Ortolani maneuver: Definition, Uses, and Clinical Overview

Posted on February 28, 2026 | by drhip

Ortolani maneuver Introduction (What it is)

The Ortolani maneuver is a hands-on clinical exam used to assess an infant’s hip stability.
It helps clinicians check for developmental dysplasia of the hip (DDH), where the hip is loose or not well seated.
It is commonly performed during newborn and early-infant physical exams in pediatrics and orthopedics.
It is a screening and diagnostic-support tool, not a treatment.

Why Ortolani maneuver used (Purpose / benefits)

The main purpose of the Ortolani maneuver is to detect a hip that is dislocated but reducible—meaning the femoral head (top of the thigh bone) is sitting out of the hip socket but can be guided back into position during the exam.

In general terms, it addresses the problem of early detection of DDH, a spectrum that can include:

A shallow acetabulum (hip socket)
Hip laxity (looseness)
Partial displacement (subluxation)
Full dislocation

Potential benefits of using the Ortolani maneuver as part of a structured infant hip exam include:

Earlier identification of abnormal hip mechanics before an infant is walking
Targeted follow-up (for example, repeat exams and/or imaging when appropriate)
Risk stratification when combined with history (breech position, family history) and other exam findings
Documentation of hip stability over time in a consistent clinical language (e.g., “reducible” vs “irreducible”)

It is important to note that the Ortolani maneuver is an exam finding, not a standalone diagnosis. Interpretation commonly depends on clinician experience, infant age, and whether other findings (limited abduction, asymmetry, imaging) are present.

Indications (When orthopedic clinicians use it)

Clinicians commonly consider the Ortolani maneuver in situations such as:

Routine hip screening in newborns and young infants
Follow-up physical exams when DDH risk factors are present (e.g., breech positioning, family history)
Evaluation of infants with asymmetric hip motion, such as limited abduction on one side
Assessment when there is concern for hip instability on prior exam (including a prior positive or equivocal finding)
Monitoring hip stability over time in infants already being observed for possible DDH (varies by clinician and case)

Contraindications / when it’s NOT ideal

The Ortolani maneuver is a gentle examination technique, but there are circumstances where it may be less informative, harder to interpret, or not appropriate.

Situations where it may not be ideal include:

Older infants: As infants grow and soft tissues tighten, the exam becomes less sensitive and a “clunk” may be absent even if dysplasia exists (varies by age and case).
Fixed (irreducible) dislocation: If the hip cannot be reduced, the classic Ortolani finding may not be present.
Significant pain or guarding: Pain with motion may indicate another condition where forceful testing is not appropriate.
Suspected fracture or recent trauma: Hip manipulation is generally avoided until evaluated.
Suspected infection or inflammatory condition involving the hip (e.g., concerning systemic illness with hip pain): clinicians typically prioritize urgent assessment rather than stability testing.
Post-operative or post-reduction precautions: After certain hip procedures, the exam approach is determined by the surgical team and the clinical context.

When the maneuver is less useful, clinicians may rely more on observation over time, range-of-motion assessment, and/or imaging (such as ultrasound in young infants, or radiographs later), depending on age and clinical scenario.

How it works (Mechanism / physiology)

Core biomechanical principle

The Ortolani maneuver assesses whether a dislocated femoral head can be gently guided back into the acetabulum (hip socket). A “positive” finding is traditionally described as a distinct reduction of the femoral head into the socket, sometimes felt as a “clunk” by the examiner.

Relevant anatomy (simplified but accurate)

Key structures involved include:

Femoral head: the ball at the top of the femur.
Acetabulum: the cup-shaped socket in the pelvis.
Capsule and ligaments: soft tissues that contribute to hip stability; in infants these can be relatively lax.
Labrum (including the limbus in infant hips): fibrocartilaginous rim that can affect stability and reduction mechanics.
Cartilage and growth centers: the infant hip is largely cartilaginous, which is one reason ultrasound can be helpful in this age group.

In DDH, the acetabulum may be shallow and the femoral head may sit partially or fully outside the socket. The maneuver attempts to determine whether the relationship is unstable but reducible, which carries different implications than a stable hip or a fixed dislocation.

Onset, duration, and reversibility (as applicable)

The Ortolani maneuver does not have an “onset” or “duration” in the way a medication does. It is an instantaneous physical exam finding observed at the time of testing. Its “reversibility” is best understood as whether the hip is reducible during the exam, which can change with age, muscle tone, and progression of dysplasia (varies by clinician and case).

Ortolani maneuver Procedure overview (How it’s applied)

The Ortolani maneuver is not a treatment procedure. It is a structured clinical examination technique performed by trained clinicians, typically during infant hip screening.

A high-level workflow often looks like this:

Evaluation/exam context – The clinician reviews basic risk factors (such as birth history and family history) and observes posture, leg motion, and symmetry.
Preparation – The infant is positioned comfortably, commonly lying on the back. – The clinician aims to keep the infant calm, because crying or muscle activation can make findings harder to interpret.
Intervention/testing (the maneuver) – The clinician gently positions the hips and knees in flexion and then carefully moves the thigh outward (abduction) while applying a directed lift to assess whether a displaced femoral head reduces into the socket. – The examiner is assessing for a distinct reduction sensation rather than a soft click that can come from tendons or soft tissues.
Immediate checks – Findings are typically compared side-to-side. – Range of motion (especially hip abduction) and general symmetry may be rechecked to support interpretation.
Follow-up – Depending on the overall picture, next steps may include repeat exams, referral, and/or imaging. Timing and approach vary by clinician and case.

Because this is a clinician-performed exam, interpretation depends on training and the infant’s age and cooperation. A single exam is often considered alongside other findings rather than in isolation.

Types / variations

The Ortolani maneuver itself is fairly standardized, but “variations” commonly refer to how it is combined with other exams, how it is documented, and the clinical context.

Common related approaches include:

Ortolani maneuver vs Barlow maneuver
The Barlow maneuver tests whether a hip is dislocatable (can be pushed out of the socket).
The Ortolani maneuver tests whether a hip is reducible (can be brought back into the socket).
They are often performed as complementary parts of infant hip screening.
Modified techniques (gentleness, positioning)
Clinicians may slightly adjust hand placement and the degree of motion to match infant size and comfort, while aiming to avoid excessive force.
Documentation may note “positive,” “negative,” or “equivocal,” and may specify whether a finding is a true “clunk” versus a nonspecific “click” (terminology can vary by clinician and case).
Exam combined with imaging
In many settings, the maneuver is used to determine whether ultrasound evaluation is warranted in a young infant, especially when risk factors are present.
Later in infancy, clinicians may rely more on radiographs because the hip is more ossified and exam sensitivity changes.
Screening vs diagnostic support
In primary care, it is frequently used as a screening component.
In orthopedics, it may be used as diagnostic support alongside imaging and serial exams.

Pros and cons

Pros

Noninvasive bedside assessment that can be performed quickly during a physical exam
Focuses on clinically meaningful instability (a dislocated hip that can be reduced)
Can support early identification of DDH when used with history and other exam findings
Does not require radiation or equipment
Encourages structured documentation of hip stability over time
Can be repeated at follow-up visits to track changes (varies by clinician and case)

Cons

Accuracy can vary with clinician experience and infant cooperation (varies by clinician and case)
Becomes less sensitive as infants get older and soft tissues tighten (age dependent)
A benign “hip click” from soft tissue can be confused with more significant findings in some cases
Does not directly measure acetabular shape or cartilage coverage (imaging may still be needed)
Not a treatment and does not define management by itself
May be difficult to interpret in complex presentations (e.g., limited motion from other causes)

Aftercare & longevity

Because the Ortolani maneuver is an exam finding rather than a treatment, “aftercare” refers to what typically influences follow-up planning and how long the clinical significance of a finding remains relevant.

Factors that can affect outcomes and next steps in general include:

Age at detection: Exam findings and imaging choices often differ between newborns and older infants.
Severity and type of instability: A reducible dislocation, a dislocatable hip, and isolated acetabular dysplasia are not identical patterns.
Consistency across exams: Some findings may be transient or equivocal, while others persist across visits.
Associated exam findings: Limited hip abduction, asymmetry, or limb length differences may influence concern levels.
Risk factors: Breech positioning, family history, and other clinical context may increase suspicion even if the exam is subtle.
Follow-up adherence: Keeping scheduled reassessments and imaging appointments can affect how promptly DDH is clarified (general informational point).
Comorbidities or neuromuscular conditions: These can influence hip stability and exam interpretation (varies by case).

In practice, the “longevity” of the maneuver’s usefulness is tied to developmental timing: it is most discussed in early infancy, while later assessments may rely more on range-of-motion limits and imaging rather than a classic reduction “clunk.”

Alternatives / comparisons

The Ortolani maneuver is one component of a broader approach to infant hip assessment. Common comparisons include:

Observation/monitoring vs immediate imaging
Some infants with mild or uncertain findings may be monitored with repeat physical exams, while others proceed to ultrasound sooner based on risk factors and exam results.
The choice and timing vary by clinician and case.
Physical exam vs ultrasound
The Ortolani maneuver evaluates dynamic stability felt during motion.
Ultrasound can evaluate hip morphology and coverage in a largely cartilaginous infant hip and can also assess stability dynamically when performed that way.
Ultrasound is commonly used when the exam is positive, equivocal, or risk factors are significant.
Physical exam vs radiographs (X-rays)
Radiographs are less useful very early because much of the hip is cartilage, but they become more informative as ossification progresses.
The maneuver and radiographs answer different questions: stability on exam versus bony alignment and acetabular development.
Ortolani maneuver vs Barlow maneuver
Barlow: attempts to provoke displacement (dislocatable hip).
Ortolani: attempts to reduce an already displaced hip (reducible dislocation).
Together, they provide a more complete picture of instability patterns.
Screening exam vs comprehensive orthopedic evaluation
Primary care screening focuses on early detection.
Orthopedic assessment often integrates serial exams, imaging interpretation, and classification frameworks for DDH (details vary by clinician and case).

Ortolani maneuver Common questions (FAQ)

Q: Is the Ortolani maneuver painful for the baby?
It is designed to be a gentle exam, and many infants tolerate it without obvious distress. However, babies may cry during any handling, and discomfort can vary. If an infant appears to have significant pain with hip motion, clinicians typically consider other causes and adjust the evaluation.

Q: What does a “positive” Ortolani maneuver mean?
A positive Ortolani maneuver classically indicates the clinician felt the femoral head reduce back into the socket during the test. This suggests a dislocated but reducible hip and raises concern for DDH. The finding is generally interpreted alongside other exam features and, often, imaging.

Q: Is an Ortolani “click” the same as a “clunk”?
Clinicians often distinguish a soft, nonspecific “click” (which can come from tendons or soft tissues) from a more distinct “clunk” associated with reduction. The terms can be used differently across clinicians, which is why context and follow-up evaluation matter. When uncertainty exists, additional assessment may be used (varies by clinician and case).

Q: How is the Ortolani maneuver different from the Barlow maneuver?
They assess different directions of instability. The Barlow maneuver tests whether the hip can be gently displaced out of the socket (dislocatable), while the Ortolani maneuver tests whether a displaced hip can be reduced back in (reducible). They are commonly used together during infant hip screening.

Q: Does a normal Ortolani maneuver rule out DDH?
Not always. Some forms of DDH involve acetabular shallowness without a clear instability “clunk,” and the exam becomes less sensitive as infants get older. Clinicians may still consider imaging or follow-up if risk factors or other exam findings are present.

Q: What happens after an abnormal finding?
Next steps commonly include repeat examination, referral, and/or imaging such as ultrasound in young infants. The goal is to clarify whether the hip is truly unstable or dysplastic and to document severity. The exact pathway varies by clinician and case.

Q: How long do the results “last”?
The Ortolani maneuver reflects hip stability at the moment of the exam. Hip stability can change over time as an infant grows, muscle tone changes, and the joint develops, so repeat assessments may be used. Clinicians typically interpret the finding in a time-sensitive developmental context.

Q: Is the Ortolani maneuver safe?
When performed properly by trained clinicians, it is generally considered a gentle, standard part of infant musculoskeletal screening. Like any physical exam maneuver, it should be done carefully and appropriately for the situation. If there are concerns like pain, trauma, or infection, clinicians may avoid provocative testing.

Q: Can parents perform the Ortolani maneuver at home?
It is a clinician-performed assessment because interpretation depends on training and subtle tactile feedback. Non-clinicians may misinterpret normal soft tissue sounds or miss important findings. If a parent has concerns about hip motion or asymmetry, clinicians typically recommend professional evaluation rather than home testing.

Q: What does the Ortolani maneuver cost?
It is usually part of a standard newborn or infant physical examination, so it may not be billed separately. Overall cost considerations depend on the healthcare setting, insurance coverage, and whether follow-up imaging or specialist evaluation is needed. Details vary by region and case.