- Discussion:
- glomus body is a neuromyoarterial apparatus;
- glomus is a controlled arteriovenous anastomosis or shunt between terminal vessels;
- its function is to regulate peripheral blood flow in the digits;
- majority of the lesions occur in females between the ages of 30 and 50 years;
- note the association between glomus tumor and neurofibromatosis:
- ref: The Association Between Glomus Tumors and Neurofibromatosis
- in the report by Bhaskaranand K and Navadgi C (2002), the authors reported a series of 18 patients with pain in the thumb or
finger tips who were diagnosed as having glomus tumour;
- 14 patients were found to have histopathologically proven glomus tumours, one had a neuroma and three had haemangioma;
- duration of symptoms before treatment averaged 1.9 years;
- cold-sensitivity and Hildreth's tests have sensitivities of 100% and 77.4% respectively and specificity of 100%;
- Love's pin test had a sensitivity of 100% and cold-sensitivity test was 100% accurate;
- none of these patients experienced recurrence during post op follow up;
- ref: Glomus tumour of the hand.
- Clinical Presentation:
- frequently involves nail bed w/ classic triad of pain, tenderness and cold sensitivity;
- placing involved digit in ice water will usually reproduce pain within 60 sec;
- nail bed ridging (and possibily a small blue spot at the base of the nail can be seen;
- multiple tumors in 25% of patients
- recurrent excruciating pain
- may have no visible or palpable signs (ladies should remove nail polish) except for a bluish discoloration;
- Radiographs:
- x-rays for appositional loss: perforating lesion of the phalanx;
- radiographs may also show a shelled out lesion dorsal lesion;
- radionuclide scanning
- Treatment:
- in terms of excision the tumor is usually well encapsulated and can be shelled out;
- surigical through lateral approach or thru nail bed (see nail bed removal);
- lateral approach:
- preferred technique if the lesion is on the margin of the nail;
- elevate the entire flap, which includes the nail plate, nail bed, and periosteum superiorly in order to excise the circumscribed
lesion on the undersurface of the flap, or within bone;
- flap is then replaced and held with nylon sutures
Glomus Tumors: A Review of Preoperative Magnetic Resonance Imaging to Detect Satellite Lesions
Glomus tumor of the hallux: case presentation and review of the literature.
Thermographic diagnosis of glomus tumor.
Multiple occurrences of different histologic types of the glomus tumor.