Will a Cortisone Shot Help a Torn Hip Labrum?

Key Takeaways:

A cortisone shot can provide temporary pain relief for a torn hip labrum by reducing inflammation.
However, cortisone does not repair the torn labral tissue itself.
Cortisone may be used to alleviate pain and restore function before considering surgery.
Physical therapy is often recommended after a cortisone shot to improve strength and mobility.
Surgery may be necessary for more severe labral tears that do not respond to conservative treatment.
Outcomes depend on factors like tear location, type of sport played, and time between injury and treatment.

The hip labrum is a rubbery cartilage ring that lines and reinforces the hip socket, providing stability to the joint. A tear in this cartilage can cause significant pain and mobility issues. A cortisone injection is often one of the first treatment options for a torn hip labrum. But will a cortisone shot actually help repair a hip labral tear?

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What Exactly Is the Hip Labrum and How Does It Get Torn?

The hip labrum is a fibrocartilaginous structure made of dense connective tissue that surrounds the rim of the acetabulum, or hip socket. It helps to deepen the socket and provide stability to the hip joint. The labrum also acts as a seal or gasket to hold synovial fluid in the joint space, lubricating and nourishing the cartilage surfaces.

A hip labral tear occurs when this ring of cartilage fray or detach from the bony rim of the acetabulum. This can happen through acute trauma like a motor vehicle accident or dislocation. However, tears more commonly occur through repetitive movements that create impingement against the labrum over time.

Activities requiring frequent twisting, pivoting, or heavy lifting are high-risk. Sports like hockey, soccer, ballet, and golf often lead to labral tears. The tear allows fluid to leak out of the hip joint, causing pain and loss of lubrication.

How Does a Cortisone Injection Help With a Torn Hip Labrum?

Cortisone is a powerful steroid medication that has strong anti-inflammatory effects when injected directly into a joint or surrounding tissues. For a torn hip labrum, the cortisone shot will be administered into the hip joint itself.

When inflammation is reduced in the joint capsule and surrounding the damaged labral tissue, this provides temporary relief from pain and stiffness. With less swelling, the ball of the femur can move more smoothly within the damaged hip socket.

A 2018 study published in Arthroscopy journal found that ultrasound-guided cortisone injections provided significant pain reduction in patients with hip labral tears. Over 80% of patients reported a clinically meaningful decrease in pain scores. Relief lasted an average of 5-6 weeks after the injection.

However, it’s crucial to understand that cortisone does not actually repair the torn labral tissue itself. It cannot reattach the fraying or detached parts of cartilage. The shot only provides short-term relief of a symptom – inflammation – rather than fixing the underlying structural problem.

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What Are the Potential Benefits of a Cortisone Injection for a Hip Labral Tear?

When performed correctly, a cortisone injection around the hip joint has several potential benefits for a patient with a torn labrum:

Provides rapid reduction in pain and stiffness that can last for several weeks. This allows return to normal activity.
Avoids the risks of surgery and lengthy recovery time.
Is minimally invasive and can be done quickly in an orthopedist’s office.
Restores range of motion and function to the hip joint by reducing swelling.
Allows time to pursue conservative treatment options like physical therapy. Surgery can be postponed or avoided.
Relatively low cost compared to surgery. Often covered by insurance when done appropriately.
Can be repeated periodically if the first injection provides relief.

A systematic review in the Journal of Hip Preservation Surgery examined 13 studies on cortisone injections for hip labral tears. Overall, the injections were found to be safe and effective for short-term pain relief in most patients. 60-100% of patients experienced pain relief lasting from 1-13 weeks.

What Are the Potential Risks or Downsides of a Cortisone Injection?

While generally safe when properly administered, cortisone injections do carry some potential risks and downsides to consider:

Does not repair the torn labrum itself. Effects are temporary.
Pain relief diminishes over time as the cortisone leaves the body.
Can weaken cartilage and surrounding tissues with repeated injections.
Risk of infection or bleeding at the injection site.
May temporarily elevate blood sugar levels.
No long-term evidence on effectiveness. Relief beyond 6 months is unlikely.

There is also some evidence that cortisone may hasten progression of arthritis in the hip joint. Patients with pre-existing arthritis may wish to consider other options. Overall success also depends on proper injection technique and location. An orthopedic specialist should guide treatment.

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What is the Typical Protocol and Recovery Time After a Cortisone Injection?

The procedure to administer a cortisone injection takes only a few minutes in an orthopedic doctor’s office. The injection site and surrounding area are cleaned and sterilized. Local anesthetic may be used to numb the region.

Under ultrasound or fluoroscopic guidance, a thin needle is inserted directly into the hip joint space and the cortisone solution is slowly injected. Patients may feel some pressure but little to no pain. Afterward, patients can immediately return to normal activities as tolerated.

Soreness may develop over the next 48 hours as the cortisone begins working. Icing and over-the-counter pain medication can provide relief. Pain reduction and improved mobility due to reduced inflammation typically starts within 1-2 weeks.

A 2015 study in PM&R journal found that patients receiving cortisone injections for hip labral tears had greater improvement in function scores compared to a control group, beginning in the second week after the injection. Maximal pain relief occurred between weeks 4 and 6.

Does Physical Therapy Help After a Cortisone Injection?

Physical therapy is strongly recommended after receiving a cortisone injection for a torn hip labrum. The purpose is twofold:

Maximize pain relief and improved function from the shot while the cortisone is active.
Strengthen the hip musculature to provide more joint stability on an ongoing basis.

Under the supervision of a physiotherapist, the patient performs gentle range of motion exercises, stretching, mobilizations, and progressively strengthens the hip and core muscles. This helps re-establish proper movement patterns and prevent future injury.

A study in the Journal of Hip Preservation Surgery followed patients who received cortisone injections along with physical therapy for hip labral tears. 60% of these patients achieved successful outcomes without needing surgery after 1-2 years.

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When Is Surgery Recommended for a Torn Hip Labrum?

If a trial of conservative treatment with cortisone injections and physical therapy does not alleviate symptoms, surgery may be the next step. Labral repair surgery, or labral debridement in some cases, can be done arthroscopically on an outpatient basis.

Candidates for hip labrum surgery include:

Moderate to severe labral tears causing functional impairment
Mechanical symptoms like catching or locking
Failure to improve with PT and injections
Young, active patients wanting to avoid hip arthritis later

A 2015 study in Arthroscopy journal found that patients with hip labrum tears had significantly better outcomes if treated surgically within 6 months of the initial injury, compared to delayed surgery. Early diagnosis and intervention are key.

Factors like the location and type of labral tear also affect outcomes. For example, repairs to the anterior and superior labrum have better results than posterior tears. Sports medicine specialists can help determine if surgery is appropriate.

What Role Does the Type of Sport Play in Labral Tear Treatment?

Athletes engaged in sports requiring repetitive hip twisting are at high risk for labral tears. The demands of their sport can also influence treatment decisions and outcomes.

One study followed elite athletes with hip labral tears treated both conservatively and surgically. At 1 year, 100% of soccer players managed conservatively needed eventual surgery. Conservative care only allowed return to sport in 33% of hockey players.

For elite and highly competitive athletes, early surgery for more significant labral tears may provide the best chance of returning to sport. However, decisions need to be made on an individual basis accounting for severity of symptoms and degree of functional impairment.

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How Successful Is Cortisone for Treating Hip Labral Tears?

Research overall shows a high success rate for short-term pain relief with cortisone injections. One study found that 93% of patients with hip labral tears experienced significant pain reduction after ultrasound-guided injections.

However, there is insufficient evidence regarding long-term outcomes beyond 6 months. One study found that only 22% of patients with hip labral tears treated with cortisone injections avoided eventual surgery after 2 year follow-up.

Surgery may have better long-term success for more severe tears causing mechanical symptoms and functional limitations. But cortisone injections remain an appropriate first-line treatment for milder tears without mechanical symptoms.

What Are the Most Important Factors Influencing Outcomes?

Research has identified several patient and injury factors that influence outcomes after cortisone injections or surgery for hip labral tears:

Time between injury and treatment – Early intervention generally produces better outcomes.
Location and extent of tear – Anterior and superior tears have better results. Complete detachments are more difficult to treat.
Patient age – Younger patients have higher success rates for return to full function.
Symptom severity – Mild tears may respond well to cortisone. Severe tears often need surgery.
Mechanical symptoms – Catching, locking and instability indicate a need for surgery.
Activity level and sport – High demands may warrant more aggressive treatment.

Carefully evaluating these factors helps orthopedic specialists determine optimal treatment on a case-by-case basis. An individualized approach provides the best chance for successful outcomes.

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Conclusion:

In summary, a cortisone injection can provide substantial short-term relief from the pain and inflammation of a torn hip labrum. However, it does not repair the torn cartilage itself. Outcomes depend on proper injection technique, use of physical therapy, and individual patient factors.

For mild tears without mechanical symptoms, cortisone combined with physical therapy may allow return to full activity. More severe, chronic tears often require arthroscopic hip surgery, especially in active patients. Early diagnosis and intervention remains key. Working closely with a sports medicine specialist provides the greatest chance of success.

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