Paralabral cyst of the hip
Updates to Article Attributes
Paralabral cysts of the hip joint are a location specific subtype of paralabral cysts. They are predominantly small, sometimes septate, well-defined multiloculated fluid intensity lesions seen closely associated with acetabular labral tears. Their presence requires a thorough search for a labral tear which may be missed as non-arthrographic MRI imaging may look deceivingly normal deceivingly normal.
Some authors have divided these as cysts that directly communicate with the synovial fluid of hip joint (true paralabral cysts) and those that do not (perilabral cyst). They may be confused with small bursal fluid collections around the hip joint, however 90, 90% of cystic cystic lesions lateral to the iliopsoas are paralabral cysts.
Epidemiology
Incidence
Usually seen in 1-4% of the asymptomatic population, and in 50-70% of patients with labral tears. They are more common in males.
Clinical presentation
- anterior hip pain
- restriction of rotatory movements
- painful flexion at the hip
- snapping sensation
Pathology
Paralabral cysts are seen at multiple joints, commonly at hip and shoulder, and less commonly at knee and wrist.
Commonly seen with labral tears which occur due to:
- developmentally dysplastic hips
- trauma which includes overuse ie, sports injuries
- degenerative arthrosis of the hip.
It is thought that incongruity of the femoral head with acetabulum causes causes increased intraarticular pressure especially during flexion and rotatory movements of the hip joint, which forces the synovial fluid through the pathological labrum into the paraarticularperiarticular soft tissues.
Size
Their usual size range is around 3 3-30mm.
Location
Most are located anterosuperiorly: ~ 56% 4, other locations include:
- anteriorly: ~ 22%
- posterosuperiorly: ~ 17%
- anteroinferiorly: ~ 6%
Clinical presentation
anterior hip painrestriction of rotatory movementspainful flexion at hipsnapping sensation
Radiographic features
Plain filmradiograph
Plain radiographs have limited value but may detect other associated bony pathologypathologies.
Ultrasound
Ultrasound is helpful in cysts larger than 1.5 cm but givegives little information about the labrum.
MRI
MRI with MRI arthrography is the modality of choice to detect paralabral cysts and delineate labral tears, hip dysplasia, signs of trauma and degenerative changes.
The vast majority are are seen as multilocular cystcysts and fill with intra-articular contrast medium.
- T2 / STIR - high signal
Treatment and prognosis
Cysts may be aspirated but recur commonly. The definitive treatment is to surgically excise the cyst with arthroscopic labral repair. Arthroscopic cyst decompression and debridement of the degenerative labral tissues were performed using an arthroscopic thermal probe and a shaver is an effective surgical method of management.
-<p><strong>Paralabral cysts of hip joint</strong> are a location specific subtype of <a href="/articles/paralabral-cysts">paralabral cysts</a>. They are predominantly small, sometimes septate, well-defined multiloculated fluid intensity lesions seen closely associated with <a href="/articles/acetabular-labral-tears">acetabular labral tears</a>. Their presence requires a thorough search for a labral tear which may be missed as non-arthrographic MRI imaging may look deceivingly normal.</p><p>Some authors have divided these as cysts that directly communicate with the synovial fluid of hip joint (true paralabral cysts) and those that do not (perilabral cyst). They may be confused with small bursal fluid collections around the hip joint however 90% of cystic lesions lateral to the iliopsoas are paralabral cysts.</p><h4>Epidemiology</h4><h5>Incidence</h5><p>Usually 1-4% of asymptomatic population, and 50-70% of patients with labral tears. They are more common in males.</p><h4>Pathology</h4><p>Paralabral cysts are seen at multiple joints, commonly at hip and shoulder, and less commonly at knee and wrist.</p><p>Commonly seen with labral tears which occur due to :</p><ul>- +<p><strong>Paralabral cysts of the hip joint</strong> are a location specific subtype of <a href="/articles/paralabral-cysts">paralabral cysts</a>. They are predominantly small, sometimes septate, well-defined multiloculated fluid intensity lesions seen closely associated with <a href="/articles/acetabular-labral-tears">acetabular labral tears</a>. Their presence requires a thorough search for a labral tear which may be missed as non-arthrographic MRI imaging may look deceivingly normal.</p><p>Some authors have divided these as cysts that directly communicate with the synovial fluid of hip joint (true paralabral cysts) and those that do not (perilabral cyst). They may be confused with small bursal fluid collections around the hip joint, however, 90% of cystic lesions lateral to the iliopsoas are paralabral cysts.</p><h4>Epidemiology</h4><h5>Incidence</h5><p>Usually seen in 1-4% of the asymptomatic population and in 50-70% of patients with labral tears. They are more common in males.</p><h4>Clinical presentation</h4><ul>
- +<li>anterior hip pain</li>
- +<li>restriction of rotatory movements</li>
- +<li>painful flexion at the hip</li>
- +<li>snapping sensation</li>
- +</ul><h4>Pathology</h4><p>Paralabral cysts are seen at multiple joints, commonly at hip and shoulder, and less commonly at knee and wrist.</p><p>Commonly seen with labral tears which occur due to:</p><ul>
-<li>degenerative arthrosis of hip.</li>-</ul><p>It is thought that incongruity of the femoral head with acetabulum causes increased intraarticular pressure especially during flexion and rotatory movements of hip joint, which forces the synovial fluid through the pathological labrum into the paraarticular soft tissues.</p><h5>Size</h5><p>Their usual size range is around 3-30mm.</p><h5>Location</h5><p>Most are located anterosuperiorly: ~ 56% <sup>4</sup>, other locations include</p><ul>- +<li>degenerative arthrosis of the hip.</li>
- +</ul><p>It is thought that incongruity of the femoral head with acetabulum causes increased intraarticular pressure especially during flexion and rotatory movements of the hip joint, which forces the synovial fluid through the pathological labrum into the periarticular soft tissues.</p><h5>Size</h5><p>Their usual size range is around 3-30mm.</p><h5>Location</h5><p>Most are located anterosuperiorly: ~ 56% <sup>4</sup>, other locations include:</p><ul>
-</ul><h4>Clinical presentation</h4><ul>-<li>anterior hip pain</li>-<li>restriction of rotatory movements</li>-<li>painful flexion at hip</li>-<li>snapping sensation</li>-</ul><h4>Radiographic features</h4><h5>Plain film</h5><p>Plain radiographs have limited value but may detect other associated bony pathology</p><h5>Ultrasound</h5><p>Ultrasound is helpful in cysts larger than 1.5 cm but give little information about the labrum</p><h5>MRI</h5><p>MRI with MRI arthrography is the modality of choice to detect paralabral cysts and delineate labral tears, hip dysplasia, signs of trauma and degenerative changes.</p><p>The vast majority are seen as multilocular cyst and fill with intra-articular contrast medium.</p><ul><li>- +</ul><h4>Radiographic features</h4><h5>Plain radiograph</h5><p>Plain radiographs have limited value but may detect other associated bony pathologies.</p><h5>Ultrasound</h5><p>Ultrasound is helpful in cysts larger than 1.5 cm but gives little information about the labrum.</p><h5>MRI</h5><p>MRI with MRI arthrography is the modality of choice to detect paralabral cysts and delineate labral tears, hip dysplasia, signs of trauma and degenerative changes.</p><p>The vast majority are seen as multilocular cysts and fill with intra-articular contrast medium.</p><ul><li>