Clinical inquiries. How useful is a physical exam in diagnosing testicular torsion?

A physical exam is useful, but imperfect, in ruling out testicular torsion. The cremasteric reflex or a nontender testicle usually excludes testicular torsion, but case reports have noted the opposite to be true. An abnormal testicular lie can help establish the diagnosis, but occurs in fewer than 50 percent of cases. Other findings are less reliable. The standard of care for diagnosing testicular torsion relies on studies beyond the physical examination.