Disclosures: Stephen M. Covington, DO: Nothing to disclose

Case Description: A 52-year-old left-handed female presented with a 6-year history of right thumb pain. There was no history of trauma to the digit, nailbed changes were present at the onset of symptoms. Aggravating factors included cold temperatures, gripping and pinching with the thumb. Pain was described as burning sensation with radiation proximally into the thenar eminence. The pain was resistant to duloxetine, gabapentin and pregabalin. Lidocaine and capsaicin provided no relief. She underwent right stellate ganglion block, cervical epidural injection and right superficial radial nerve pulse RF ablation with no improvement. She was evaluated for cervical radiculopathy with MRI and EMG, ultimately undergoing a decompression surgery without resolution of symptoms. The patient was referred to a tertiary care center for further evaluation.

Setting: Tertiary Care Center

Patient: 52-year-old female

Assessment/Results: A distal phalanx ultrasound revealed a mass under the thumb nail bed with hyperemic changes on Doppler flow. MRI of the thumb revealed a subungual soft tissue mass suspicious for glomus tumor. The patient underwent a right thumb mass excision and had complete relief of symptoms. She was functioning pain free 6 months after surgery in follow up.

Discussion: Three main structures comprise the glomus body including glomus cells, capillary vasculature and vascular smooth muscle cells. Abnormal growth of any of these structures can result in a glomus tumor. Plain radiographs and CT can be helpful if scalloping of the bone surface is present. MRI can show hyperintense lesions on T2 weighted imaging. Ultrasound with Doppler flow was particularly helpful in this case. Surgical excision with nailbed repair is the standard of care for symptom relief.

Conclusion: When treating chronic distal digit pain resistant to multiple medications and procedures, it is important to keep an open differential including the glomus tumor. Ultrasound with Doppler flow can be an effective tool for evaluating glomus tumors.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/case-report-as-a-good-rule-of-thumb-check-under-the-nailbed/