When you get a wedgie so bad that it makes your balls hurt just like they tied in a knot.
Ron: "Dude, I just a major wedgie!"
Denny: "Man, that must have hurt like hell!?"
Ron: "Yah, I pretty much had my balls in a knot!"
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When someone is being an ignorant scumbag and is acting like an annoying grump for no apparent reason.
Jake: Hey broskie, wanna head to the fair with me in a bit
Chris: No bro, piss the fuck off!
Jake: Jeez man, Who got your balls in a knot?