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