The hip joint is a ball-and-socket mechanism, where the head of the thigh bone, or femur, fits into the cup-shaped socket of the pelvis, known as the acetabulum. Surrounding the rim of this socket is the labrum, a ring of specialized fibrocartilage that functions like a gasket, providing a suction seal and enhancing the stability of the joint. A hip labral tear is an injury to this cartilage ring, which is a common cause of pain and mechanical symptoms within the hip.
Recognizing the Symptoms of a Labral Tear
Individuals with a tear in the hip labrum typically report a deep, aching pain, most frequently localized in the groin area. This pain pattern results from the anterior location of the majority of labral tears and is often exacerbated by specific movements or prolonged periods of activity. Pain may also radiate toward the front of the thigh or the buttocks, depending on the tear’s location.
Beyond pain, patients often describe mechanical symptoms, such as clicking, catching, or locking deep within the joint during movement. These feelings signal that the torn flap of cartilage is momentarily being pinched between the moving bones. Discomfort may also intensify when performing activities that involve deep hip flexion, like squatting, or when sitting for an extended time.
The Cluster of Key Physical Examination Tests
A definitive diagnosis of a hip labral tear is rarely made based on a single physical maneuver; rather, clinicians rely on a cluster of provocative tests that, when positive together, suggest damage to the intra-articular structures. These tests are designed to mechanically stress the labrum or pinch it between the femoral head and the acetabulum. A positive result is the reproduction of the patient’s familiar hip or groin pain, sometimes accompanied by a distinct clicking sensation.
Flexion-Adduction-Internal Rotation (FADIR) Impingement Test
The FADIR test is one of the most consistently used and sensitive screening tools for anterior labral tears and femoroacetabular impingement (FAI). The maneuver is performed with the patient lying on their back, where the examiner brings the hip into maximal flexion, adduction across the body, and internal rotation. This combination of movements forcefully jams the anterior aspect of the femoral head against the anterior labrum.
Reproduction of the patient’s pain during this maneuver is considered a positive test result, strongly suggesting an underlying issue like a labral tear or FAI. While highly sensitive (meaning it is very good at ruling out a tear when negative), the test has a lower specificity, meaning a positive result does not confirm a labral tear, as other hip pathologies can also cause pain.
Flexion-Abduction-External Rotation (FABER) Test
The FABER test, also referred to as the Patrick test, is an essential component of the physical examination cluster, though it is less specific to the labrum itself. This maneuver assesses the hip joint, the sacroiliac joint, and the surrounding musculature. The patient is positioned with the hip flexed, abducted, and externally rotated, resembling a figure-four shape.
The examiner then applies gentle downward pressure to the knee of the bent leg. When a labral tear is present, the test typically reproduces pain in the anterior hip or groin due to the strain placed on the joint capsule and the anterior labrum. If the pain is felt in the posterior buttock area, it may indicate a problem with the sacroiliac joint rather than the labrum.
Scour Test
The Scour test, or Quadrant Scour test, is a dynamic maneuver used to assess the integrity of the articular cartilage and the labrum by grinding the femoral head against the acetabular rim. The patient lies on their back, and the clinician applies an axial load down the femur while simultaneously moving the hip in large, sweeping arcs of flexion, adduction, and abduction. This motion effectively “scours” the joint surfaces.
A positive result occurs if this grinding action reproduces the patient’s groin pain, or if a clicking, catching, or grinding sound is felt or heard. This test helps localize symptoms to the joint surfaces and is useful in identifying tears located throughout the arc of motion. The constant compression and rotation places direct stress on the labral tissue.
Log Roll Test
The Log Roll test is a simple, passive maneuver that is highly specific for intra-articular hip pathology, making it a valuable tool in the diagnostic cluster. With the patient lying supine, the examiner grasps the lower leg just above the ankle and gently rolls the entire leg into maximal internal and external rotation. This maneuver causes the femoral head to rotate within the acetabulum.
Because the movement is performed passively and does not strongly engage the surrounding muscles, a positive result—reproduction of pain—is often attributed to irritation of the joint capsule or an intra-articular structure like the labrum. This ability to isolate the pain to the joint itself helps distinguish it from muscular or soft tissue injuries outside the joint.
Confirmatory Imaging Studies
Although physical examination tests are highly suggestive, imaging studies are required to definitively confirm the presence, size, and location of a labral tear. The initial step typically involves obtaining plain film X-rays of the hip. While X-rays cannot visualize the soft tissue of the labrum, they are indispensable for identifying bony abnormalities, such as femoroacetabular impingement or hip dysplasia, which are frequent underlying causes of labral tears.
Following the initial X-ray, the most common and accurate method for visualizing the labrum is Magnetic Resonance Arthrography (MRA). This procedure involves injecting a contrast dye (typically a gadolinium solution) directly into the hip joint before the Magnetic Resonance Imaging (MRI) scan is performed. The injected contrast material seeps into any tears or defects, effectively outlining the injury on the subsequent images.
MRA is generally considered the gold standard for labral tear diagnosis, offering high sensitivity and specificity. However, advancements mean that high-resolution 3-Tesla (3T) MRI without the injection of contrast is increasingly being used and, in some settings, shows comparable diagnostic accuracy. The choice between standard MRI and MRA often depends on the quality of the equipment, the expertise of the radiologist, and the specific clinical question being asked.