C L Nebreda1, B J Urban, A E Taylor. 1. Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina 27710, USA.
Abstract
BACKGROUND AND OBJECTIVES: Long-standing limb pain typically has a multifactorial etiology not amenable to causal therapy. We present a case of chronic progressing upper extremity pain caused by a glomus tumor; the excision was curative. METHODS: A 39-year-old woman presented with 10-year history of constant deep internal throbbing, aching pain localized to the radial aspect of the left index finger and additional intermittent shooting pains radiating up the arm toward the shoulder. Pain was increased after minor local trauma, following cold exposure, and for unknown reasons. A blotchy, bluish skin discoloration could appear on the radial aspect of the index finger during severe pain. Nonsteroidal antinflammatory drugs, narcotics, amitriptyline, local heat, bracing, and a sympathetic nerve block had all been ineffective. The physical 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 pressures abolished pain. A glomus tumor was suspected and confirmed by histologic examination. CONCLUSIONS: Glomus tumors are rare, benign neoplasms (1 to 5% of all hand tumors), developing from neuromyoarterial glomus bodies. They usually present with pain and may mimic other painful conditions, delaying the average time until diagnosis for up to 10 years. The classic diagnostic triad consists of local pain, pressure tenderness, and cold hypersensitivity. Abolition of pain following inflation of a blood pressure cuff to above systolic levels (ischemia test) is highly diagnostic. We suggest routine use of this test in cases of upper limb pain of unclear etiology.
BACKGROUND AND OBJECTIVES: Long-standing limb pain typically has a multifactorial etiology not amenable to causal therapy. We present a case of chronic progressing upper extremity pain caused by a glomus tumor; the excision was curative. METHODS: A 39-year-old woman presented with 10-year history of constant deep internal throbbing, aching pain localized to the radial aspect of the left index finger and additional intermittent shooting pains radiating up the arm toward the shoulder. Pain was increased after minor local trauma, following cold exposure, and for unknown reasons. A blotchy, bluish skin discoloration could appear on the radial aspect of the index finger during severe pain. Nonsteroidal antinflammatory drugs, narcotics, amitriptyline, local heat, bracing, and a sympathetic nerve block had all been ineffective. The physical 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 pressures abolished pain. A glomus tumor was suspected and confirmed by histologic examination. CONCLUSIONS:Glomus tumors are rare, benign neoplasms (1 to 5% of all hand tumors), developing from neuromyoarterial glomus bodies. They usually present with pain and may mimic other painful conditions, delaying the average time until diagnosis for up to 10 years. The classic diagnostic triad consists of local pain, pressure tenderness, and cold hypersensitivity. Abolition of pain following inflation of a blood pressure cuff to above systolic levels (ischemia test) is highly diagnostic. We suggest routine use of this test in cases of upper limb pain of unclear etiology.