Barlow maneuver: Definition, Uses, and Clinical Overview

Barlow maneuver Introduction (What it is)

The Barlow maneuver is a hands-on clinical exam used to check hip stability in infants.
It helps clinicians identify a hip that can be gently dislocated with specific positioning and pressure.
It is most commonly used in newborn and early infancy screening for developmental dysplasia of the hip (DDH).
It is often discussed alongside the Ortolani maneuver, which assesses hip reduction.

Why Barlow maneuver used (Purpose / benefits)

The main purpose of the Barlow maneuver is early detection of hip instability in babies, particularly instability related to developmental dysplasia of the hip (DDH). DDH is an umbrella term that can include a shallow hip socket (acetabular dysplasia), a loose or unstable hip, or a hip that is partially or fully dislocated.

In simple terms, the maneuver is designed to answer a specific clinical question: “Can this hip be pushed out of the socket under gentle stress?” If a hip is “dislocatable,” it suggests the joint is unstable and may need closer monitoring, repeat exams, and sometimes imaging.

Potential benefits of using the Barlow maneuver in routine infant care include:

• Screening at the bedside without equipment, especially during newborn exams.
• Earlier recognition of concerning hip laxity, which may support timely follow-up.
• Guiding next steps (for example, whether to repeat exams or consider ultrasound in the appropriate age range).
• Standardizing hip checks as part of routine well-baby assessments, especially when risk factors are present.

The Barlow maneuver is not a treatment. Its value is in detection and clinical decision support, and interpretation varies by clinician and case.

Indications (When orthopedic clinicians use it)

Orthopedic and pediatric clinicians typically use the Barlow maneuver in scenarios such as:

• Routine newborn physical examination shortly after birth
• Well-baby visits during early infancy (especially in the first weeks)
• Infants with risk factors for DDH, such as:
• Breech positioning during pregnancy or delivery
• Family history of DDH in a first-degree relative
• Known “packaging” issues (limited space in the womb), which can vary by clinician and case
• When there is clinical concern based on exam findings, such as:
• Asymmetry in hip motion (for example, differences in abduction)
• A history of hip “click” or perceived instability noted by a clinician (recognizing that clicks can be benign and nonspecific)

Contraindications / when it’s NOT ideal

The Barlow maneuver is a provocative stability test, meaning it intentionally applies a gentle stress to see whether the hip can be displaced. Because of that, it may be not ideal or deferred in certain situations, including:

• Known hip dislocation already identified on exam or imaging (clinicians may prioritize different assessments, such as evaluating reducibility)
• Significant infant distress where a calm, controlled exam is not possible (test reliability can drop)
• Suspected fracture or acute injury around the pelvis or femur (a different approach may be chosen)
• Neuromuscular or syndromic conditions that change baseline hip stability (interpretation and exam strategy can vary by clinician and case)
• Later infancy, when the maneuver may become less informative and clinicians may rely more on range-of-motion findings and imaging (exact age thresholds vary by clinician and case)
• Situations where repeated provocative testing is not desired; clinicians may favor imaging-based assessment (for example, ultrasound in young infants) rather than repeated stress maneuvers

When the Barlow maneuver is not suitable, another approach may be preferred, such as focused range-of-motion assessment, the Ortolani maneuver (when appropriate), or age-appropriate imaging.

How it works (Mechanism / physiology)

The Barlow maneuver is based on basic hip biomechanics and infant hip anatomy.

Key anatomy involved

• Femoral head: the “ball” at the top of the thigh bone.
• Acetabulum: the “socket” portion of the pelvis.
• Hip capsule and ligaments: soft tissues that help stabilize the joint.
• Labrum (cartilage rim): contributes to socket depth and stability.

Biomechanical principle In some infants, the acetabulum is relatively shallow and/or the soft tissues are relatively lax. This can allow the femoral head to move excessively. During the Barlow maneuver, the clinician positions the hip in a way that can reveal instability by applying gentle posteriorly directed pressure while the hip is flexed and adducted (moved toward the midline). If the femoral head can be displaced out of the socket, that suggests a dislocatable hip.

What a “positive” finding generally means A classic positive finding is often described as a palpable shift or “clunk” as the femoral head moves out of the socket under the applied stress. Not every sound or sensation is meaningful; clinicians often distinguish between:

• A deeper, more concerning “clunk” (suggesting displacement of the femoral head), and
• A softer “click” (which can come from tendons or soft tissues and may be less specific)

Onset, duration, and reversibility The Barlow maneuver does not have an onset/duration like a medication. It is a moment-in-time exam finding. Hip instability in infancy can change over time as tissues tighten, growth occurs, or treatment is provided when needed—so the significance of a finding depends on age, clinical context, and follow-up.

Barlow maneuver Procedure overview (How it’s applied)

The Barlow maneuver is not a procedure in the surgical sense. It is a structured clinical exam maneuver performed during an infant hip assessment.

A typical high-level workflow looks like this:

1. Evaluation/exam – The clinician reviews relevant history (birth presentation such as breech, family history, prior exam findings). – The infant’s hips are assessed for symmetry of motion and overall comfort.

2. Preparation – The infant is placed in a stable position, commonly lying on the back. – The clinician aims to keep the infant calm, since muscle tension and movement can affect what is felt.

3. Intervention/testing – The hip is positioned in flexion, then gently moved toward adduction. – A controlled posteriorly directed force is applied through the thigh to assess whether the femoral head can be displaced from the socket. – The clinician compares the feel of both hips.

4. Immediate checks – The clinician notes whether the test feels clearly negative, clearly positive, or equivocal. – If there is concern, the clinician typically considers the full exam (including the Ortolani maneuver and range-of-motion findings) rather than relying on one sign.

5. Follow-up – Depending on the exam and risk factors, next steps may include repeat exams at future visits and/or imaging (often ultrasound in young infants, with radiographs used later), and referral pathways vary by clinician and case.

This overview is intentionally general. Exact hand placement and interpretation details are taught in clinical training and can vary.

Types / variations

The term Barlow maneuver is sometimes used interchangeably with Barlow test, and there are practical variations in how it is used in real clinical settings.

Common variations and related concepts include:

• Screening vs targeted examination
• Screening use: performed as part of routine newborn or early-infant exams.

• Targeted use: performed when risk factors or prior findings raise suspicion for DDH.

• Barlow vs Ortolani pairing

• The Barlow maneuver assesses whether a hip can be dislocated with stress (dislocatable/unstable).
• The Ortolani maneuver assesses whether a displaced femoral head can be reduced back into the socket (reducible dislocation).

• Many clinicians consider both maneuvers complementary rather than interchangeable.

• “Gentle stress” vs more conservative handling

• Some clinicians emphasize very light, minimal stress—especially if a prior exam suggested instability—to avoid unnecessary provocation.

• The intensity and repetition of maneuvers can vary by clinician and case.

• Exam plus imaging pathways

• In some care pathways, clinical exam findings are integrated with imaging (often ultrasound in early infancy) to clarify anatomy and stability.
• Imaging choices are age-dependent and practice-dependent.

Pros and cons

Pros:

• Noninvasive bedside assessment that requires no equipment
• Can help identify hip instability early in infancy
• Quick to perform as part of a routine infant physical exam
• Helps guide whether closer monitoring or imaging may be appropriate
• Often paired with other exam elements for a more complete hip assessment
• Supports standardized documentation of hip stability findings

Cons:

• Accuracy depends on examiner experience and infant relaxation
• Findings can be subtle; false positives and false negatives can occur
• Less useful as infants grow and soft tissue tightness increases (timing varies by clinician and case)
• A “click” can be nonspecific and may create uncertainty without other findings
• Does not directly show hip anatomy; may need imaging for clarification
• Provocative nature means clinicians typically avoid excessive force or repetition

Aftercare & longevity

Because the Barlow maneuver is an exam maneuver—not a treatment—there is no direct “aftercare” like there would be after surgery or an injection. However, the outcome of the exam often influences what happens next.

What commonly affects next steps and longer-term outcomes (in general terms) includes:

• Severity and type of hip instability
• A mildly unstable hip may be monitored differently than a clearly dislocatable or dislocated hip.
• Infant age at the time of detection
• Hip stability and the usefulness of certain exam findings can change as an infant grows.
• Consistency of follow-up
• Repeat physical exams and, when indicated, imaging help clarify whether hip stability is improving, unchanged, or worsening.
• Associated risk factors
• Breech presentation and family history may influence the threshold for imaging or referral, though practices vary.
• Imaging findings (when obtained)
• Ultrasound can help assess socket shape and femoral head position in younger infants; later, radiographs may be used depending on age and clinical context.
• If treatment is required
• Longevity of results depends on diagnosis and treatment approach (for example, bracing vs other interventions), and treatment choices vary by clinician and case.

In short, the “longevity” here relates to how the infant’s hip stability evolves over time and how consistently the healthcare team can reassess it.

Alternatives / comparisons

The Barlow maneuver is one component of infant hip assessment. Clinicians often use it alongside or in comparison with other approaches:

• Ortolani maneuver
• Focus: reducibility (whether a displaced femoral head can be guided back into the socket).

• Comparison: Barlow looks for a hip that can be pushed out; Ortolani looks for a hip that can be put back in. They answer different questions and are often used together.

• Range-of-motion and symmetry assessment

• Limited hip abduction or asymmetry can raise suspicion, particularly as infants get older.

• This can be helpful when the classic instability signs are less apparent.

• Observation/monitoring with repeat exams

• Some mild or equivocal findings may be followed over time with repeated physical exams.

• The choice to monitor versus image promptly varies by clinician and case.

• Ultrasound (in younger infants)

• Provides an anatomic view of the developing hip joint before the bones are fully ossified.

• Often used when risk factors exist or when the physical exam is concerning or unclear.

• Radiographs (X-rays) in later infancy

• As bones mature, radiographs become more informative for assessing hip alignment and socket development.
• Timing and indications depend on age and clinical practice patterns.

No single approach fits every infant. Many clinicians integrate history, exam maneuvers, and imaging when needed.

Barlow maneuver Common questions (FAQ)

Q: Is the Barlow maneuver painful for a baby?
The maneuver is intended to be gentle. Babies may cry during an exam for many reasons (cold hands, being handled, hunger), and crying does not automatically mean pain. If an infant appears very uncomfortable, clinicians may adjust the exam approach.

Q: What does a “positive” Barlow maneuver mean?
A positive Barlow maneuver generally suggests the hip is unstable and can be displaced from the socket under gentle stress. It does not by itself define the full diagnosis or severity. Clinicians usually interpret it along with the rest of the hip exam and, when indicated, imaging.

Q: What is the difference between a hip “click” and a “clunk”?
In clinical teaching, a “clunk” is often used to describe a more substantial shift that may reflect the femoral head moving in relation to the socket. A “click” can come from soft tissues like tendons and may be less specific. The distinction can be subtle and varies by clinician and case.

Q: How long does the Barlow maneuver take?
It is a brief part of a larger newborn or infant physical exam. The maneuver itself typically takes only moments, but clinicians often repeat gentle assessments and compare both hips.

Q: If the Barlow maneuver is normal, does that rule out DDH?
A normal exam is reassuring, but it does not eliminate all possibility of DDH. Some forms of dysplasia involve socket shape more than obvious instability, and findings can evolve with growth. Clinicians may still consider risk factors and follow-up schedules.

Q: If the Barlow maneuver is abnormal, what happens next?
Next steps commonly include a repeat exam, consideration of age-appropriate imaging (often ultrasound in younger infants), and possible referral to a specialist. The exact pathway varies by clinician and case.

Q: How much does an exam like this cost?
The maneuver is part of a routine physical exam, so cost typically depends on the visit type, healthcare system, and insurance coverage. If imaging or specialist evaluation is needed, costs can change accordingly. Specific pricing varies widely by region and setting.

Q: Is the Barlow maneuver considered safe?
When performed correctly, it is widely taught as a standard component of infant hip screening. Clinicians typically emphasize gentle technique and avoid excessive force or repeated provocative testing. As with any physical exam maneuver, interpretation and technique vary by clinician and case.

Q: Can a baby resume normal activity after the exam?
Yes. Since it is an exam maneuver and not a treatment, there is usually no activity restriction related to the maneuver itself. If follow-up evaluation identifies a hip condition requiring management, activity considerations would relate to that plan rather than the exam.

Q: Does the Barlow maneuver affect crawling, walking, or weight-bearing later on?
The maneuver itself does not change development. The underlying issue being screened—hip instability or dysplasia—can be relevant to long-term hip development if not recognized and managed appropriately. How any individual child is affected varies by clinician and case.