Identifying Labral Tears of The Hip: The Diagnostic Accuracy of Tests


The sports physiotherapists reading this would be aware of the challenge of accurate diagnosis of hip pathology. The hip/groin area is an area with incredibly complex anatomy and biomechanics (Feeley et al., 2008). To quote a former anatomy lecturer of mine; “It is real tiger country!”. This means to improve clinical reasoning and diagnosis clinicians (and/or diagnosticians) must be acutely aware of the diagnostic accuracy of the clinical tests in their arsenal.

Labral tears in the hip are now becoming widely recognised as a source of anterior hip/groin pain and intra-articular pathology. The prevalence of acetabular labral tears in some populations presenting with hip or groin pain has been reported to be between 22% and 55% (Narvani et al., 2003; McCarthy et al., 2001). I think that is a WHOPPING percentage (and probably a bit high), but nonetheless it shows the frequency with which you will come into contact with these pathologies.

Identifying Labral Tears of The Hip

There are a number of clinical tests and subjective pieces of information that clinicians may associate with labral pathology of the hip. Fortunately Burgress and crew (2011) have performed a systematic review to identify the diagnostic accuracy of these clinical tests. The following sensitivities, specificities, positive and negative likelihood ratios have been calculated from their results.

Diagnostic Accuracy of Subjective Information 

Anterior Groin Pain


  • Sensitivity: 100%
  • Specificity: 4%
  • Positive LR: 1.04
  • Negative LR: 0
Mechanical Symptoms: Clicking, locking, popping, giving way
  • Sensitivity: 53 –  100%
  • Specificity: Could not be calculated

Diagnostic Accuracy of Objective/Physical Tests

Impingement Test
    • Sensitivity: 75%
    • Specificity: 43-100%
    • Positive LR: 1.3 – 
    • Negative LR: 0.01 – 0.58

Modified Thomas Test
    • Sensitivity: 89%
    • Specificity: 92%
    • Positive LR: 11.13
    • Negative LR: 0.12

Fitzgerald Test
    • Sensitivity: 98%
    • Specificity: Could not be calculated

Quadrant Test
  • Sensitivity: 75%
  • Specificity: 43%
  • Positive LR: 1.32
  • Negative LR: 0.58

Diagnostic Accuracy of Imaging

Magnetic Resonance Arthrography
  • Sensitivity: 63-100%
  • Specificity: 71-100%
  • Positive LR: 2.17 – 
  • Negative LR: 0 – 0.52
Magnetic Resonance Imaging
  • Sensitivity: 25 – 30%
  • Specificity: 33 – 100%
  • Positive LR: 0.67 – 
  • Negative LR: 0.7 – 2.27
CT Arthrography
  • Sensitivity: 92 – 97%
  • Specificity: 87 – 100%
  • Positive LR: 7.46 – 
  • Negative LR: 0.03 – 0.09

Limitations of This Research

There are some significant limitation in this research, of which the authors are only too aware of. Overall, the quality of data from the included the studies was low. The articles were plagued by selection biases, small sample sizes, lack of blinding, and heterogenous populations (i.e. not all sports). These methodological limitations are displayed by the inability to establish specificity for some tests and additionally the wide range of values shown (e.g MRI Specificity 33 – 100%!). This clearly means that these results should be taken with significant caution and have questionable clinical implications.

Clinical Implications of This Research 

What we can interpret from the research is:

  • MRA consistently performs better than MRI and should be the first choice for imaging
  • CT Arthrography was useful in diagnosing labral pathology
  • Negative test results are of more use in ruling OUT the condition, given the high reported sensitivities of many tests
  • A battery of tests should be utilised to improve the accuracy of your clinical reasoning

What are your experiences in the diagnosis of labral pathology of the hip? Be sure to let me know in the comments or catch me on Facebook or Twitter

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Photo Credit: jmd41280


Burgess RM, Rushton A, Wright C, Daborn C. The validity and accuracy of clinical diagnostic tests used to detect labral pathology of the hip: A systematic review.  Manual Therapy 2011;16:318-326

Feeley B, Powell J, Muller M, Barnes R, Warren R, Kelly B. Hip injuries and labral tears in the national football league. The American Journal of Sports Medicine 2008;(36):2187-95.

McCarthy J, Noble P, Schuck M, Lee J. The Otto E. Aufranc Award: the role of labral lesions to development of early degenerative hip disease. Clinical Orthopaedics 2001;(393):25-37

Narvani A, Tsiridis E, Kendall S, Chaudhuri R, Thomas P. A preliminary report on prevalence of acetabular labrum tears in sports patients with groin pain. Sports Medicine 2003;(11):403-8.



  1. I am an ART provider.

    I’ve found groin “pinching” with hip flexion to be extremely common, more than 50% of the patients I treat.

    My rule of thumb is usually to treat the posterior hip capsule, hip external rotators, and adductor magnus for about 4 visits.

    If results don’t last progressively from visit to visit, I refer for an MRA. But I’ve found that the majority of these symptoms are due to posterior capsule adhesions.

    I would like to hear other opinions on this.

    Thanks for sharing your findings!


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