When hip pain is coming from within the joint, the most common cause of that type of pain comes from a labral tear. And the labrum is the cartilage lining of that socket joint of the socket of the ball-and-socket of the hip joint, and that can tear in different areas. Typically, patients will present with pain in the groin. They can feel a locking, or a catching, or giving way, and sense of decreased strength on that side.

The pain can be sharp, it can — or it can feel like a catching sensation. Labral tears can occur in the younger population, including athletes, gymnasts, dancers. However, it can also occur in an older population where the type of tear is more degenerative.

In diagnosing the labral tear, normally, the MRI will show where exactly in the labrum is the tear located. In addition to doing the MRI, an arthrogram is helpful, because when you inject a small amount of lidocaine, if it is — if it relieves some of the patient’s symptoms, then this clues us in that the problem is actually coming from within the hip joint itself.

The labral tear can be treated with an intra-articular injection, ideally, of steroid and lidocaine. In addition to injections into the hip, oral anti-inflammatories can also be helpful. These can either be prescribed or over-the-counter. Ideally, the injection will be in addition to physical therapy will be sufficient to help the person get to complete pain relief. In recalcitrant cases, when the physical therapy and the injections haven't been sufficiently helpful, then a surgical recommendation is — surgical evaluation is recommended. But ideally, the physical therapy and injections will be sufficient.

Cartilage on its own won’t — does not heal; it is not innervated. But the physical therapy will help to reduce the stress and the pressure that is on the joint, and reduce the stresses that most likely brought on the labral tear to begin with. Also, the anti-inflammatory medications just help with the inflammation in the fluid surrounding the injury; they don't do anything to the tear itself.

Dr. Ana Bracilovic is a physiatrist at the Princeton Spine and Joint Center, where she has more than a decade of experience specializing in the diagnosis and non-surgical treatment of spine, joint, and muscle pain.