Traction Technique for Manual Detorsion

May 31, 2023

Written by Aaron Lacy

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Pulling traction on a testicle with torsion is proposed by these authors to help relieve pressure, identify direction of torsion, and to make manual detorsion easier to perform. See figure below for technique.

Why does this matter?
Testicular torsion is a time sensitive emergency that requires urologic consultation and operative intervention. Sometimes providers temporize a testicle with torsion through manual reduction (rotation). Reduction can be complicated by uncertainty of torsion direction or difficulties from swelling and edema. A technique to address these difficulties would be useful to clinicians.

Holding traction: not just for third-year med students on surgical rotations
Detorsion of testicular torsion can save it from ischemic damage and death. While ultimately all testicular torsion patients require operative exploration, immediate manual reduction can restore blood flow to the appendage rapidly, increasing likelihood of viability and reduce painful symptoms.

While traditionally taught to “open the book” (i.e. externally rotate the testicle for detorsion), up to one-third of torsion cases require internal rotation for detorsion. Additionally, swelling, edema, and pain can limit the ability of physicians to detect the direction of torsion or may prevent manual detorsion altogether. These authors describe a technique to help address both limiting factors as well as two case reports of the technique being employed.

Torsed Testicle Traction Technique (image below)

1. Document torsion of the spermatic cord with absence of blood flow to the testicle with ultrasound.
2. Consider analgesia for the procedure.
3. Grasp the testicle and extend the spermatic cord to maximal length.
4. At this point the testicle may spin or flip in its “desired” direction.
5. If the testicle has not declared its rotation, begin with external rotation. If resistance is met, stop and transition to internal rotation.
6. Document return of flow or absence of whirlpool sign with ultrasound.

This technique seems intuitive and is worth a try if you find yourself in a twisted situation.

Source
The torsed testicle traction technique and 2 case reports. Pediatr Emerg Care. 2023 May 1;39(5):364-367.