Last reviewed: 16 Dec 2020
Last updated: 10 Jun 2020



History and exam

Key diagnostic factors

  • testicular pain
  • intermittent or acute on-and-off pain
  • no pain relief upon elevation of scrotum
  • scrotal swelling or oedema
  • scrotal erythema
  • reactive hydrocele
  • high-riding testicle
  • horizontal lie
  • absent cremasteric reflex

Other diagnostic factors

  • nausea and vomiting
  • abdominal pain
  • fever
  • urinary frequency

Risk factors

  • age under 25 years
  • neonate
  • bell clapper deformity
  • trauma/exercise
  • intermittent testicular pain
  • undescended testicle
  • cold weather

Diagnostic investigations

1st investigations to order

  • grey-scale ultrasound
  • power Doppler ultrasound
  • colour Doppler ultrasound
More 1st investigations to order

Investigations to consider

  • spectral Doppler
  • urinalysis
  • FBC
  • CRP
  • scintigraphy
More investigations to consider

Treatment algorithm


Professor of Surgery

Department of Surgery

UC San Diego School of Medicine

San Diego



GK declares that he has no competing interests.

Dr George Kaplan would like to gratefully acknowledge Dr Deborah Dean and Dr Paul Hamilton, the previous contributors to this monograph. DD and PH declare that they have no competing interests.

Peer reviewersVIEW ALL

Associate Professor

Division of Pediatric Urology

Cincinnati Children's Hospital Medical Center




EM declares that he has no competing interests.

Consultant Pediatric Surgeon/Urologist

Alder Hey Children's NHS Foundation Trust




SEK declares that he has no competing interests.

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