The peak age is 14 years, although a smaller peak also occurs during the first year of life. History includes a sudden onset of severe unilateral scrotal pain. Onset of pain can occur more slowly, but this would be an uncommon presentation for torsion. Torsion can occur with activity, be related to trauma, or develop during sleep. The involved testicle is painful to palpation and frequently is elevated in position when compared to the other side.
Fever is uncommon.
Testicular torsion is a clinical diagnosis. If the diagnosis is equivocal, radionuclide scan of the testicles can be helpful to assess blood flow and to differentiate torsion from other conditions. Scan is abnormal in torsion when it demonstrates decreased uptake in the affected testicle suggesting no blood flow to that side. Color Doppler ultrasonography is increasingly being used to demonstrate arterial blood flow to the testicle while providing information about scrotal anatomy and other testicular disorders. Plain Doppler ultrasonography is less accurate than color Doppler in assessing testicular blood flow.