A comprehensive clinical examination is the basis for selecting further diagnostic steps:
- General physical examination – including blood pressure, pulse, body weight, height; furthermore:
- Inspection (observation) and palpation (palpation) of the genitals (testicular position, size, and painfulness compared to the opposite side or where is the punctum maximum of pain); dark blue to black discoloration of the testis; often the testis on the affected side is fixed close to the body or lies transversely, due to 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 hydatid torsion: 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].
- Inspection and palpation of the inguinal region: a thickened swelling in the region of the inguinal canal may indicate an incarcerated inguinal hernia
- Inspection of the skin, here in particular the lower legs due topossible petechiae (flea-like bleeding), which are pathognomonic (indicative of the diagnosis of a disease) for a purpura Schoenlein-Henosch
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].