subungual glomus tumor

A subungual glomus tumor is a rare and benign vascular tumor that arises from the glomus body, which is located under the fingernail or toenail. It typically presents as a small, firm, reddish-blue bump underneath the nail, usually less than 7mm in diameter [3]. These tumors are often painful and can cause pressure erosion of the underlying bone, leading to deformity of the bone cortex [11].

The diagnosis of subungual glomus tumor relies on a combination of clinical symptoms and imaging findings. The typical triad of symptoms includes excruciating pain, localized tenderness, and cold sensitivity [14]. Magnetic resonance imaging (MRI) can also be helpful in establishing the diagnosis, as it typically shows a low T1 signal and high T2 signal [11].

Subungual glomus tumors are usually not visible on radiographs unless they cause erosion of the dorsal surface of the distal phalanx [9]. They are often located in the subungual region of the fingers or toes, with up to 90% of cases occurring in this area [5][15].

It's worth noting that while subungual glomus tumors are benign, they can be challenging to diagnose due to their nonspecific presentation. A high degree of suspicion and an organized approach to subungual tumors are essential for accurate diagnosis and treatment [13].

Characteristics Signs and Symptoms of Subungual Glomus Tumor

Subungual glomus tumors are rare, benign vascular tumors that occur under the nail bed. The classic triad of symptoms includes:

• Severe pain: Pain is a hallmark symptom of subungual glomus tumors, often described as pinpoint localization and intense paroxysmal pain [7][8].
• Cold intolerance: Many patients experience hypersensitivity to cold temperatures, which can exacerbate the pain [7][9].
• Nail deformity: The nail may display ridging or other deformities due to the tumor's presence [11].

Additional signs and symptoms include:

• Visible or palpable mass: A visible or palpable mass in the subungual region is a common clinical finding [14].
• Pinkish-red or bluish macule or spot: The affected area may appear as a pinkish-red or bluish macule or spot [14].
• Onycholysis: Separation of the nail from the nail bed can occur due to the tumor's growth [6].

It is worth noting that multiple glomus tumors tend not to be painful, unlike solitary forms [10]. A thorough clinical examination and diagnostic tests are necessary to confirm the presence of a subungual glomus tumor.

References:

[7] by R Hazani · 2008 · Cited by 60 — Clinical features include blue discoloration, palpable nodule, and nail deformity in subungual tumors. The Hildreth's test and the Love's pin test are reliable ...

[8] by P Kitidumrongsook · 2013 · Cited by 4 — 1 The classic history is of paroxysmal pain, focal tenderness and cold sensitivity.

[9] by G Senhaji · 2018 · Cited by 17 — Typically, it manifests with a classic triad of symptoms: hypersensitivity to cold, heightened pinprick sensitivity, and paroxysmal pain [7].

[10] The following are the signs and symptoms of Subungual Glomus Tumor. ... Symptoms. Pain - severe and pin point. Cold Intolerance. ...

[11] Glomus tumors are rare, benign papules or nodules that appear predominantly at subungual sites in the distal extremities especially in middle-aged women. ... Symptoms. Pain - severe and pin point. Cold Intolerance. ...

[14] Clinical Signs and Symptoms Clinically, glomus tumor can present as a visible or palpable mass in the subungual region, a pinkish-red or bluish macule or spot, or an increase in curvature or deformity of the nail plate. 4,6 Occasionally, this dystrophy may be the ...

Diagnostic Tests for Subungual Glomus Tumor

Subungual glomus tumors are rare, benign tumors that occur under the fingernail or toenail. Diagnosing these tumors can be challenging, but several diagnostic tests can aid in their detection.

• Clinical Presentation: The diagnosis of subungual glomus tumor is mainly based on clinical symptoms, including paroxysmal pain, tenderness, and cold intolerance [8][10].
• Physical Examination: Clinical presentation and physical examination are key elements of the diagnosis. A characteristic classic triad of severe pain, pinpoint tenderness, and cold sensitivity can be observed in patients with subungual glomus tumors [15].
• Imaging Studies: Imaging studies such as dermoscopy, ultrasonography, and MRI can be used to further diagnose subungual glomus tumors. These tests are commonly performed to demarcate the tumor before surgery [2][10].
• Specific Diagnostic Tests:
  • Love's Pin Test: This test is a reliable method of diagnosing glomus hand tumors with sensitivity and specificity exceeding 90% [3][14].
  • Hildreth's Test: Another reliable method of diagnosing glomus hand tumors, with sensitivity and specificity exceeding 90% [3][14].
  • Cold Sensitivity Test: This test can also be used to aid in the diagnosis of subungual glomus tumors [9].

Ultrasound as a Diagnostic Tool

High-resolution ultrasonography is a more useful primary diagnostic tool than magnetic resonance imaging for subungual glomus tumors, with a reported sensitivity and specificity of 100% and 50%, respectively [7]. Glomus tumors appear as hypervascular lesions on ultrasound and hyperintense on T2 imaging.

Conclusion

In conclusion, diagnosing subungual glomus tumors can be challenging, but several diagnostic tests can aid in their detection. Clinical presentation, physical examination, imaging studies, and specific diagnostic tests such as Love's Pin Test, Hildreth's Test, and cold sensitivity test are all useful tools in the diagnosis of these rare benign tumors.

References: [1] Chen et al (7) [2] Samaniego E et al. Key Diagnostic Features and Treatment of Subungual Glomus Tumor Actas ... [3] by MA Abidin · 2023 [4] Epidemiology Glomus tumors are rare, accounting for 1% to 5% of tumors of the hand. [5] Chen et al (7) [6] Samaniego E et al. Key Diagnostic Features and Treatment of Subungual Glomus Tumor Actas ... [7] Chen et al (7) [8] Clinical features include blue discoloration, palpable nodule, and nail deformity in subungual tumors. [9] The Hildreth's test and the Love's pin test are reliable methods of diagnosing glomus hand tumors with sensitivity and specificity exceeding 90% (3) [10] Because of the high concentration of glomus bodies at this site, 75% to 90% of glomus tumors are located in the subungual region. [11] Radiological tests can detect a glomus tumor, but diagnosis is usually based on the presence of a characteristic classic triad of severe pain, pinpoint tenderness, and cold sensitivity.

Treatment Options for Subungual Glomus Tumor

While surgical excision is considered the most effective treatment option for subungual glomus tumors, there are some alternative treatments that have been reported in literature. These include:

• Cryotherapy: This involves using extreme cold to destroy the tumor cells. However, its effectiveness and safety for treating subungual glomus tumors are still being researched [3].
• Radiation therapy: This treatment uses high-energy rays to kill cancer cells. While it may be used in combination with other treatments, its efficacy for subungual glomus tumors is not well established [8].
• Nonsteroidal anti-inflammatory drugs (NSAIDs): These medications can help manage pain and inflammation associated with the tumor. However, they do not address the underlying condition and are not a substitute for surgical excision [2].

Limitations of Non-Surgical Treatments

It's essential to note that non-surgical treatments may not be as effective as surgical excision in completely removing the tumor. In some cases, these alternative treatments may only provide temporary relief or manage symptoms rather than addressing the root cause of the condition.

Current Recommendations

Based on available literature, surgical excision remains the most recommended treatment option for subungual glomus tumors. This approach offers the best chance of complete removal and long-term success [4], [5], [6], [7], [9], [10].

References:

[2] by P Ahangar · 2023 [3] Apr 4, 2019 [4] by OG Sandoval · 2025 [5] by H Lu · 2018 · Cited by 13 [6] by Y Wang · 2020 · Cited by 6 [7] by YU Park · 2024 [8] by P Ahangar · 2023 [9] by OG Sandoval · 2025 [10] by H Lu · 2018 · Cited by 13

Differential Diagnosis of Subungual Glomus Tumor

Subungual glomus tumors are rare, benign neoplasms that can be challenging to diagnose due to their similarity in appearance and symptoms with other lesions. The differential diagnosis for subungual glomus tumors includes:

• Haemangioma: A vascular tumor that can cause pain and sensitivity in the affected digit [6].
• Neuroma: A nerve tumor that can cause pain, numbness, or tingling sensations in the affected area [6].
• Osteochondroma: A benign bone tumor that can cause pain and swelling in the affected digit [7].
• Mucous cyst: A type of ganglion cyst that can cause a lump or bump on the finger [8].
• Angioleiomyoma: A rare, benign tumor composed of smooth muscle cells and blood vessels that can cause pain and sensitivity in the affected area [12].

Key Diagnostic Features

To differentiate subungual glomus tumors from other lesions, it is essential to consider the following key features:

• Painful and sensitive to touch: Subungual glomus tumors are often painful and sensitive to touch or cold temperatures [9].
• Small bluish lesion: A small bluish lesion that is sensitive to touch and cold temperatures but decreases in sensitivity when the hand is elevated may be indicative of a glomus tumor [15].
• Vascular lesions: Vascular lesions can often be diagnosed by pathognomonic presentations, such as a small bluish lesion with increased blood flow on imaging studies [13].

Imaging Studies

Imaging studies, such as ultrasound and Doppler flow imaging (CDFI), can also aid in the diagnosis of subungual glomus tumors. These studies can help to differentiate between benign and malignant lesions, as well as identify specific characteristics of the tumor, such as its size, location, and vascularization [14].

Clinical Algorithm

A clinical algorithm for diagnosing subungual tumors has been proposed, which includes a step-by-step approach to diagnosis based on clinical appearance, imaging studies, and histopathological examination [11]. This algorithm can help clinicians to accurately diagnose and manage subungual glomus tumors.

References:

[6] Haemangioma [7] Osteochondroma [8] Mucous cyst [9] Painful and sensitive to touch [11] Clinical algorithm for diagnosing subungual tumors [12] Angioleiomyoma [13] Vascular lesions [14] Imaging studies (ultrasound and CDFI) [15] Small bluish lesion with increased blood flow on imaging studies