Orthopedic Surgery for Glomus Tumor Clinical Presentation

Updated: Apr 29, 2020
  • Author: Seema N Varma, MD; Chief Editor: Harris Gellman, MD  more...
  • Print
Presentation

History

Symptoms are often present for a long time before the patient seeks medical attention, and the diagnosis can be delayed for several years if the tumor is not suspected.

Pain is the usual presenting symptom of a glomus tumor. [9] This pain related can be excruciating and intermittent. The worst pain may occur at night, and it may disappear when a tourniquet is applied to the hand proximal to the lesion. This palliation reflects the vascular nature of the tumor and the consequent effect of ischemia. [23] Some have proposed that the exquisite pain may be associated with the presence of nerve fibers that contain pain neurotransmitter substance P, which has been identified in the tumor. [24]

Patients also have temperature sensitivity, especially when they are exposed to cold. The classic triad of sensitivity to cold, pain, and point tenderness is not always found.

Patients with the rare familial multiple glomus tumors may have a family history of similar lesions. [7, 8]

Next:

Physical Examination

Local soft-tissue tenderness and thickening may be present. A mass is sometimes detectable in the area of tenderness. When the lesion is superficial, it may be visible as a small red-blue nodule or a bluish area beneath the skin or fingernail (see the image below). It may be associated with deformity of nail growth. Placement of the affected part in cold water may reproduce symptoms.

Subungual hue seen with a superficial glomus tumor Subungual hue seen with a superficial glomus tumor.

On clinical examination, a positive result with the Love test and the Hildreth sign suggest the diagnosis. To perform the Love test, a fine instrument, such as a pin or a toothpick, is used to elicit point tenderness in the affected region; this maneuver elicits no pain in the area immediately adjacent to the pinpoint area. The Hildreth sign is the disappearance of pain after a tourniquet is placed on the extremity proximal to the lesion. The vascular nature of the tumor is probably the reason why the pain resolves. [25]

On occasion, a patient may present with multiple nodular glomus tumors.

Previous