Date amended:
External
Statements of Principles
Current RMA Instruments
Reasonable Hypothesis SOP
36 of 2017
Balance of Probabilities SOP
37 of 2017
Changes from previous Instruments

Document

ICD Coding
  • ICD-9-CM Codes: 840.8, 843.8
  • ICD-10-AM Codes: S43.7, S73.18
Brief description

A labral tear is a tear involving the lip of fibrocartilagenous tissue (the labrum) of the socket of the hip joint (acetabulum) or the shoulder joint (glenoid). The labrum deepens the functional joint socket and thus serves to help keep the joint in place by providing physical restraint. Only the hip joint and the glenohumeral joint of the shoulder have a labrum, so only these joints are covered by the SOP.

Confirming the diagnosis

Diagnosis is based on the clinical presentation together with MRI scan, CT scan or arthroscopy findings.  Clinical manifestations (particularly local pain and tenderness) attributable to a tear need to be present for the diagnosis to be confirmed.

The relevant medical specialist is an orthopaedic surgeon.

Additional diagnoses covered by SOP
  • Bankart lesion – this is a detachment of the labrum from the glenoid of the shoulder normally associated with shoulder dislocation.  The labral tear part of the lesion is covered by this SOP. If there is also a bony lesion it will be covered by the fracture SOP.  See further comments below
  • Shoulder SLAP lesion [Superior Labral tear from Anterior to Posterior]. There are multiple different types of SLAP tears
  • Traumatic labral tear
Conditions excluded from SOP
  • Adhesive capsulitis of the shoulder*
  • Chondral defect of the hip or glenohumeral joint* - acute articular cartilage tear SOP
  • Congenital/ developmental hip dysplasia (cam or pincer morphology)* - femoroacetabular impingement SOP
  • "Degenerative" labral tear (non-traumatic) of the hip or shoulder  - see comments
  • Femoroacetabular impingement syndrome*
  • Osteoarthritis*
  • Rotator cuff syndrome*

* another SOP applies  - the SOP has the same name unless otherwise specified

Clinical onset

Clinical onset will be when symptoms (chiefly pain) attributable to a labral tear first developed.  In the case of acute trauma resulting in labral tear, the clinical onset will be at the time of the trauma.

Clinical worsening

The only SOP worsening factor is for inability to obtain appropriate clinical management.  Treatment may be conservative or surgical.

Comments

For an acute labral tear that occurs in conjunction with an acute dislocation injury ("soft" Bankart lesion), the labral tear can be separately determined using this SOP, or can be considered to be a component of the dislocation and determined using the dislocation SOP (provided an appropriate diagnostic label, that includes the labral tear, is used).

This SOP does not cover degenerative labral tears. A degenerative labral tear may be an integral component of osteoarthritis, or of femoroacetabular impingement syndrome, or may also be an incidental finding that is seen on imaging (MRI) but is not of clinical significance.  A degenerative labral tear should generally not be diagnosed as a stand-alone condition.