In the Bursal Test, the iliopectineal (iliopsoas) bursa is stressed using which hip position?

• A. Hyperflexion-External Rotation
• B. Hyperextension-Internal Rotation
• C. Flexion-Adduction-External Rotation
• D. Flexion-Adduction-Internal Rotation

Answer: (A)

Stressing the iliopectineal (iliopsoas) bursa is best achieved by placing the hip in a position that maximizes tension on the iliopsoas tendon and brings the bursa into contact with surrounding structures. When the hip is hyperflexed, the iliopsoas tendon is stretched over the anterior hip region, and adding external rotation further tenses the tendon and shifts it across the anterior aspect of the joint. This combination compresses and irritates the bursa between the tendon and the femur, making any bursitis or inflammation within the iliopectineal bursa reproduce pain.

Other positions don’t place the same amount of stretch and compression on the anterior bursa. Hyperextension-relating positions relieve tension on the iliopsoas tendon, and flexion with adduction or internal rotation does not maximize anterior stress on the bursa the way hyperflexion with external rotation does.