A glomus tumour is a few millimetres across and usually sits under a fingernail. It causes pain out of all proportion to its size, exquisite tenderness at one exact spot and striking sensitivity to cold. People are frequently told for years that nothing is wrong.
A glomus tumour is a small benign tumour arising from the glomus body, a structure that regulates blood flow in the skin. Most occur under a fingernail. The triad is severe localised pain, pinpoint tenderness and marked cold sensitivity. Diagnosis is largely clinical and confirmed on MRI or ultrasound. Excision is curative and the relief is usually immediate.
The tumour is often only two to five millimetres across and sits deep to the nail, where nothing may be visible at all. Sometimes there is a faint bluish or reddish spot through the nail, or a slight ridge in it.
What patients describe is far more dramatic than anything that can be seen: severe pain in the fingertip, often worse at night, a single point that is agonising when pressed, and pain triggered by cold that can be brought on simply by putting the hand in cool water. Because examination looks normal and plain X rays are usually unremarkable, people are commonly told it is nothing, or treated for arthritis or a nerve problem for years.
The diagnosis is made mostly by listening. That triad of localised pain, pinpoint tenderness and cold intolerance is characteristic, and two simple bedside tests support it: firm pressure with a pen tip reproducing exact pain, and immersion in cold water doing the same. MRI or high resolution ultrasound then confirms it and shows exactly where it sits, which matters for planning the approach.
Excision cures it. Most patients describe the relief as immediate and complete, which is unusual and satisfying in hand surgery.
Where the clinical picture is characteristic and imaging agrees, excision is straightforward and curative.
MRI or ultrasound shows exactly where the tumour sits, which decides whether the approach is through the nail or from the side.
A ring block numbs the finger, and a tourniquet gives a bloodless field so a two millimetre lesion can actually be seen.
For a subungual tumour the nail plate is lifted and the nail bed opened directly over the lesion. A lesion to the side is reached without disturbing the nail.
The tumour is shelled out completely. It is well defined, and complete removal is what prevents recurrence.
The nail bed is closed with fine absorbable sutures. Careful repair here is what determines whether the new nail is smooth.
The nail plate, or a substitute, is replaced to protect the repair and guide the new nail out.
The original pain is usually gone immediately. Some post operative soreness. Keep the hand elevated and the dressing dry.
Wound healed. The old nail plate lifts off in its own time. Fingertip may be sensitive for a while.
New nail grows out gradually. Any ridge becomes apparent during this period.
Nail fully regrown. Final appearance settled.
Pain relief is usually immediate and complete, and patients who have had symptoms for years often describe it as dramatic. The main imperfection is the nail. Reaching a tumour under the nail means lifting the nail plate and opening the nail bed, and a ridge or a small split in the regrowing nail is possible. The nail takes six to nine months to grow out fully. Recurrence happens in a small number of cases, almost always because a small part of the tumour was left, and is treated by re-excision.
Most relate to the nail, since that is the route to the tumour.
Simple, with the nail taking the longest to settle.
Glomus tumours are soft tissue and only a few millimetres across. Plain X rays are usually normal. MRI or high resolution ultrasound is the appropriate test.
Glomus tumours are benign. Malignant versions exist but are very rare. The tissue is examined after removal to confirm.
The pain is genuinely characteristic of this lesion and is well described. It is one of the classic examples in hand surgery of symptoms far exceeding physical signs.
A ridge or a small split is possible, because the nail bed has to be opened. Careful repair usually gives a good nail, and it takes six to nine months to see the final result.
The commonest problem with glomus tumours is not the surgery, it is being believed. A characteristic history with normal X rays deserves an MRI rather than reassurance, and that is usually the step that has been missing.
A short day case procedure under local or regional anaesthetic, so the cost is modest. Excision of a symptomatic tumour is commonly covered by health insurance. Imaging is usually the larger part of the cost. A written estimate follows assessment.
Often asked with some relief, by people who were told it was in their head.
Ask your question →Because there is usually nothing to see, plain X rays are normal, and the tumour is only a few millimetres across. The diagnosis rests on a characteristic history, and it is frequently missed until someone tests specifically for pinpoint tenderness and cold sensitivity.
No. Glomus tumours are benign. A malignant form exists but is very rare. The tissue is sent for examination after removal to confirm.
Usually yes. Most patients describe immediate and complete relief of the original pain, with only ordinary post operative soreness for a few days. It is one of the more satisfying operations in hand surgery for exactly that reason.
Usually normal, though a ridge or small split is possible because the nail bed has to be opened to reach the tumour. The nail takes six to nine months to grow out fully, so the final appearance takes time.
In a small number of cases, almost always because a fragment was left behind. Return of the original pain after a period of relief is the sign, and re-excision deals with it.
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