Author: Kelly Evans-Rankin, MD
Co Author #1: Wade M Rankin, DO, CAQSM
Co Author #2: Spencer Jones, DO

Patient Presentation:
Testicular pain

History:
A 24-year-old male presented to the 40-mile aid station of a 50-mile trail-based ultramarathon. He reported acute onset of extreme left groin pain rendering him unable to continue. He required two-person assistance for a half mile up the mountain to reach the aid station. He believes the pain started when running downhill on a rocky portion of trail, but could not recall any specific injurious event. When he slowed to a walk, he hoped the pain would resolve spontaneously, however it worsened and had become nauseating.

He was a generally healthy, active male with no PMH to speak of apart from hamstring strains. He had previously worn compression shorts to help with these strains, but they caused significant irritation on longer trail runs. Therefore, he stopped wearing compressive gear over the last month of his training. He had no history of pelvic or testicular trauma, and denied history of hernia. He had urinated without difficulty within the last hour, and further review of systems was negative.

Physical Exam:
Vitals: BP 115/68, Pulse 82, Temp 98.2° and BMI 17.6
General: Clinically healthy appearing adult male in moderate distress
Neck: No lymphadenopathy
Respiratory: Respirations unlabored, no cough or wheeze
GI: Soft, nontender, nondistended, no hepatosplenomegaly
GU: Scrotal guarding, mild swelling noted on left. Left testicle high-riding, tenderness to the lower pole more than the epididymis. Right testicle, grossly normal with normal vertical lie.
Prehn sign: Positive on left
Cremasteric reflex: Absent ipsilaterally, normal on right
Transillumination: Positive for small left hydrocele
No evidence of inguinal hernia
MSK: Lower extremity musculature generally tight, strength preserved 5/5. Range of motion in hips equal in passive and active ROM, some groin pain reproduced on external rotation of left hip. Able to bear weight normally, gait has accentuated lateral swing of left leg.

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