The testicular appendix is an embryologic remnant on the anterosuperior aspect of the testes of approximately 3 mm in diameter that fails to fully regress. Torsion of the testicular appendage refers to a twisting of this remnant appendage that results in sudden-onset, unilateral scrotal pain, inflammation, erythema, and tenderness of the testicular appendage without testicular tenderness. It occurs spontaneously, most commonly in boys aged 7-12. Patients will have preservation of the cremasteric reflex and a nontender testicle, although this can be difficult to differentiate due to often extreme tenderness of the adjacent testicular appendage.

Management is typically noninvasive, including analgesia, bed rest, and scrotal support.

Excluding alternative etiologies that may warrant more expedited emergency attention (eg, testicular torsion) is of paramount importance.