Testicular Inflammation (Orchitis): Examination

A comprehensive clinical examination is the basis for selecting further diagnostic steps:

  • General physical examination – including blood pressure, pulse, body temperature, body weight, body height; furthermore:
    • Inspection (viewing).
      • Skin and mucous membranes [Purpura Schoenlein-Henoch (Purpura anaphylactoides) – spontaneous small skin hemorrhages, especially in the area of the lower legs (pathognomonic/disease characteristic), occurring mainly after infections or due to drugs or food; the epididymis or testis is often enlarged]
    • Inspection and palpation (palpation) of the abdomen (belly), inguinal region (groin region), etc. [thickened swelling in the inguinal canal area may indicate incarcerated inguinal hernia] [tenderness?, tapping pain?, release pain?, coughing pain?, defensive tension?, hernial orifices?, renal bed knocking pain?].
    • Inspection and palpation of the genitals (penis and scrotum) [testicular location, size, and painfulness compared to the opposite side or where is the punctum maximum of pain):
      • [Orchitis: there is a reddened and swollen scrotum (scrotum); palpatorily, there is enlargement/swelling (edema), induration, and tenderness of the testis; Prehn’s sign is usually positive; however, this is not definite clinical evidence of orchitis
      • Testicular torsion: dark blue to black discoloration of the testis; often the testis is fixed on the affected side close to the body or lies transversely, due to the torsion of the shortened spermatic cord/Brunzel’s sign: fixed, painful, horizontal protrusion of the testis in the presence of testicular torsion]

      [due toDifferential diagnosis “hydatidentorsion”: in a diaphanoscopy (fluoroscopy of the scrotum with light) are often found in such cases so-called “blue dot sign” (bluish shimmering structures), as an indication of a circulatory disorder of the appendices of the testis or epididymis].

    • Digital rectal examination (DRU): examination of the rectum and adjacent organs with the finger by palpation: assessment of the prostate in size, shape and consistency.

Square brackets [ ] indicate possible pathological (pathological) physical findings.

The following signs are suitable for differential diagnosis of testicular torsion or orchitis:

  • Cremasteric reflex (testicular elevator reflex; trigger: brushing the inner thigh) – the cremasteric reflex is abolished [may be absent in testicular torsion].
  • Prehn’s sign:
    • Positive: when lifting the testicle, the pain decreases, indicating orchitis or epididymitis.
    • Negative: when lifting the testicle, the pain increases or remains unchanged, which is the case, for example, with testicular torsion
  • Gersche’s sign – retractions of the scrotal skin at the base of the scrotum [indicating an early stage of testicular torsion].