Testicular torsion is a urological emergency affecting 3.8 per 100,000 males younger than 18 years. Differential diagnosis of the acutely painful scrotum is crucial for the advance practice nurse to understand. Advanced practice nurses should consider the differential diagnosis of testicular torsion for any patient with testicular pain despite the patient's age, history, or physical examination findings. The standard of care for a patient with testicular pain to rule out testicular torsion is a Doppler ultrasound scan and an emergent urology consult. Immediate attention to this urological emergency will decrease risks to testicular viability.