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Glomus Tumor


- 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.

Glomus tumors of the digits

Thermographic diagnosis of glomus tumor.  

Glomus tumour of the hand.

Multiple occurrences of different histologic types of the glomus tumor.

The Anatomic Location of Digital Glomus Tumor Recurrences