Manual detorsion of the testicle

(A) The right testicle shows the characteristic medial torsion with elevation and horizontal lie of the testis.
(B) After appropriate sedation and analgesia has been administered, manual detorsion is performed by grasping the testicle and rotating it within the scrotum outward (medial to lateral) one to two full 360 degree turns. Prompt relief of pain, lower position of the testis in the scrotum, and return of arterial flow on Doppler ultrasound suggests detorsion. If there is no improvement, try rotating the testicle in the opposite direction (lateral to medial) because approximately one-third of torsed testicles may have lateral rotation.