What kind of pain does a patient with ovarian torsion experience during palpation?

Pain Characteristics in Ovarian Torsion During Palpation

Patients with ovarian torsion typically experience severe, sharp pain with tenderness during palpation of the affected adnexal region, which is a key diagnostic finding that should prompt immediate surgical evaluation. 1

Clinical Presentation During Examination

• Palpation of the abdomen in ovarian torsion cases reveals severe unilateral lower abdominal tenderness, often with a palpable laterouterine pelvic mass 1, 2
• The pain is typically constant but may fluctuate in intensity, rarely completely resolving without intervention 1
• During bimanual examination, patients often demonstrate exquisite tenderness in the adnexal region of the affected side 1
• The pain may be accompanied by nausea and vomiting, which are common associated symptoms 2, 3

Diagnostic Challenges During Physical Examination

• Ovarian torsion can be mistaken for other conditions during palpation, such as appendicitis, pyelonephritis, or renal colic due to similar pain characteristics 4
• Not every patient will have a palpable mass on examination, making the diagnosis more challenging 4
• The American College of Radiology notes that transvaginal ultrasound combined with transabdominal views provides the most comprehensive assessment when physical examination findings suggest torsion 1

Key Physical Examination Findings

• Acute onset of unilateral lower abdominal pain with tenderness to palpation is the hallmark physical finding 3
• Palpation may reveal an enlarged, tender ovary or adnexal mass 1, 5
• The severity of pain during palpation is often disproportionate to the physical examination findings, which should raise clinical suspicion for torsion 4
• Pain may be elicited with gentle movement of the cervix during bimanual examination 1

Important Clinical Considerations

• Normal physical examination findings do not rule out ovarian torsion, as the condition can be intermittent 4
• Patients may have symptoms for several hours or days, and thus, ovarian torsion may still be present even with a longer duration of symptoms 4
• In postmenopausal women, ovarian torsion is often associated with an underlying mass and may present with more subtle findings during palpation 6
• The American College of Radiology emphasizes that early recognition of characteristic pain during examination is crucial for timely intervention to preserve ovarian function 1

Imaging Correlation with Physical Findings

• When physical examination suggests ovarian torsion, ultrasound is the first-line imaging modality with findings including unilaterally enlarged ovary, peripheral follicles, and abnormal or absent venous flow 1
• The "whirlpool sign" on ultrasound represents the twisted vascular pedicle and supporting ligaments, with a sensitivity of 90% in patients with confirmed adnexal torsion 1
• MRI has 80-85% sensitivity for ovarian torsion and can be used when ultrasound findings are inconclusive but clinical suspicion based on physical examination remains high 1, 7

Common Pitfalls in Physical Examination

• Relying solely on physical examination findings without appropriate imaging can lead to missed or delayed diagnosis 4
• Assuming ovarian torsion only occurs in reproductive-aged women; it can affect females of all ages including postmenopausal women 6
• Waiting for all classic symptoms to appear before considering the diagnosis; not all patients will present with the complete clinical picture 4
• Delaying surgical consultation when physical examination findings are concerning despite inconclusive imaging 4