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Am Fam Physician. 2022;106(6):712-713

This clinical content conforms to AAFP criteria for CME.

Author disclosure: No relevant financial relationships.

Clinical Question

How accurate are history and physical examination in diagnosing testicular torsion?

Evidence Summary

Testicular torsion has an annual incidence of approximately 1 in 4,000 males younger than 25 years.1 It is more common in children and adolescents, and delayed repair can result in the loss of the testis.1 Therefore, prompt and accurate diagnosis is important when patients present with acute scrotal or testicular pain.

Testicular torsion typically presents with unilateral scrotal pain that begins suddenly. Individual clinical findings that best predict testicular torsion include nausea and vomiting, past trauma, a tender testicle, an abnormal testicular lie (i.e., elevated or transverse), and an absent cremasteric reflex.2,3 This reflex is triggered by gently scraping the medial thigh adjacent to the testis and looking for the testicle to retract. The patient must be comfortable and the examination room should be warm for this finding to be observed.

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This guide is one in a series that offers evidence-based tools to assist family physicians in improving their decision-making at the point of care.

This series is coordinated by Mark H. Ebell, MD, MS, deputy editor for evidence-based medicine.

A collection of Point-of-Care Guides published in AFP is available at

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