). The tear itself separates the two groups poorly.
The cartilage separates them better. In the same review, cartilage defects were found in 12 percent of painless hips and 64 percent of painful ones (Heerey et al., 2018). If your report mentions the cartilage of the socket or the ball, that is the line to ask about.
Bone shape is common too. Across 26 studies of 2,114 hips in people with no symptoms, cam morphology was present in 37 percent overall and in 55 percent of athletes (Frank et al., 2015). A cam or pincer shape on your report is a description of your anatomy, not proof that it is the cause of your pain.
A diagnosis needs three things. The international consensus on femoroacetabular impingement syndrome requires symptoms, positive clinical signs and imaging findings together (Griffin et al., 2016). Imaging alone is not a diagnosis, and that principle applies to the labrum as much as to the bone shape.
It does not decide between physiotherapy and surgery. That decision rests on how much the hip limits you, your age, the state of the cartilage and how the hip responds to a proper course of rehabilitation. The trials below show why.
Three randomised trials have compared keyhole hip surgery with physiotherapy-led care. They point the same way: both groups improve, surgery sometimes adds a little, and starting with physiotherapy does not burn a bridge.
I start with where the pain is and what brings it on: deep groin pain with sitting, squatting, getting out of a car or turning on the leg points to the joint, while pain on the outside of the hip or in the buttock usually points elsewhere. I ask about injuries, sport, how long it has been going on and what it stops you doing.
On examination I measure hip range of motion, test the movements that pinch at the front of the hip, and test strength in the hip and trunk. I screen the lower back and the sacroiliac joint, because they refer pain to the same area. I read the report alongside that, with more weight on the cartilage and the socket shape than on the labral tear itself.
The plan is usually strength for the hip and trunk, work on the movements that provoke the hip so you can do them without pinching, and changes to the loads that flare it, built up toward the sport or activity you want back. Hands-on treatment can help with pain and movement alongside that. If the hip is not responding after a fair course, or the report shows a shallow socket or cartilage damage that changes the picture, I say so and refer you through your family doctor for a surgical opinion. I cannot order imaging; when more imaging would change the plan, I flag it and refer you.
The labrum has a limited blood supply and a tear is not expected to knit back together. Pain and function can still improve a great deal without the tear changing, which is what the trials of physiotherapy show, and many people with tears on scans have no pain at all.
Not on the strength of the report. In the randomised trials both physiotherapy and surgery groups improved; surgery added a modest amount in some, nothing in others, and starting with physiotherapy did not harm later surgical results. Surgery is a reasonable option for a hip that still limits you after a proper course of rehabilitation.
A small pocket of joint fluid that has pushed out next to a labral tear. It usually confirms the tear rather than being a separate problem, and it does not change the plan by itself.
No. The labrum is the rim of the socket; arthritis is wear of the cartilage on the joint surfaces. They can occur together, and the cartilage findings on your report matter more than the labral tear for what happens next.
Often, with the loads adjusted. Deep hip bending under load and pivoting are the movements that pinch, so those are trimmed and rebuilt as strength and control improve, while the rest of training continues. The report is not a reason to stop on its own.
Extra bone at the junction of the ball and neck of the thigh bone, which can make contact with the socket rim in deep bending. It is found in about a third of people with no hip pain and over half of athletes, so it is part of the picture rather than a diagnosis by itself.
The trials that followed people for one to two years did not find that choosing physiotherapy first led to worse results, including in those who later had surgery. The cartilage, not the labrum, is the structure that decides the long-term outlook, and that is monitored by your doctor if it is a concern.
The main sources behind this guide. Other studies are named in the text where they are used.
2012 Register B et al., American Journal of Sports Medicine
45 volunteers with no hip pain, injury or surgery. Labral tears on MRI in 69 percent, any abnormality in 73 percent, more frequent with age.
2018 Heerey JJ et al., British Journal of Sports Medicine
29 studies. Labral tears in 54 percent of painless and 62 percent of painful hips; cartilage defects in 12 percent of painless and 64 percent of painful hips.
2015 Frank JM et al., Arthroscopy
26 studies, 2,114 symptom-free hips. Cam morphology in 37 percent overall and 55 percent of athletes; pincer features in 67 percent, with definitions that varied widely.
2016 Griffin DR et al., British Journal of Sports Medicine
Consensus: the syndrome is diagnosed from symptoms, clinical signs and imaging findings together, and imaging alone does not make the diagnosis.
2018 Griffin DR et al., The Lancet
348 adults. Both groups improved at 12 months; arthroscopy improved hip-related quality of life by about 7 points more on a 100-point scale than physiotherapist-led care.
2018 Mansell NS et al., American Journal of Sports Medicine
80 military patients. No significant difference between surgery and physiotherapy at two years; 28 of 40 assigned to rehabilitation crossed over to surgery without changing the result.
2024 Martin SD et al., American Journal of Sports Medicine
97 patients aged 40 and over with limited radiographic arthritis. Arthroscopy plus physiotherapy scored better over two years; 71 percent of the physiotherapy group crossed over, and prior physiotherapy did not compromise surgical outcomes.
2011 Yazbek PM et al., Journal of Orthopaedic & Sports Physical Therapy
Four patients with labral tears improved in pain and function with a progressive strengthening and movement program.
Condition pages for the problems most often behind a hip MRI report.
Strength and movement work carry the plan. These are the pieces that fit around it, including rehabilitation if surgery is the path you take.
I see patients for hip pain at Endorphins Health & Wellness Centre in Burlington. The clinic serves people coming in from Burlington, Waterdown, Oakville, Hamilton, Flamborough, and Carlisle, with free parking on site and a ground-floor entrance.
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