Initial evaluation and management of acute scrotal pain.

OBJECTIVE: To provide the reader with the background knowledge to ensure a prompt and proper initial evaluation of the athlete with acute scrotal pain. DATA SOURCES: A MEDLINE search was conducted using the key words "scrotum" and "pain" for the years 1980 to 1999. DATA SYNTHESIS: The 4 most common causes of acute scrotal pain in athletes are trauma, testicular torsion, torsion of a testicular appendage, and epididymitis. Although all can appear clinically similar, subtle features in the history and physical examination may lead the examiner to the correct diagnosis. However, physician evaluation is essential, and diagnostic imaging or surgery may be required for a definitive diagnosis and to avoid loss of the testicle. CONCLUSIONS AND RECOMMENDATIONS: Although acute scrotal pain is a rare occurrence, it is important for the athletic trainer to recognize the common causes of the condition. An understanding of normal scrotal anatomy and the pathology of scrotal trauma, testicular torsion, torsion of a testicular appendage, and epididymitis are essential to provide a prompt initial evaluation and appropriate referral.