Page 280 - ATP-P 11th Ed

TESTICULAR PAIN PROTOCOL

SPECIAL CONSIDERATIONS
1. The primary concern in testicular pain is differentiating testicular torsion from
other causes of testicular pain.
2. Testicular torsion is an medical emergency requiring urgent correction to prevent
loss of the affected testicle.
SECTION 2 tions commonly caused by STDs, as well as hernias and testicular masses.
3. Other common causes of testicular pain include epididymitis and orchitis, infec-

Signs and Symptoms
1. Testicular Torsion:
a. Sudden onset testicular pain
b. Usually associated with activity
c. Associated testicular swelling
d. Abnormal position of the affected testicle
e. Symptoms may be increased by testicular elevation
f. Usually associated with pain induced nausea and vomiting
g. Loss of cremasteric reflex is the best diagnostic indicator for testicular torsion.
2. Epididymitis:
a. Gradual onset of worsening pain
b. May have fever and/or dysuria
c. Can also be traumatic
d. Symptoms may be relieved with elevation
e. Significant swelling may be present
Management
1. If pain is sudden onset and the testicle is lying abnormally in the scrotum, an attempt to
manual detorse the testicle is warranted.
a. A single attempt to rotate the testicle outward (like opening the pages of a book)
should be made.
i. With torsion of the left testis, hold the testicle with the right thumb and fore-
finger and then rotate the testicle clockwise 180°. This manipulation may need
to be repeated 2–3 times, because testicular torsion may involve rotations of
180–720°. These repeated attempts should be guided by resolution of pain and
return to normal anatomy.

270 SECTION 2 TACTICAL MEDICAL EMERGENCY PROTOCOLS (TMEPs) ATP-P Handbook 11th Edition 271