Various forms of blunt, penetrating, or degloving testicular injury are recognized in the literature. Sports-related trauma and motor vehicle accidents are the two most common modes, and in the majority of cases, unilateral scrotal pain is the main clinical presentation. The diagnosis is made after conducting a detailed patient history and a physical examination, followed by ultrasonography of the testes.
Despite the fact that testicular injuries comprise less than 1% of all trauma-related injuries, early recognition of this condition is vital in order to reduce potential complications . The most common, and often the only symptom of testicular injury, is a scrotal pain, which may be sometimes accompanied by swelling, and appears after one of the recognized forms of trauma      :
- Blunt injuries - Sport-related activities are responsible for up to 50% of all testicular trauma, for eg. during contact sports (kicking in the groin area), ice hockey and baseball, during which the testes are crushed between the thighs or the symphysis pubis   . Due to the higher anatomical location of the right testis, it is more frequently injured than the left . Intentional injuries and motor vehicle accidents are other notable causes .
- Penetrating trauma - Animal bites, injuries from sharp objects (e.g. knife) and gunshot wounds, considered as the most common penetrating form of injury, are possible causes of penetrating testicular injury . This type, unlike blunt trauma, more commonly involves both testes.
- Iatrogenic injury - Complications during inguinal and scrotal surgery (spermatic cord transection, nerve injury, infection, etc.) can result in testicular injury and the appearance of bleeding, the formation of hematomas and progressive testicular swelling .
Regardless of the mode of trauma, hematomas, hydroceles, hematoceles, testicular fractures, dislocation, torsion and even testicular rupture in rare cases may be seen  . Moreover, subsequent infection (epididymis and epididymo-orchitis) is a known complication, while up to 15% of testicular tumors are incidentally discovered during evaluation of testicular injury . Additional injuries of the genitalia (the urethra and the penis) are often concomitantly present with symptoms of hematuria, penile swelling and ecchymoses  . For this reason, a comprehensive workup is necessary.
Entire Body System
Mookie Betts hits three home runs and makes insane catch Caleb Joseph was hit in the groin by a foul ball on Monday and placed on the disabled list on Tuesday. [nydailynews.com]
BALTIMORE — The Baltimore Orioles have placed catcher Welington Castillo on the 10-day disabled list with a testicular injury. [sportsnet.ca]
Castillo was on the disabled list earlier this month with right shoulder tendinitis. Caleb Joseph received most of the starts behind the plate during that time. Joseph started Wednesday night against New York. [nbcsports.com]
May 31, 2017 Luke Jones BALTIMORE — The Orioles have placed starting catcher Welington Castillo on the 10-day disabled list with a testicular injury after he took a foul ball to the groin in Tuesday’s loss to the New York Yankees. [wnst.net]
As minimal, the blood-clot from the tunica vaginalis sac should be evacuated, which would relieve disability and hasten recovery. Article / Publication Details [karger.com]
Any sudden onset of severe testicular pain is a cause for concern and careful monitoring. [auanet.mediaroom.com]
A person with a testicular injury may experience testicular pain or discomfort, testicular swelling, redness, tenderness of the testicle, lacerations or abrasions to the scrotum and bruises to the testicular. [firstaidservices.ca]
Signs and Symptoms of Testicular Trauma Testicular pain, scrotal hematoma, soft tissue injuries depending on the etiology of testicular trauma. [urology-textbook.com]
Sports-related trauma and motor vehicle accidents are the two most common modes, and in the majority of cases, unilateral scrotal pain is the main clinical presentation. [symptoma.com]
Testicular trauma is the third most-common cause of acute scrotal pain and may result in various degree of damage to the testes. Testicular rupture and testicular ischemia/infarct are two severe complications which need to be ruled out. [radiopaedia.org]
PubMed Central View Article PubMed Google Scholar Koester MC: Initial evaluation and management of acute scrotal pain. J Athl Train. 2000, 35: 76-79. [casesjournal.biomedcentral.com]
Case Study: Scrotal Pain in a Young Man [pdf] This document was amended in July 2016 to reflect literature that was released since the original publication of this content in May 2012. [auanet.org]
Initially patients with acute scrotal pain are told to look for signs of injury and infection, but they should also be aware of the signs of sepsis and SIRS. [snopes.com]
Orchiectomy – Testicular masses, if malignant, are usually removed along with the entire affected testicle. [wmuro.com]
Other authors support the use of sonoelastography for the evaluation of testicular masses. [cancerimagingjournal.biomedcentral.com]
In this series, several factors supported our consideration of conservative treatment, including a prior history of testicular sperm extraction or aspiration (even if performed 1 year previously), the absence of a palpable testicular mass or signs of [ajronline.org]
Ultrasound is extremely sensitive in the detection of testicular masses, but does not provide a histological diagnosis [ 2 ]. [link.springer.com]
Traditionally, B-mode ultrasound is extremely sensitive in the detection of testicular masses, but does not provide histological diagnosis. [birpublications.org]
Swelling of the Scrotum
Testicular rupture, like testicular torsion and other serious injuries to the testicles, causes extreme pain, swelling in the scrotum, nausea, and vomiting. To fix the problem, surgery is necessary to repair the ruptured testicle. [kidshealth.org]
Other symptoms can include: Nausea (especially common with testicular torsion) Bruising or discoloration of the scrotum Swelling of the scrotum Blood in the urine Difficulty urinating Fever Diagnosing Testicular Injuries It's important to see your doctor [webmd.com]
Testicular rupture causes extreme pain, swelling in the scrotum, nausea, and vomiting. Surgery is necessary to repair the ruptured testicle. If your son’s testicular injury pain doesn’t subside in less than an hour, we suggest seeing a professional. [wmuro.com]
You notice new or worse swelling in your scrotum. You have symptoms of a urinary problem, such as a urinary tract infection. These may include: Pain or burning when you urinate. A frequent need to urinate without being able to pass much urine. [myhealth.alberta.ca]
There is bruising or swelling of the scrotum or the scrotum fills with fluid. 5. You have difficulty urinating. 6. There is blood in your urine. 7. You have fever after an injury to the testicles. 8. [manipalfertility.com]
A scrotal mass is a lump or bulge that can be felt in the scrotum, and may result from a variety of factors There are several kinds of scrotal masses: Hydrocele (non-cancerous): A mass or swelling caused by a buildup of fluid around the testicle. [urologygroup.com]
Most scrotal masses are due to far more common problems, such as: Infection of the epididymis Testicular torsion We will determine a mass from these more common conditions by how it feels and if light shines through it. [wmuro.com]
Evaluation of scrotal masses. Crawford P1, Crop JA1. [dontcookyourballs.com]
Having in mind the numerous types of injuries that stem from testicular trauma, a rapid but thorough diagnostic workup is necessary. A detailed patient history needs to be conducted, during which the mode of injury and the presence of symptoms are assessed, and together with a careful physical examination (since patients experience profound discomfort due to pain) that will confirm testicular involvement, a presumptive diagnosis can be made  . However, imaging studies are mandatory for determination of the exact type of injury and selection of appropriate therapy. Currently, ultrasonography (US), both standard and color doppler, are considered as the gold standard    . Focal, or sometimes multifocal hyperechoic lesions suggest acute bleeding, anechoic fluid collections point to hydroceles, whereas a linear hypoechoic band is a hallmark of a testicular fracture  . In addition, hemorrhage and extrusion of testes into the scrotal sac are highly indicative of a testicular rupture, and a range of other findings on ultrasonography can be encountered, further strengthening its role in the diagnosis of testicular injury  . In rare cases of testicular dislocation, but also in polytraumatic patients, computed tomography (CT) of the perineum and lower abdomen is highly useful to identify the location of the testicle and assess additional organ trauma .
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