Forty-eight glomus tumours of the hand. Retrospective study and four-year follow-up.

We report a series of 48 glomus tumours of the hand, which have been reviewed with an average follow-up of 4.5 years (2-14). The tumour was nearly always sited in the distal digit, para-ungual (22 cases), more rarely subungual or under the pulp, with an even distribution among the fingers. Diagnosis was made preoperatively in 37 of 47 tumours of the digits, based on clinical features: consistent eliciting of pain by touch, less often by chill and occasionally accompanied by vasomotor phenomena. The pain and therefore the tumour could be accurately located with the tip of a pencil (Love's sign); these symptoms are abolished by inflation of a tourniquet proximally (Hildreth's sign). In 40% of cases a small defect in the distal phalanx is visible on plain radiographs, as well as an enlargement of the subungual tissues when the tumour is dorsal. The surgical approach was usually para ungual, in a sub-periosteal plane. Tumours were small (3.3 mm) and rarely multiple (3 cases). In 46 cases the pain was relieved quickly and definitively. Two true recurrences occurred after 5 years, without a satisfactory explanation. Except for those cases with transungual approach, there was no aesthetic compromise. We maintain that careful clinical assessment provides the diagnosis in most cases. Plain radiographs, lateral and comparative, are useful. MRI scan may occasionally prove of diagnostic value. The lateral ungual approach permits complete excision and healing. Recurrence is rare.