Upper extremity pain of 10 years duration caused by a glomus tumor

Background and Objectives. Long-standing limb pain typically has a multifac torial etiology not amenable to causal therapy. We present a case of chroni c progressing upper extremity pain caused by a glomus tumor; the excision w as curative. Methods. A 39-year-old woman presented with 10-year history of constant dee p internal throbbing, aching pain localized to the radial aspect of the lef t index finger and additional intermittent shooting pains radiating up the arm toward the shoulder. Pain was increased after minor local trauma, follo wing cold exposure, and for unknown reasons. A blotchy, bluish skin discolo ration could appear on the radial aspect of the index finger during severe pain. Nonsteroidal antinflammatory drugs, narcotics, amitriptyline, local h eat, bracing, and a sympathetic nerve block had all been ineffective. The p hysical examination was characterized by exquisite pressure tenderness over the radial aspect of the left index finger, most pronounced just distal to the distal interphalengeal joint. Results. Inflation of a left arm blood pressure cuff to above systolic pres sures abolished pain. A glomus tumor was suspected and confirmed by histolo gic examination. Conclusions. Glomus tumors are rare, benign neoplasms (1 to 5% of all hand tumors), developing from neuromyoarterial glomus bodies. They usually prese nt with pain and may mimic other painful conditions, delaying the average t ime until diagnosis for up to 10 years. The classic diagnostic triad consis ts of local pain, pressure tenderness, and cold hypersensitivity. Abolition of pain following inflation of a blood pressure cuff to above systolic lev els (ischemia test) is highly diagnostic. We suggest routine use of this te st in cases of upper limb pain of unclear etiology.