Dr. Ebraheim’s educational animated video describes the Barlow and Ortolani test and maneuver, illustrates how to preform it, and explains its indications and meaning.
Here is an easy way to remember these tests. The B comes before the O. B for Barlow and O for Ortolani.
Barlow: we are going out tonight. The hip can be popped out of the acetabulum with this maneuver.
Ortolani: once we have been out, now its time to go home! The femoral head is reduced back into the acetabulum with this maneuver.
The Barlow maneuver identifies the unstable hip that is in a reduced position that the clinician can passively dislocate.
Barlow test: the examiner will flex the knee and hip to 90 degrees. The maneuver is performed by bringing the thigh towards the midline (adducting the hip). Mild pressure is then placed on the knee while directing the force posteriorly. The femoral head will be pushed ut of the socket. The Barlow test is considered positive if the hip can be popped out of socket with this maneuver. The dislocation will be palpable.
Ortolani test: used to confirm the findings of the Barlow test, the Ortolani maneuver is performed following the Barlow test to determine if the hip is actually dislocated.
O out for Ortolani. If we are out, then we go home. Reduction of the dislocated hip. The Ortolani test is performed by the examiner flexing the hips and knees to 90 degrees. The reduction is done by abduction of the hip and pushing the thigh anteriorly. The test is positive if a palpable, audible clunk is heard from the hip being reduced. A hip click is a non specific finding.
Both tests are used for screening of newborns. Barlow test (hip started reduced): test will dislocate the hip. Ortolani test (hip started dislocated ): test will reduce the hip. These tests are done for children in the neonatal period. The hips are examined one at a time and usually the hips are flexed during these maneuvers. Early diagnosis by these tests and preferably with ultrasound is essential to detect hip instability and dislocation in the neonatal period.
Treatment is directed at stabilizing the hip that has positive Barlow and Ortolani signs. First born female with breech presentation and a positive family history is at risk of developing developmental dysplasia of the hip (DDH). If the hip remains dislocated for weeks, these two tests are usually not reliable. Barlow and Ortolani are not positive after 3 months because of soft tissue contracture around the hip region. Limitation of abduction becomes the most consistent clinical findings. Children older than 12 months will have other findings which include asymmetry of hip abduction, a positive Trendelenburg gait and a positive Galeazzi sign .
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Background music provided as a free download from YouTube Audio Library.
Song Title: Every Step
