Understanding Labral Tears: Why MRI Isn’t the Whole Story
Labral tears in the hip have become one of the most commonly discussed—and frequently misunderstood—diagnoses in orthopedic sports medicine. Thanks to improvements in imaging, particularly MRI and MR arthrograms, we’re better able than ever to visualize the labrum. But with that comes a common clinical dilemma: just because a labral tear is seen on MRI doesn’t mean it’s the source of a patient’s symptoms.
Let’s break down what a labral tear really means, how we determine whether it’s clinically relevant, and why surgery is often not the first step.
What Is the Labrum—And What Does It Do?
The labrum is a ring of cartilage that surrounds the hip socket (acetabulum), helping to:
Deepen the socket for joint stability
Maintain fluid pressure for smooth movement
Provide a cushion against mechanical stress during activity
Tears can occur due to structural abnormalities (like femoroacetabular impingement, or FAI), trauma, repetitive motion, or simply as part of the aging process.
Labral Tears Are Common—Even in People Without Symptoms
One of the most important things to understand is that labral tears are very common on MRI, even in people who have no hip pain at all.
Multiple studies have shown that:
Labral tears are present in up to 68% of asymptomatic individuals on MRI.
Athletes and active individuals may have adaptive changes that appear abnormal but aren’t clinically significant.
So while imaging is a helpful tool, it’s only one piece of the puzzle.
MRI Helps—but Clinical Exam Matters More
MRI is useful for evaluating labral integrity, but it’s even more valuable in identifying other potential causes of pain:
Core muscle injury (Sports hernia)
Adductor or hip flexor strains
Lumbar Spinal Stenosis
Cartilage damage or early arthritis
Signs of hip instability (e.g., acetabular undercoverage or version abnormalities)
To determine whether a labral tear is symptomatic, we rely heavily on:
History: How symptoms started and what makes them worse
Physical exam: Provocative maneuvers like the FADIR test, checking for mechanical symptoms or loss of motion
Response to therapy or injections: Improvement with targeted rehab or intra-articular injection can help confirm the joint as the pain source
Most Patients Don’t Need Surgery
Yes, some labral tears require surgical repair—especially when there's mechanical conflict from bone abnormalities or true instability.
But a large percentage of patients can manage their symptoms and return to activity with:
Physical therapy focused on hip mobility, strength, and stability
Activity modification and load management
Anti-inflammatories or a short course of injections if needed
Surgery becomes an option if:
Symptoms persist despite dedicated nonoperative care
There’s clear mechanical conflict (like FAI) that hasn’t responded to rehab
The patient’s goals and functional demands can’t be met without intervention
Bottom Line
An MRI finding of a labral tear isn’t an automatic ticket to surgery. The decision to operate is based on a combination of symptoms, exam findings, imaging, and—most importantly—your goals and lifestyle.
In many cases, a structured rehab program is all that’s needed to get patients back to doing what they love—without an incision.
If you’ve been told you have a labral tear and are wondering what it really means for your hip, feel free to reach out for an evaluation. The right treatment starts with the right diagnosis—and that means more than just looking at a scan.
