Ortolani Maneuver: Technique and Interpretation
The Ortolani maneuver is performed by abducting and gently lifting the flexed thigh while pushing the greater trochanter anteriorly; a positive result is a palpable or audible "clunk" as a dislocated femoral head relocates into the acetabulum 1.
How to Perform the Ortolani Maneuver
The technique requires specific positioning and movements:
- Patient position: The infant should be relaxed, lying supine on a firm surface
- Examiner hand placement: Grasp the infant's thigh with fingers over the greater trochanter and thumb over the inner thigh near the femoral neck
- Hip positioning: Flex the hip and knee to 90 degrees
- The maneuver: Gently abduct the hip while simultaneously lifting the thigh anteriorly and applying anterior pressure over the greater trochanter with your fingers 1
Positive Finding
A positive Ortolani test produces a tactile "clunk" (not a click) that should be felt or heard as the dislocated femoral head reduces back into the acetabulum 1. This is a primarily proprioceptive sensation indicating the femoral head was dislocated and has now relocated 2.
Critical Distinction: Clunk vs. Click
The Ortolani maneuver detects a true clunk from hip relocation, which differs completely from the inconsequential audible clicks commonly heard in normal infant hips 2. Stable "clicking" hips without laxity are not positive Ortolani signs 1.
Age-Related Effectiveness
The Ortolani test is most effective in newborns and infants under 3 months of age 1. After 3 months, capsular laxity decreases and muscle tightness increases, making the maneuver less likely to yield positive results even in the presence of DDH 3. In older infants beyond 3 months, limited hip abduction becomes the more reliable clinical sign 1.
Clinical Context and Predictive Value
The Ortolani test has a positive predictive value of 39-61% for detecting DDH on subsequent ultrasound examination when performed by specialists 4. This is substantially higher than the Barlow test (4-16% positive predictive value), making the Ortolani maneuver the more reliable indicator of true hip pathology 4.
Important Caveats
- Examiner expertise matters: The sensitivity and specificity depend heavily on the skill and experience of the examiner 1
- Gentle technique required: The maneuver should be gentle to avoid overstressing the joint. Studies show peak forces should not exceed what's necessary to detect instability 5
- Timing is critical: The examination requires a relaxed infant; performing it on a crying or tense baby yields unreliable results 2
- Not a screening guarantee: A normal neonatal Ortolani test does not ensure normal hip development, as DDH can develop later 6
What the Ortolani Test Detects
The Ortolani maneuver specifically identifies already dislocated hips by relocating them into the acetabulum 1. This contrasts with the Barlow test, which attempts to dislocate a reduced but unstable hip. Both tests assess instability between the femoral head and acetabulum, indicating ligamentous or capsular laxity 1.