Monday, October 29, 2007

Glomus Tumor

A glomus tumor is a rare benign tumor of the hand. It constitutes 1–5% of the soft-tissue tumors in the hand. It arises from the glomus body which is a neuromyoarterial apparatus described by P. Masson in 1924. The normal glomus body is an arteriovenous shunt that is composed of an afferent arteriole, an anastomotic vessel (Sucquet-Hoyer canal), a collecting vein, and a capsular portion. It resides in the stratum reticulum of the skin. There are large numbers in the subungual region and in the distal pad of the digits. The glomus body is a controlled arteriovenous anastomosis or shunt between the terminal vessels thought to be important in regulating peripheral blood flow in the digits, which secondarily controls peripheral blood pressure and body temperature. (photo credit)

Glomus tumors affect women two to three times more often than men. Most are in the 30-50 year age group. Most occur in the subungual area (approximately 50%), but can occur on the finger tip pulp, the palm, wrist, forearm and foot. Glomus tumor can occur near the tip of the spine, where it may arise from the glomus coccygeum. Glomus tumors have also been described in locations where the glomus body does not normally occur. These unusual sites include the patella, bone, chest wall, eyelid, colon, rectum, and cervix. Over 75% of glomus tumors occur in the hand.

Symptoms usually consist of a triad

  • severe paroxysmal pain--the pain can be excruciating and is described as a burning or bursting
  • localized tenderness
  • extreme cold sensitivity

Physical exam reveals a blue-pink tender mass that can often be seen through the nail plate or skin. When the mass is growing beneath the nailbed (subungual), it can displace the nailbed dorsally. (photo credit) When the lesion is beneath the nail matrix, it can produce a longitudinal ridging of the nail plate. Placing the involved digit or extremity in ice water will reproduce the pain within 60 seconds. Typically, the mass is usually less than 7 mm in diameter, so can be very difficult to palpate even when not beneath the nail. There are two clinical findings described, particularly in relation to the painful subungual solitary glomus tumors. They are the Hildreth's sign and Love's test. Hildreth's sign is disappearance of pain after application of a tourniquet proximally on the arm. Love's test consists of eliciting pain by applying pressure to a precise area with the tip of a pencil. Routine laboratory studies have no role in diagnosis of glomus tumor.

X-rays of the finger may show bone erosion, ranging from a small concave defect to a sharply defined radiolucent lesion seen in the region of the tuft of the phalanx. There is often a thin sclerotic margin about the defect as a secondary reaction to the tumor pressure. Standard magnetic resonance imaging (MRI) can be used to detect glomus tumors. (photo credit)

The tumor consist of a highly organized, well-encapsulated mass consisting of glomus cells, curled blood vessels, and a large number of nerves within or adjacent to the lesion. This explains the great sensitivity of the glomus tumor.

Treatment is surgical. Surgical approach will vary depending on the location of the tumor. The glomus tumor is always well encapsulated and can usually be "shelled out" with little or no difficulty. When excision is complete, the prognosis is excellent for full recovery with no recurrence.

References

Glomus Tumor by Henry DeGroot, III MD--bonetumor.org

Glomus Tumor at Wheeless Textbook of Orthopedics

Subungual glomus tumor by Dr. K.-- MSKcases

Glomus Tumor of the Finger Tip and MRI Appearance by David H Kim, MD--Iowa Orthop J. 1999; 19: 136–138.

Two cases of subungual glomus tumor; Murthy PS, Rajagopal R, Kar PK, Grover S; Indian J Dermatol Venereol Leprol 2006;72:47-9

Glomus Tumor by Michael B Reynolds, MD--eMedicine Article

233 comments:

«Oldest   ‹Older   201 – 233 of 233
Anonymous said...

I was diagnosed with a GT just this week and am waiting to see a Plastic Surgeon for it removing. I am almost in tears reading all the comments above because it is such a relief to finally have a diagnosis and know that other people are experiencing the same problem. Can anyone tell me if they have lost their nail during this procedure or has it grown back normal?

Anonymous said...

Omg so happy ive found this site i have been in pain for about 4 years and im only 16 went to the hospital today to find out ive got a GT on my thumb right hand but not under the nail just on the side outwards towards my body i thought i was the only as the specialist said to me he had worked there for 17 years and only 3 people had been to see him about this me being the 3rd i have been in so much pain everytime i bang it or its cold and i flip out when i knock it or my girlfriend touches it by accident and look a complete weardo even my mum kept sayin to me over the years its nothin kept going to doctors about it being sent away each time and said put bandages on it or take pain killers and it have no effect it just kept gettin worse and worse until a month ago when the doctors refered me to a specialist went to see him today im having the opperation in around 9 weeks cant wait to acctually go out in the snow and have a snowballfight with my little brother who i have had to let down each time because of the pain but now i just cant wait for those who cant seem to figure a way to help the pain i have one solution when i bang my thumb i wrap 2 fingures around the base of it and slowly push them towards the GT like when you put an elastic band around your finger and it turns your fingure a funny colour reliefs the pain just feel a slight throbing for a few seconds hope this helps and hope this little bstrd is gone when i have the opp coz of the stories of it coming back :/

Anonymous said...

I've had a glomus tumor in the pad of my right index finger for 30 years, but it didn't get real painful until about 10 years ago. The pain was so intense if I bumped it that I would feel like passing out. Over the years I tried to manage it, but it just got too painful. Even weather changes were painful. I finally got it properly diagnosed and had it removed a week ago, and I've been pain-free since! The piercing debilitating pain that would just make me want to cut my finger off is gone! I can't wait to get the stitches out and start using my finger again! I know it could come back, but for now I feel renewed!

Anonymous said...

clint said...
i have just had surgery on my right ring finger to remove the glomus tumor,so i can relate to anyone who has been living with this affliction,quite literally living on the edge of sanity,the levels of pain ,frustration and loss to quality of life,all this from a tiny tumor that took so long to diagnose.
i'm relieved to know what it is ,and hope its all gone.
my sympathies to all going through this.

Anonymous said...

Thank you all for your comments, it feels good to know that I am not alone/crazy/oversensitive/with no pain tolerance.

I was diagnosed a couple of weeks ago and I will have it taken out soon. Wish me luck! It's my first time having any kind of surgery, but I guess that after almost 10 years of GT pain, it will be well worth it.

Anonymous said...

Hi Kiff

Before I had my GT removed I used to get a pain which radiated away from the tumour site. I began to worry that I had the same problem in other fingers too because I experienced pain there. I also had a terrible pain which radiated along towards my elbow when my glomus tumour was hurting. I had extra pain in it when I was stressed too. I think this was an adrenaline response.


Now that the tumour has been removed from under my nail, there is no more pain anywhere in my hand or arm.

Hope this reassures you.

Good luck.

simon said...

I had been suffering for many years, finally a MRI report show that I have Glomus tumor. Thank God, Surgery done on April 27, 2012 on my left pinky. I have stitches on, but still it hurts. I am not sure whether it is from the GT or from the surgery. I have to see my GP soon. hope it is healed.

Kiff said...

Hi 6 days post op finger is still tender,I have bumped it a few times, painful but nothing like before.The surgeon removed 2/3 of my nail as the tumor was under the nail bed.( It never did show on the surface Hard to convince anyone that there was a problem.)It will take 6-9 months to grow back the nail and it may not be normal looking . A small price to pay if the pain is gone.5

Anonymous said...

I had my GT removed 3weeks ago and now i am experiencing the shooting pain people have mentioned before, sometimes its unbearable i can cope in the day but night time is horrid and it keeps me awake. As anyone got an answer for why im gettin this i go on holiday next tuesday and need some answers please

Anonymous said...

For as long as I can recall, the excruciating pain that is a glomus tumor has plagued me. After 3 failed attempts of removing the entire tumor, now so small it is barely visible on an MRI, I opted to have my fingertip removed. I am 4 days post op. Today I awoke to the shocking pain I am so familiar with. Just like the last three times, I know the surgery has failed. And now I am left with an ugly stump of a finger to boot. I am furious. Somebody needs to find a definitive cure for this awful condition.

Unknown said...

I would say the pain could be "phantom pain". It's very common among amputees.

Anonymous said...

Wow we aren't alone. I am one week post op and if it doesn't work I am going to ask to get my finger tip removed. It would be great to have a full functioning finger without the pain.Goodluck everybody.

Anonymous said...

I've been lurking on this site for the last few years. My husband has a glomus tumor under his right thumb nail which has grown back and has recently developed one under the ball of his foot.



Unfortunately, he has a fear of surgery that is greater than the pain he is experiencing. We have found something that actually helps subdue the pain to a managable level & I thought it might help some of you until you have your surgeries. It is called "black ointment" by Dr. Christopher. The smell is terrible, but has helped my husband function.



Thank you to all of you who have shared your stories. They have had great impact on our lives and helped me to better understand my husbands suffering.

Anonymous said...

I had a glomus tumour under the nail of my left ring finger removed, which grew back. I had it removed again, few months later pain was back. The surgeon tells me that the second time there was no tumour, just that the nerves and tissues in the area, after 8 years of the tumour were damaged and causing the pain. Now the pain was exactly the same as glomus tumour pain, identical, it wasnt scar tissue pain as they said, so after a few unsuccessful visits to an occupational therapist, and the surgeon saying they'd do nothing else for me I amputated the entire end of my finger from the joint upwards. I had surgery to cover the end, and I wont lie the amputation and healing was painful, but no more than recovering from previous surgeries, and now 8 weeks later I am pain free for the rest of my life, and the missing tip doesn't hinder me at all. I am by no means suggesting this as a treatment option for anyone, but i'm sure the poeple on this forum can understand the desperation that led me to this decision. I will never regret doing it; even if there had been complications such as nerve damage, it would have been no where near as painful as living with the glomus tumour for the rest of my life.

Kiff said...

usurgery went well pain gone no problem now with cold water. fingernail still deformed but pea sized tumor was directly under the nailbed and the surgeon warned me about that. well worth it though even the radiating pain is gone yeah! Thank you for this blog spot.

Bert said...

Diagnosed Glomus tumor in July 2012 after having it since 2004. Right Thumb nail was completely removed as it was a large tumor. Hasn't quite been a month since the operation but seems to be healing nicely, only pain i have in that area now is a tearing sensation when i reach for something. Also if you have ever cut yourself accidently ( while cooking or something ) the pain associated with recovering from that is what i am experiencing now.

Anonymous said...

Morning,
Just been diagnosed with a GT under my right thumb nail - pain is terrible & no-one understands.
I have an appointment with an Orthopaedic Surgeon on Thursday, 20 September. Is there anything I can take for the pain until then, as keeping it warm no longer helps?

Anonymous said...

Hieveryone. I have a glomus tumor on the right side of my index on my right hand. been there for about 10 years. Very sensitive to the cold and it just throbs if it gets too cold. Keeps me awake some nights from the throbbing and nerve pinching. I knocked my finger at work the other day and almostbpassed out from the pain. THE PAIN IS UNBEARABLE. When its really bad I feel like I need to throw up because my body reacts so badly. I can't stand ny finger being touched not even slightly. Even the slightest touch and I yelp in pain.

nerys said...

When i was at the hospital the doctor argued with me till he had the lab reports that it wasn't a glomus tumor but everything i had read on the web said it was. It was removed but it errupted again within 1 month, whilst i was still having dressings changed, it came up like pround flesh and was the most painfull experiance ever - that lasted about 3 months (until the nail grew over it) - it is still painfull now but no where near as bad as the recovery, so at the moment i suffer it :(

Adelaide Melia said...

Just wondering if anyone has experienced a glomus tumor in the actual bone of the finger rather than the nail bed? I have had four operations to remove my GT, most recently partial amputation of fingertip but pain (3 months on) is returning to a daily occurrence. For the last two surgeries there has been no more visible tumours on my MRIs, so the surgeons went in "blind" each time successfully coming out with glomus cells, proving the pain is not just in my head... But nonetheless, I still feel crazy asking for more diagnostic imaging or another surgery. I am just so sick of this pain, I have had it for over 10 years now... Would love sone advice!

Anonymous said...

I hit my finger at work last week, the same finger that has a glumous tumour in it. It was the hardest I have ever hit it. The pain was so bad my finger went numb and I could barely move it. Then I suddenly was overcome with severe nausea, cold sweats and I became very faint. I had to sit down after vomiting. My finger where the tumour is was tender for the rest of the day and the following day and had a black bruise on my finger where the tumour is.

Patti said...

About 20 years ago I slammed my left index finger in a car door, a stupid mistake that has caused me years of suffering and apparently many mis-diagnoses. Originally I was told I had reflex sympathetic dystrophy, now goes by another name. And yes, I went to the doctor holding out my finger and trying to make him understand just how bad it hurts. Another medical emergency put me on lyrica and this helped abate the times when my finger would "go off". But the med caused problems with serious swelling after two years of reasonable relief. New med, Horizant, doesn't help much and the pain is nearly constant. Today I got a new diagnosis, a possible gloms tumor. MRI scheduled tomorrow to confirm th e bluish spot now in the nail. I can expect the pain when winter comes or even in other seasons when cold dampness makes me shiver. Certain drugs also trigger an attack, such as "trip tans" that I take for migraine or pseudo ephedrine for congestion. I drive to works most cool to cold moorings with one hand on the wheel and the other with my finger stuck in the heater on the dashboard. If this is GT I will have the surgery, I can't go on this way much longer. Yes I considered amputation but I need my digits for work as a pharmacist and my passion for sewing and quilting. thanks for telling me I'm not insane with crushing pain that at times has dropped me to my knees. 20 years is enough!
Patti, pharmacist

Anonymous said...

Patti, I'm glad you finally received a diagnosis. Until you are able to get it removed, try using the handwarmer packets in a glove. He would get a large pack of them at Walmart or any sporting goods store & every morning before heading out he'd shove one in the thumb of his glove. I really improved his quality of life.

Anonymous said...

I have been woken up for the hundredth time with my mystery finger pain. I'm lying here crying in sheer relief at the post describing the same pain and symptoms that I have.
Extreme pain when I bang(now lightly tap my nail) extreme pain in cold weather, blue tinge to the nail, shooting pains in my finger, ignoring it as nerve damage, thinking ot wont be taken seriously, not being able to explan just how painful a light tap on the nail can be.
I cant thank you all enough, going to see my gp asap.

Anonymous said...

After years of pain, i found this blog and printed it off and took it to my GP. Since then I've had X-rays and MRI scans and they have confirmed it is a GT. SO happy that it is sorted. My appointment for surgery is on Friday - can anyone tell me how long surgery lasts, i'm going for a local or regional anaesthetic rather than General. And what is recovery like, will I have a bandage and a sling and for how long? Thank you!

Anonymous said...

I have just had a confirmed GT in my right index finger, and surgery is this week. Could anyone tell me recovery time post surgery? I am having a regional anaesthetic to numb my arm - did you have a sling and a bandage following the operation, and if so for how long?

neil P said...

Wow. I am amazed to find so many other people who have the same thing as I...and that for those who haven't suffered with it there is no pain like it. I had mine removed in left hand ring finger in 2009, then it came back worse and was removed again along with some nerve endings in 2011. Unfortunately its returned again - and this time its the worst its ever ever been - in cold its ridiculous levels of pain, and now its just hurting all the time, keeping me up and night and no longer being relieved with heat. I am going to insist the surgeon amputate fingertip this time because i am unable to live with this level of pain anymore and cant risk it growing back again its just too much!!!
I have read all posts here up to 2010 but will read the rest later...and I feel for every one of you putting up with this horrible condition...

Anonymous said...

Can anyone with a GT please respond if you feel your GT is related to a previous trauma at the tumor site or an occupational situation where the site receives continual pressure? Thanks

Anonymous said...

I had my surgery for my glomus tumor on the palm side of my left thumb a week ago. Im so glad to be free of that thing. I have been dealing with it for about 8 years. At first only cold weather would bother it. Then this year it started hurting for no reason at all. Made it difficult to work. It took 4 doctors before I recived a diagnoses. Now im happy and waitin for it to heal. My surgery was fast and painless(i opted to be knocked out and had a beer blocker). Im still having numbness in the area where I was cut. My doctor told me to tap the area for 5 minutes 3 times a day. Is there anyrhing else I can do to get the feeling back in my thumb.

rlbates said...

Anon (5/16/13), it'll take time for the nerves to heal. Tapping or skin massage will help "retrain" the nerve as it heals so it has less chance of becoming sensitive or over-reactive.

Anonymous said...

Did u ever get an answer to this or did ur pain go away eventually? I just had a gt removed 2 weeks ago.sharp shooting unbearable pain returned a few days ago. Dr told me to wait a month. It feels just like my old pain but im wondering if its just part of the healing process?

Anonymous said...

If it wasn't for this blog, I would be living with the pain in my right ring finger for another 10 years. I had been misdiagnosed several times in the past with "extreme carpal tunnel". I saw many GP's and even a neurologist who couldn't definitively explain my pain. After discovering this blog and the comments, I was more sure than ever this was a GT. I went straight to an Ortho Surgeon who diagnosed my symptoms within 5 minutes as a textbook case of subungual GT. Had a local and had it completely removed a week after diagnosis. In the first 3 weeks, the sharp pain was still there. But the doctor explained that it was part of the healing process. He was correct, within 1.5 months the familiar pain subsided and i'm pain-free. I was lucky and there was no abnormality in the growth of my fingernail with minimal numbness. Full recovery (including full nail growth) was about 4 months.

Anonymous said...

I have had pain in my right middle finger for 3 years. Every time I bumped it or it got cold, I would feel excruciating pain. It took me moving and getting a new doctor to finally get somewhere with my pain. I was then referred to a dermatologist where in 5 minutes I was bei g told it was a Glomus Tumor and I would be referred to a Plastic Surgeon. From the dermatologist appt to Plastic Surgeon appt, it was about 3 weeks and then I was scheduled for surgery the following week. Local anesthetic, which hurt like hell, he then cut the centre of my nail out and removed the tumor. 4 stitches and now I am a week out from surgery and am getting better each day. Still very tender, had to have 2 year old daughter watched by sitter last week for fear of her hitting it while we played and have had to ask for help with the simplest things while finger heals because of the location, but recovery is going well. Go next week to have stitches removed. Looking forward to not having pain wake me in the middle of night this winter.

«Oldest ‹Older   201 – 233 of 233   Newer› Newest»