Glomus Tumors of the Hand: A Striking Clinical Problem Frequently Missed

Introduction: Glomus tumors of the hand usually present with classical triad of paroxysmal pain in fingertips, tenderness, and cold sensitivity. However, they often go undiagnosed or misdiagnosed for years and followed by inadequate treatment. We aimed to present our experience with the management of glomus tumors of the hand, which were analyzed according to their clinical presentation, diagnosis, surgical approach, and outcome. Material and Methods: Seventeen patients with clinical diagnosis of hand glomus tumors operated between 2013 and 2023 were retrospectively reviewed. The data collected included demographics, presenting symptoms, duration, physical examination including Love test, Hildreth test, and cold sensitivity test, diagnostic imaging including X-ray, ultrasonography and MRI, treatment, and outcome. Results: The mean age was 42.35 years (range: 25 - 59 years), and the female to male ratio was 14:3. The mean duration of symptoms was 2.4 years (range: 1 - 5 years). Ten (58.8%) cases had left-hand affection. Nine (52.9%) patients had nail bed changes. Transungual approach was done in 13 (76.5%) patients, while lateral subperiosteal approach was done in 4 (23.5%) patients. The mean tumor size was 5.76 mm (range: 3 - 9 mm). 16 cases were found to have histopathologically proven glomus tumors, while one patient had a non-specific fibrotic lesion and returned with pain recurrence. There was no other patient who experienced recurrence of symptoms. None of our patients developed nail bed deformity during a mean follow-up period of 7.2 months. Conclusions: Early and accurate diagnosis of glomus tumors of the hand should be made by utilizing a combination of thorough history taking, clinical tests and imaging tools. Complete surgical excision is the only effective method for treatment and recurrence prevention. Transungual approach followed by meticulous repair of the nail bed is recommended for central lesions while lateral subperiosteal approach is recommended for peripheral lesions.