A 10-year-old boy with sprinting-induced acute scrotal pain. Which examination finding most indicates testicular torsion?

A 10-year-old boy with sprinting-induced acute scrotal pain. Which examination finding most indicates testicular torsion?

• A. Absence of cremasteric reflex
• B. Presence of cremasteric reflex
• C. Pain relieved by scrotal elevation
• D. Positive Prehn sign

Answer: (A)

In an acute scrotal emergency, the cremasteric reflex provides a quick clue about torsion. The cremasteric reflex is produced when the inner thigh is stroked, causing the same-side testicle to rise. If torsion has compromised the nerves or blood flow to the testis, this reflex often disappears on the affected side. Therefore, absence of the cremasteric reflex strongly points to testicular torsion and demands urgent evaluation and management to save the testicle. The other findings are less reliable for torsion. A present cremasteric reflex makes torsion unlikely. Pain relief with scrotal elevation (the Prehn sign) is not a dependable indicator and is more typically associated with epididymitis; a positive Prehn sign would argue against torsion.

In an acute scrotal emergency, the cremasteric reflex provides a quick clue about torsion. The cremasteric reflex is produced when the inner thigh is stroked, causing the same-side testicle to rise. If torsion has compromised the nerves or blood flow to the testis, this reflex often disappears on the affected side. Therefore, absence of the cremasteric reflex strongly points to testicular torsion and demands urgent evaluation and management to save the testicle.

The other findings are less reliable for torsion. A present cremasteric reflex makes torsion unlikely. Pain relief with scrotal elevation (the Prehn sign) is not a dependable indicator and is more typically associated with epididymitis; a positive Prehn sign would argue against torsion.