Symptoms
A twisting of the testicle is usually accompanied, especially in young adulthood, by a sudden onset of severe pain in the affected scrotum. The testicle is very sensitive to touch and pressure painful. Every touch often aggravates the pain.
The unpleasant pain can also radiate through the inguinal canal into the lower half of the abdomen. Therefore, sometimes the search for the cause of the pain can be misleading. Nausea, vomiting and heavy sweating can also occur.
Due to the severe pain, the heart rate often increases in patients. Due to the twisting of the spermatic cord, the supply of blood to the testicles is disrupted. On the one hand, this leads to a discoloration of the affected testicle to blue-purple, on the other hand, the accumulated blood can no longer drain off.
After some time the injured testicle will swell increasingly.A swelling of the injured testis can usually be recognized by the fact that the typical folding of the testis is gradually lifted. A twisted testicle should be recognized as soon as possible and treated directly, since without a secure blood supply to the organ, the testicle can eventually die. A testicular torsion can also occur without pain.
A short-term relief of pain can also be achieved, for example if the blood circulation is restored in the short term. This process often occurs in the case of an incomplete torsion of the testicle. The symptoms then subside temporarily and come back insidiously.
If the patient initially has no pain at all, they can then develop increasingly. Painless torsion of the testis may also be present if it was already present before birth. The children then usually have a reddened and hardened testicle.
Diagnosis
Often a twisted testicle can be diagnosed very well without the need for many examinations. The symptoms and signs are in most cases clear. Nevertheless, a twisted testicle can also be atypical.
Accompanying symptoms such as nausea and vomiting or also increased radiation of the pain into the abdominal area, may initially indicate another cause. The physician should also think of a twisted testicle and can perform further diagnostics. Thus, certain parameters in the blood can be determined, which help to distinguish a testicular torsion from an inflammation of the epididymis.
In case of an acute inflammation certain values such as CRP, the leucocytes and the blood sedimentation rate increase rapidly. They are typical inflammation parameters. If the testis is twisted, they would only slowly increase much later.
Furthermore, there are various imaging techniques available to confirm the diagnosis. The ultrasound of the testis is a very popular method. The testicle can be displayed together with its condition and blood circulation.
In Doppler sonography, the vessels can be assessed even more precisely, since the blood flow is measured here. Typically, the blood flow is reduced or even completely occluded when the testicle is twisted. A scintigraphy of the testis can also be performed.
In this case the patient is administered a radioactive contrast medium. Due to the radioactive substance, the distribution of the substance in the body can be measured, including the testicle. Since the supply of the testicle is disturbed when it is twisted, the distribution of the contrast medium in the affected testicle is also delayed or even completely absent.
This examination method is time-consuming, which is why it is not often used when a twisted testicle is suspected, as in such cases quick action is required. In the worst case, a twisted testicle can mean the loss of the organ. It is therefore all the more important that twisting of the testicle is quickly detected and treated accordingly.
There are some examinations and signs that the doctor can observe and possibly indicate a torsion of the testicle. They occur in addition to the typical symptoms such as pain, swelling and reddening of the testicle and can additionally confirm the diagnosis. If there is torsion, the pain does not subside when the scrotum is lifted.
In this case we speak of a negative Prehn’s sign, which is typical for torsion. This test is also done in the case of epididymitis. In the case of inflammation, the lifting of the testicle causes an improvement of the symptoms, the Prehn’s sign is then positive.
Another sign of torsion is the Brunzel sign. Here the twisted testicle is pulled upwards by the contraction of the cremasteric muscle in the inguinal canal. The patient may also experience pain during this procedure.
Due to this reflex tensing of the muscle, the reflex (cremasteric reflex) on the opposite side can no longer be triggered, since the muscles are also tensed here. The cremasteric reflex describes the reflex-like tensing of the muscle after the inner side of the thigh has been coated, causing the testicle to be pulled upwards. The Tenkhoff sign is a soft audible crackling sound that occurs when the twisted testicle is touched. It is considered a rather late indication of a torsion of the testis.