Ortolani Maneuver: Sensitivity and Specificity

Introduction: None written. Excerpt from the entry in Congenital Hip Dysplasia:
For the examinations, the infant's hips are flexed to 90 degrees; the thumbs of the examiner are placed on the medial proximal thigh, and the long fingers are placed over the greater trochanter. For the Ortolani maneuver, the contralateral hip is held still while the thigh of the hip being tested is abducted and gently pulled anteriorly. The sensation of instability in a positive Ortolani maneuver is the palpable and sometimes audible "clunk" of the femoral head moving over the posterior rim of the acetabulum and relocating in the cavity. The more poorly developed the acetabulum (and thus the more unstable the hip), the less pronounced the "clunk." Consequently, the Ortolani maneuver must be performed very gently to avoid obscuring the sound of the femoral head passing over a poorly developed posterior acetabulum. Audible high-pitched "clicks" without a sensation of instability have no pathologic significance.

This exam have very limited sensitivity in inexperienced hands.