From the Guidelines
Glomus tumor of the fingernail is a rare, benign neoplasm that arises from the glomus body, a specialized arteriovenous structure, characterized by localized tenderness, severe paroxysmal pain, and sensitivity to cold.
Diagnosis and Treatment
- The diagnosis of glomus tumor is typically based on clinical presentation and imaging studies, although the provided evidence does not specifically discuss diagnostic methods for glomus tumors of the fingernail 1.
- Surgical excision is the treatment of choice for glomus tumors of the fingernail, as it allows for complete removal of the tumor and histological examination of the tissue 1.
- The procedure typically involves a nail plate avulsion, followed by a thorough exploration of the nail bed to locate and remove the tumor.
- Pre-operatively, a course of analgesics such as acetaminophen 650mg every 4-6 hours or ibuprofen 400mg every 4-6 hours may be prescribed to manage pain.
- Post-operatively, patients are advised to keep the affected finger elevated and apply ice packs to minimize swelling.
- A topical antibiotic ointment such as bacitracin or neomycin may be applied to the wound to prevent infection.
- Pain management post-operatively may include acetaminophen 650mg every 4-6 hours or ibuprofen 400mg every 4-6 hours as needed.
- It is essential to note that recurrence of the tumor is possible, and patients should be monitored closely for any signs of recurrence, such as persistent or recurrent pain, or changes in the appearance of the nail or nail bed 1.
From the Research
Diagnosis of Glomus Tumor
- The diagnosis of glomus tumor is generally easy when manifested with the classical clinical picture, which includes paroxysmal pain, hypersensitivity to cold, and point tenderness 2, 3, 4.
- Imaging studies such as magnetic resonance imaging (MRI), ultrasonography, and radiography are often helpful in the diagnosis 3, 4.
- A high index of suspicion is required for early diagnosis and management of glomus tumors to relieve the patient's long-term suffering and prevent possible secondary nail deformities 4.
Clinical Presentation
- The typical clinical presentation of glomus tumor includes a bluish or pinkish red discolouration of the nail plate with classical triad of localized tenderness, severe pain, and cold sensitivity 3.
- Intense point pain and hypersensitivity to cold was observed in all cases (100%) in one study 2.
- Two out of 4 patients (50%) presented an irradiation of the pain at the ipsilateral arm and shoulder in one study 2.
Treatment of Glomus Tumor
- Complete surgical excision is curative, providing immediate relief of symptoms and improvement of eventual professional or psychological discomfort 2, 5, 4, 6.
- Approaching a subungual glomus tumor through transungual approach with complete excision of the nail plate has reduced the risk of reoccurrence due to complete view/access of the tumor and placing intact the nail plate after excision reduces the incidence of post-operative nail deformity 5.
- Surgical procedure was performed successfully in all cases, with total excision of the tumor and no intraoperative or postoperative complications in one study 2.