Glomus Tumour

Definition

A glomus tumour is a benign neoplasm arising from the glomus body, a specialised arteriovenous structure involved in thermoregulation (regulating skin blood flow in response to temperature). The most common sites include the subungual region (under the nail bed) of the fingers or toes, though they can also appear on the palm, wrist, or forearm.

Symptoms

• Typically small (1–2 cm), bluish-red or reddish-purple nodule

• Exquisite tenderness to touch or pressure (even slight pressure can cause severe pain)

• Pain may be exacerbated by temperature changes (cold sensitivity)

• Often located under the nail plate, leading to a purple discoloration visible through the nail

Diagnosis

• Clinical Diagnosis:

  • Solitary, painful subungual or fingertip nodule

  • Pain characteristically disproportionate to lesion size (intense, sharp)

  • Love’s Pin Test: Pinpoint tenderness at a specific spot

  • Hildreth’s Test: Pain relief with tourniquet (transient)

• Imaging:

  • MRI or ultrasound can help localise the lesion, particularly if subungual and not well visualised

• Biopsy/Histopathology:

  • Optional if clinical certainty is high; definitive if uncertain

  • Shows a characteristic proliferation of glomus cells surrounding small blood vessels

Management

• Surgical Excision

  • Complete removal is curative, typically providing immediate relief from pain

  • Subungual lesions require careful approach to avoid nail bed damage

• Follow-Up

  • Usually minimal post-operative follow-up if completely excised

  • Monitor for recurrence if the lesion was not fully removed or if multiple lesions exist

Notes

• Glomus tumours are rare but should be considered in patients with focal fingertip pain that is intense and unrelieved by typical analgesics.

• Differential diagnoses include subungual exostosis, pyogenic granuloma, subungual melanoma, myxoid cyst.

• In uncertain cases, referral for specialist imaging (MRI) or hand surgery evaluation may be warranted.