[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Clinical exam](https://durgical.com/en/clinical-exam/) › [Musculoskeletal system](https://durgical.com/en/clinical-exam/#a-musculoskeletal) › Ortolani and Barlow maneuvers [Clinical exam](https://durgical.com/en/clinical-exam/) · [Musculoskeletal system](https://durgical.com/en/clinical-exam/#a-musculoskeletal) # Ortolani and Barlow maneuvers - Maneuver Two gentle maneuvers on a newborn's hip: one puts a dislocated hip back in place (Ortolani) and the other shows whether an unstable hip slips out (Barlow). Updated 2026-11-01 **See it in 3D:** [Hip bone](https://durgical.com/en/anatomy/hip-bone/) · [Femur](https://durgical.com/en/anatomy/femur/) · [Acetabular labrum](https://durgical.com/en/anatomy/acetabular-labrum/) · [Hip capsule](https://durgical.com/en/anatomy/articular-capsule-of-hip-joint/) · [Femoral head cartilage](https://durgical.com/en/anatomy/articular-cartilage-of-femoral-head/) · [Acetabular cartilage](https://durgical.com/en/anatomy/articular-cartilage-of-acetabulum/) ## Key points - Ortolani reduces: abduction of the flexed hip while lifting the greater trochanter; a 'clunk' means a dislocated hip slipping into the acetabulum. - Barlow dislocates: adduction of the flexed hip with a gentle backward push; a 'clunk' means an unstable hip slipping out. - Useful from birth and in the first two to three months; after that, limited abduction (under 60 degrees or asymmetry) is the key sign. - A soft click without movement is benign; what counts is the clunk of displacement. - Risk factors: breech presentation, female sex, first pregnancy and family history. - Imaging: ultrasound in the first months (not before about six weeks unless there is a clear finding); radiograph from four to six months. ## What it is Ortolani and Barlow are the basis of clinical screening for developmental dysplasia of the hip. Ortolani reduces a femoral head that is out of the acetabulum; Barlow tries to dislocate an unstable hip that is in. They are useful in the first months: from about two to three months of age the laxity fades, the soft tissues tighten and the most useful sign becomes limited abduction. ## The anatomy it tests - The hip is a ball-and-socket joint: the femoral head sits in the acetabulum of the hip bone, deepened by the acetabular labrum. - In the newborn the hip is mostly cartilage and the capsule is lax; if the acetabulum is shallow, the head can slip out backward. - Barlow uses that laxity by pushing the head backward in adduction; Ortolani brings it back over the posterior rim in abduction. - With time the adductors and capsule tighten, the dislocated hip no longer reduces and limited abduction appears. ## How to do it - Infant supine on a firm surface, nappy off, calm and relaxed (feeding can help). - Examine one hip at a time; one hand steadies the pelvis and the opposite hip. - Hip and knee flexed to 90 degrees; the examiner's thumb lies on the inner thigh and the index and middle fingers over the greater trochanter. - Barlow: adduct the hip, bringing the thigh toward the midline, and push gently backward along the line of the femur. - Positive Barlow: the femoral head is felt sliding backward out of the acetabulum (unstable or dislocatable). - Ortolani: from the same position, gently abduct the hip while the fingers lift the greater trochanter forward. - Positive Ortolani: a clunk is felt as the dislocated head slips back into the acetabulum. - Finish with abduction of both hips, knee height (Galeazzi) and skin folds; never use force. ## What a positive result means - Positive Ortolani: a dislocated hip that can be reduced; positive Barlow: an unstable hip that can be dislocated. - Either one positive calls for pediatric orthopedic assessment. - Equivocal finding at birth: repeat the exam at about two weeks. - From two or three months the maneuvers lose value; a fixed dislocated hip gives limited abduction, a lower knee (Galeazzi) and asymmetric folds. - In bilateral dislocation the legs can look equal; limited abduction on both sides is the clue. - A normal exam does not rule out dysplasia: the hip can be malformed without being unstable. ## Usefulness and limits - The maneuvers depend on the examiner's experience and a relaxed infant. - Ultrasound is the study of choice before six months, but in the first weeks it picks up immaturity that corrects itself. - Radiographs become useful from four to six months, when the femoral head ossifies. ## Memory aid Ortolani goes 'Out to In', Barlow goes 'Back out'. ## Test yourself Think of the answer, then tap the question to see it. ## How do the Ortolani and Barlow maneuvers differ? Ortolani reduces a dislocated hip (abduction and lifting the trochanter); Barlow tries to dislocate an unstable hip (adduction and a backward push). ## Up to what age are the Ortolani and Barlow maneuvers useful? From birth through the first two to three months; after that they lose value and limited abduction becomes the most useful sign. ## Where does the examiner place the fingers in these maneuvers? Thumb on the inner thigh and index and middle fingers over the greater trochanter, with hip and knee flexed to 90 degrees. ## Which imaging study is used for hip dysplasia before six months of age? Hip ultrasound; radiographs become useful from four to six months, when the femoral head ossifies. [Add to my cards (4)](https://durgical.app/estudiar/?add=/en/clinical-exam/ortolani-and-barlow-maneuvers/) ## See it in 3D The structures of Durgical's 3D anatomy where it is found. - [Hip bone](https://durgical.com/en/anatomy/hip-bone/) - [Femur](https://durgical.com/en/anatomy/femur/) - [Acetabular labrum](https://durgical.com/en/anatomy/acetabular-labrum/) - [Hip capsule](https://durgical.com/en/anatomy/articular-capsule-of-hip-joint/) - [Femoral head cartilage](https://durgical.com/en/anatomy/articular-cartilage-of-femoral-head/) - [Acetabular cartilage](https://durgical.com/en/anatomy/articular-cartilage-of-acetabulum/) ## Related - [Pediatric history: perinatal, growth, development and vaccines](https://durgical.com/en/clinical-exam/pediatric-history-perinatal-growth-development-and-vaccines/) - [Trendelenburg sign and gait](https://durgical.com/en/clinical-exam/trendelenburg-sign-and-gait/) - [Inspection of gait and posture (orthopedic)](https://durgical.com/en/clinical-exam/inspection-of-gait-and-posture/) - [FABER (Patrick) and FADIR tests](https://durgical.com/en/clinical-exam/faber-and-fadir-tests/) ## Related conditions - [Developmental dysplasia of the hip](https://durgical.com/en/conditions/developmental-dysplasia-of-the-hip/) [← All of the clinical exam](https://durgical.com/en/clinical-exam/) Educational content on the clinical exam; it is learned and practised under supervision. It does not replace assessment by a health professional and is not for self-diagnosis. Sources: [Developmental Dysplasia of the Hip](https://www.aafp.org/pubs/afp/issues/2006/1015/p1310.html) (American Family Physician (American Academy of Family Physicians), 2006); [Common Questions About Developmental Dysplasia of the Hip](https://www.aafp.org/pubs/afp/issues/2014/1215/p843.html) (American Family Physician (American Academy of Family Physicians), 2014). ## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake Representative model, for educational purposes only. --- Source: https://durgical.com/en/clinical-exam/ortolani-and-barlow-maneuvers/ License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/clinical-exam/ortolani-and-barlow-maneuvers/