PAINE #PANCE Pearl – Genitourinary



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

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