Which physical exam finding is most characteristic of testicular torsion?

• A. Absent cremasteric reflex on the affected side
• B. Normal cremasteric reflex
• C. Pain relief with scrotal elevation
• D. Scrotal transillumination positive

Answer: (A)

The most characteristic finding in acute testicular torsion is an absent cremasteric reflex on the affected side. The cremasteric reflex is triggered by stroking the inner thigh, causing the testicle to rise briefly. Twisting of the spermatic cord disrupts the nerves and blood flow involved in this reflex, so the reflex often cannot be elicited when torsion is present. This helps differentiate torsion from other causes of scrotal pain, such as epididymitis, where the reflex is usually intact. Other options are less specific: pain relief with scrotal elevation (Prehn sign) is not reliable for torsion and is more typical of epididymal inflammation; scrotal transillumination is positive in fluid-filled conditions like hydrocele, not torsion. In suspected torsion, time-sensitive evaluation and surgical management are essential to salvage the testis.