#paeds see: [[Scrotal pain]] - [bear - testicular torsion](bear://x-callback-url/open-note?id=B35A3BA5-D290-4E74-894B-E38FC123D5A9-2471-0000011CDF12C2F9) - [EM cases - testicular torsion](https://emergencymedicinecases.com/testicular-torsion/) > TWIST score (not validated well) > Testicular swelling 2 > Hard testicle 2 > Absent cremasteric reflex 1 > Nausea or vomiting 1 > High-riding testicle 1 > > - PPV 100% when 7 points > - NPV 96% when <5 points Look for ==blue dot== c/w hydatid of morgani torsion (testicular appendage torsion) **DDx:** - acute epididymo-orchitis - torsion of testicular appendage - strangulated hernia - haematocele - testicular tumour - varicocele **Timeframe for treatment** - 90-100% successful salvage if surg within 4-6 hours of sx onset - 20-50% for 12-24 hours **Attempt de-torsion if delay to treatment:** Outward rotation of affected testicle by 180 degrees; This may need to be repeated 2-3 times as torsion may involve rotations of 180-720 degrees; if pain increases then rotate in opposite direction. suggested success if: relief of pain, conversion of transverse lie ot longitudinal lie. lower position of testis in scrotum