SPERMATIC CORD TORSION (TESTICULAR TORSION): PALPATE THE CORD

Most people use the term “testicular torsion,” but throughout history it has also been called “spermatic cord torsion.” Many urologists prefer this term. One introduced it as “acute spermatic cord torsion, more commonly and not so exactly named testicular torsion (TT)…”(Drlik M. J Ped Urol 2013)

The reason spermatic cord torsion is a better term is that it accurately identifies the pathologic organ. By neglecting to call it by its right name, we don’t necessarily realize that we can palpate the actual pathology in this disease.

That is why it took until 2011 for an article to assess the sensitivity and specificity of palpation of the spermatic cord knot.(Al-Terki A. Spermatic Cord Knot: A Clinical Finding in Patients with Spermatic Cord Torsion. Adv Urol 2011) With a reported 86% sensitivity and 100% specificity in 46 patients, this is worth our attention.

The knot of spermatic cord torsion may be located in the inguinal canal in neonates, but it is usually in the scrotum in adolescents and adults. We should palpate the spermatic cord in the acute scrotum. If the results of this first article are replicated, this may turn out to be the most important part of the physical examination of the acute scrotum.

Take Home Points:

-“Spermatic cord torsion” is a more accurate term than testicular torsion

-Spermatic cord torsion can often be felt as a knot on physical examination

References:

Spermatic cord knot: a clinical finding in patients with spermatic cord torsion. Al-Terki A…Adv Urol. 2011

Article located for free at:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3235495/

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