Definition
Benign tumour of the glomus body, the neuromyoarterial thermoregulatory shunt of the dermis.
Epidemiology
- Adults in the fourth and fifth decades
- Female predominance in subungual lesions
- Multiple lesions in neurofibromatosis type 1 and familial glomangiomatosis
Pathology
- Uniform round glomus cells cuffing small vessels
- Smooth muscle actin positive
- Subtypes are solid glomus tumour, glomangioma and glomangiomyoma
- Malignant glomus tumour is rare
Clinical Features
- Subungual fingertip in most hand cases
- Triad of paroxysmal pain, pinpoint tenderness and cold sensitivity
- Bluish discolouration under the nail plate
- Nail ridging or distal nail deformity
- Love pin test, exquisite pain at a pinhead point
- Hildreth test, pain relieved by inflating a proximal tourniquet
- Cold sensitivity test, pain provoked by cold water immersion
- Diagnosis often delayed for years
Investigations
- Radiographs may show scalloping of the dorsal distal phalanx
- MRI shows a small lesion, low signal on T1, high on T2, with avid enhancement
- Doppler ultrasound shows a hypoechoic hypervascular nodule
Differential Diagnosis
- Subungual melanoma
- Mucous cyst
- Subungual exostosis
- Haemangioma
- Neuroma
- Osteoid osteoma
- Complex regional pain syndrome
Management
- Marginal excision. Treatment of choice, curative in most
- Transungual approach. Nail plate removal and nail bed incision for central subungual lesions, with careful repair
- Lateral subperiosteal approach. Periungual or lateral lesions, avoiding a nail bed incision
Complications
- Recurrence from incomplete excision or a missed satellite lesion
- Nail deformity after nail bed incision
Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 19 October 2026.