During the Barlow maneuver, where should the examiner place the thumb to apply pressure?

• A. Over the lesser trochanter
• B. Over the greater trochanter
• C. On the femoral head
• D. On the iliac crest

Answer: (A)

Barlow tests hip stability by trying to dislocate a hip that is otherwise unstable. The maneuver uses adduction with the thigh flexed to about 90 degrees and applies a gentle, posteriorly directed pressure on the femur. Placing the thumb over the lesser trochanter positions your hand to push the femoral head posteromedially out of the acetabulum if instability exists. The lesser trochanter is the medial posterior part of the femur where this pressure can effectively translate the head, whereas pressing over the greater trochanter changes the vector and is less effective for dislocation. Pressing directly on the femoral head or on the iliac crest wouldn’t produce the same posterior translation needed to reveal a dislocatable hip.