Author: Nicholas Michols, DO, ATC
Editor: Richard Chang, MD, MPH
29 y/o male active duty Navy sailor with left-sided scrotal pain for four years.
- Recalls a fall on his left buttock four years ago
- Seen several times by multiple providers and each with negative point of care testing for chlamydia and gonorrhea, treated each time with antibiotics regardless.
- Pain is present daily, no change with urination or defecation.
- Denies history of urinary stones.
Patient Presentation: 29 y/o male active duty Navy sailor with left-sided scrotal pain for four years.
Recalls a fall on his left buttock four years ago when stationed in Greece. Patient seen by multiple providers, each time is tested and treated for chlamydia and gonorrhea despite negative results. Pain is present daily, no change with urination or defecation. No history of urinary stones
- Vital signs normal
- Genital: normal male anatomy, scrotal exam normal without pain on palpation and manipulation, normal testicular exam, no abdominal or inguinal hernia palpated.
- Abdominal: Soft, Non Tender, Non-distended
- OMM: Standing flexion test positive on left with elevated ASIS, Iliac crest, and PSIS. Lumbar spine Flexed/Rotated/Side bent left, left quadratus lumborum hypertonicity
- MSK: Positive Thomas test on left with reproduction of scrotal pain. MMT 5/5 in all LE motions compared bilateral
Click here to continue. Challenge yourself by writing down a broad differential diagnosis before moving to the next slide.