Hip Labral Tear or Hip Flexor Strain?

[soca3]

I just got back from seeing my orthopedic surgeon, and he said that there are not that many differences between the symptoms of a hip labral tear and a hip flexor strain, and only a MRI is definitive. Because an MRI is expensive, I would like to make sure this is true. I originally hurt my hip flexor from reaching for a ball while lifting my leg in soccer in early May 08. It doesn't hurt to run, but when I do any leg lift movements especially bringing my knee towards my chest, it starts hurting, but when I stretch it by bringing my knee to my chest and holding it, it immediately goes away. Also, when I wrap my hip flexor with ace wrap, I can play soccer with absolutely no pain while slide tackling and lifting my leg--it is only tight sometimes but no pain. My main concern that it is a labral tear is that there was a sort of popping sensation immediately before it started hurting, but that never happens when I wrap my hip. Does this sound more like a hip flexor strain or a labral tear? If it is a hip flexor strain how long do you think it will recover, and is it ok to run with a wrap if there is no pain?

Thanks

[Michael L Gross, MD]

An MRI can be definitive, especially an MRI arthrogram.  That is, when dye is injected in the joint before the MRI is completed.  The dye is usually injected under flouroscopic guidance.  When I suspect a torn labrum, I ask the radiologist to inject a long acting anesthetic into the joint as well.  If the pain and symptoms are eliminated, this is diagnostic for a labral tear.
If flexing the knee and hip to the 90/90 position and rotating the hip internally produces pain and popping, this supports the diagnosis of torn labrum over hip flexor strain.  Absence of pain with this maneuver tends to eliminate torn labrum.
If wrapping the hip eliminates the pain, and you are satisfied with that, I would be inclined to continue with that.  As far as the long term, I'm not sure anyone really knows the answer to that question presently.

[soca3]

Just making sure, when you say "flexing the knee and hip to the 90/90 position and rotating the hip internally produces pain and popping," do you mean lifting the knee up and bringing it towards the chest and rotating it inward? Do you think the wrap eliminating the pain eliminates the chance of a labral tear?

Thanks

[Michael L Gross, MD]

Thigh perpindicular to the ground. Knee bent 90 degrees with the cal parallel to the ground.The definitive test is still the MRI arthrogram.