Barlow Test | Developmental dysplasia of the hip

Barlow Test is used in evaluation of Developmental dysplasia of the hip DDH in newborn along with Ortolani test.

How do you perform the Barlow Test?

With the infant supine, the examiner passively flexes one leg, immobilizing the pelvis. The other hand grasps the knee and thigh of the leg to be examined in such a manner that the index finger and thumb rest inferior to the inguinal fold.

With the thigh initially in extreme adduction, the examiner carefully exerts axial pressure while simultaneously pressing the thigh into abduction from the medial side. The fingers provide controlled resilient resistance to this motion. Instability in the hip will be palpable as the direction of force changes between the fingers and thumb.

See Also: Ortolani Test

What does a positive Barlow Test mean?

If the hip is dislocatable — that is, if the hip can be popped out of socket with this maneuver — the Barlow Test is considered positive.

The Ortolani maneuver is then used, to confirm the positive finding (i.e., that the hip actually dislocated).

Sensitivity & Specificity

• Sensitivity: 66 %
• Specificity: 95 %

Barlow and Ortolani Test

The examiner attempts to reduce the dislocation or subluxation using the Ortolani and Barlow maneuvers.

• With the newborn supine, the clinician places the tips of the long and index fingers over the greater trochanter, with the thumb along the medial thigh. The infant’s leg is positioned in neutral rotation with 90 degrees of hip flexion and is gently abducted while lifting the leg anteriorly. With abduction one can feel a clunk, as the femoral head slides over the posterior rim of the acetabulum and into the socket. This is the clunk originally described by Ortolani, and is called the sign of entry, as the hip relocates with this maneuver.

• Maintaining the same position, the leg is then gently adducted, while gentle pressure is directed posteriorly on the knee, and a palpable clunk is noted as the femoral head slides over the posterior rim of the acetabulum and out of the socket. This clunk was originally described by Barlow, and is called the sign of exit, as the hip dislocates with this maneuver.

Both tests are designed to detect motion between the femoral head and the acetabulum.

The reproducibility of these tests is dependent on ligamentous or capsular laxity, which usually disappears by the age of 10–12 weeks.

Reference

1. Barlow TG: Early diagnosis and treatment of congenital dislocation of the hip. J Bone Joint Surg Br 44:292–301, 1962. PMID: 14080075
2. Aronsson DD, Goldberg MJ, Kling TF, et al: Developmental dysplasia of the hip. Pediatrics 94:201–208, 1994.
3. Cooperstein R, Haneline M, Young M. Mathematical modeling of the socalled Allis test: a field study in orthopedic confusion. Chiropr Osteopat. 2007 Jan 22;15:3. doi: 10.1186/1746-1340-15-3. PMID: 17241470; PMCID: PMC1796883.
4. Clinical Tests for the Musculoskeletal System 3rd Edition.
5. Dutton’s Orthopaedic Examination, Evaluation, And Intervention 3rd Edition.