Clinical assessment and risk stratification

Typically this is of acute unilateral scrotal pain, which is often distressing with nausea and associated abdominal pain. However, this is dependent on the degree of torsion. In those with the ‘bell clapper’ deformity, there may be a history of intermittent torsion where the testis torsion and detorsion spontaneously.

There is typically a unilateral swollen and tender testicle, with potentially a horizontal (rather than vertical) lie. Where one testicle rides higher than the other (and normally does not), this has an odds ratio of 59 (2) of torsion.

Another clinical sign to assess for includes absence of cremasteric reflex (OR 28(2)) where the normal response is contraction of cremaster and upward movement of the ipsilateral testicle on light stroking of the superomedial inner thigh.