---

---

Question

This one is a quick one this week. When evaluating a patient with testicular pain (either acute or chronic), what are the specific physical examination techniques you can perform and what conditions do they help rule in/out?

---

---

Answer

1. Position of the Testicle
   • Side-lying (long axis transverse) position suggests testicular torsion
     • also called the “Bell Clapper” deformity
2. Cremesteric Reflex
   • Pinching the skin of the upper thigh causes elevation of testes
     • If absent, suggests testicular torsion
3. Blue Dot Sign
   • Tender nodule with blue discoloration on the upper pole of the testes
     • If present, suggests appendix testes torsion
4. Prehn Sign
   • Manual elevation of testes relieves the pain
     • If positive, suggests epididymitis
5. Transillumination
   • In evaluating scrotal swelling, ability to transilluminate the scrotum suggests hydrocele.
   • If unable to transilluminate, suggests varicocele or mass