1 in 4000 men under 25yo. Incidence bimodal – neonates and age 12-18. Case review showed 31% of patients presented with abdominal pain alone.
Loss of cremasteric reflex is not 100% sensitive, particularly in young boys. There can be history of similar pain in the past. If pain is intermittent, can have a ‘normal’ US with intermittent torsion.
EMRAP, Medical Legal Briefs: Testicular Torsion, December 2017