From the Guidelines
Elevation of the testicle, also known as the Prehn sign, is a significant clinical finding that helps differentiate between epididymitis and testicular torsion, with relief of scrotal pain upon elevation suggesting epididymitis, as noted in the 2024 update of the ACR Appropriateness Criteria for acute onset of scrotal pain without trauma or antecedent mass 1.
Clinical Significance
The Prehn sign is a valuable tool in the clinical assessment of acute scrotum, allowing for the differentiation between epididymitis and testicular torsion.
- Epididymitis typically presents with a more insidious onset and is associated with relief of scrotal pain when the testes are elevated over the symphysis pubis.
- In contrast, testicular torsion is characterized by sudden onset of pain and is not relieved by elevation of the testes.
Diagnostic Considerations
The diagnosis of acute scrotum requires a comprehensive evaluation, including clinical history, physical examination, and imaging studies.
- Ultrasound (US) is the established first-line imaging modality for acute scrotal disease, allowing for the assessment of testicular perfusion and the detection of scrotal emergencies 1.
- The presence of a twisted spermatic cord, also known as the "whirlpool sign," is a specific US sign of testicular torsion 1.
Clinical Implications
The Prehn sign is an essential component of the clinical evaluation of acute scrotum, providing valuable information for the diagnosis and management of testicular torsion and epididymitis.
- A positive Prehn sign, indicating relief of scrotal pain with elevation, suggests epididymitis and may obviate the need for immediate surgical intervention.
- A negative Prehn sign, indicating no relief of scrotal pain with elevation, raises suspicion for testicular torsion and necessitates prompt surgical evaluation and intervention to prevent testicular loss 1.
From the Research
Significance of Elevation of the Testicle (Testis) Sign
- The elevation of the testicle sign, also known as the Prehn sign, is a physical examination technique used to differentiate between epididymitis and testicular torsion 2.
- In testicular torsion, the testicle is typically high-riding and does not relieve pain when elevated, whereas in epididymitis, the testicle may be relieved of pain when elevated 2.
- The sign is not foolproof and should be used in conjunction with other diagnostic tools, such as Doppler ultrasound, to confirm the diagnosis of testicular torsion 2.
- A high-riding testicle with an absent cremasteric reflex is a common physical examination finding in testicular torsion 3, 4.
- The presence of a high-riding testicle is a significant finding that warrants further evaluation and potential surgical intervention to prevent long-term damage to the testicle 3, 4.