A Hip Click: Normal Finding vs. Hip Dislocation

12/24/2007

I saw a two month old in my office today for a routine well visit. On exam, I noticed that her left hip had a moderate “click” during an Ortolani’s maneuver. This is part of a normal newborn exam whereby the pediatrician gently moves the hips along the normal lines of movement. Often newborns have a normal instability as a result of their tucked and bent position in utero. Add to that the presence of a maternal hormone called Relaxin, which allows Mom’s muscles to relax enough to allow passage of the newborn through the birth canal. This combination of hip flexion in utero and circulating maternal hormone Relaxin allows for loose hips.

A hip click can simply indicate a slightly loose but normal hip or it can indicate a hip that is too far out of place or dislocated. On occasion, a click can be a sign of hip dysplasia, a hip that did not develop normally. If a click or a clunk is palpated by the practitioner, a referral to a pediatric orthopedist or a radiologist might be necessary. The gold standard once a hip dislocation is suspected is a hip sonogram. This study allows a diagnosis without the radiation exposure of an x-ray examination.

Clicks are often found on routine newborn exams. It is only a very small number of them that ever require referral or work-up. Generally, the normal movement clicks that are part of a relaxed hip, disappear in the first two months. There is also a quality to the click or clunk that raises suspicion. On rare occasion, no click is detected and the dislocation is only discovered later on. These are much less common and can be very difficult to detect. The sonogram should be of both hips so that the radiologist can use the normal hip for comparison. If the study is normal, no further action is needed.

If the study shows a dislocation, a Pavlik harness is usually indicated.  The baby must wear the harness until the hip strengthens and moves back into normal position. It is usually prescribed and fitted by a pediatric orthopedist and worn for several months. The baby that I saw today was referred to a pediatric orthopedist for further evaluation. The likelihood is that this finding will turn out to be a normal variant and no action will be necessary.

      

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