Physical exam is useful, but imperfect, in ruling out testicular torsion (strength of recommendation [SOR]: C, expert opinion). The cremasteric reflex or a nontender testicle usually excludes testicular torsion, but case reports have noted the opposite to be true (SOR: C, case series). An abnormal testicular lie can help establish the diagnosis, but occurs in fewer than 50% of cases (SOR: C, case series). Other findings are less reliable (SOR: C, case series). The standard of care for diagnosing testicular torsion relies on studies beyond the physical examination (SOR: C, expert opinion)
