What Can Cause Pain Under My Nail Beds

J Clin Diagn Res. 2014 Oct; eight(ten): ND05–ND06.

Iii Cases of Subungual Glomus Tumours of the Fingers – A Case Serial

Surya Rao R Five M

ⁱ Assistant Professor, Department of Plastic Surgery, Saveetha Medical College Hospital, Thandalam, Kanchipuram, India.

D Alagar Raja

² Banana Professor, Section of Plastic Surgery, Saveetha Medical College Hospital, Thandalam, Kanchipuram, India.

Received 2014 Feb xviii; Revisions requested 2014 Jul 14; Accepted 2014 Jul 22.

Abstract

Subungual glomus tumours are rare tumours (ii% of all hand tumours) presenting with excruciating pin point hurting under the nail which is often misdiagnosed. Diagnosis is often always clinical. Here, we written report the case of three patients who had subungual glomus tumour non diagnosed earlier for many years.

Keywords: Clinical diagnosis, Painful fingertip, Rare, Surgical excision

Example Study

Example 1

A 37-year-erstwhile patient presented to us with a painful left index finger tip for the past 12 years. The hurting was excruciating with waxing and waning episodes, hurting increases in cold atmospheric condition and not relieved by any analgesics. The patient had consulted many doctors for the above complaints. On exam, there was severe point tenderness at eponychial region of the left index finger. Beloved'due south Pivot test and Hildreth's test were positive. In that location was no smash discolouration and no nail deformity.

A clinical diagnosis of a subungual glomus neoplasm of left alphabetize finger was made and proceeded for exploration.

Nether local anaesthesia (2% Obviously Xylocaine), a latero-ungual arroyo was used. An eponychial flap was raised, nail bed incised and the tumour was shelled out [Tabular array/Fig-1]. Haemostasis was secured and the eponychial flap was sutured back with 5-0 ethilon.

Glomus tumour being excised

Histopathology examination showed a circumscribed neoplasm composed of sheets of round glomus cells collared around the blood vessels which were lined by normal endothelium [Tabular array/Fig-ii]. The intervening stroma showed myxoid change.

Histopathology exam showed a confining neoplasm equanimous of sheets of round glomus (black arrows) cells collared around the blood vessels (bold white pointer) which were lined past normal endothelium. The intervening stroma (yellowish arrow) showed myxoid alter (Haematoxylin- Eosin stain, high power magnification)

Case 2

A 47-twelvemonth-erstwhile male presented to united states with pain and deformity of right little finger for the past 4 years. He was wrongly diagnosed as a subungual haematoma elsewhere where an incision and drainage was washed, merely swelling recurred and hurting was persistent.

On examination, there was deformity and bluish discolouration under the nail with the Love'southward Pin examination and the Hildreth's exam being positive. A clinical diagnosis of a subungual glomus neoplasm of the correct footling finger was made and preceded for exploration [Tabular array/Fig-3a]. Through a transungular arroyo [Tabular array/Fig-3b], the deformed nail plate was excised and the nail bed was incised. A minor pivot sized swelling with surrounding fibroareolar tissue was excised and sent for histopathology. The nail bed was repaired with 5-0 monocryl and a Vaseline gauze and finger bandage was applied. Histopathology examination confirmed glomus tumour.

Subungual glomus tumour of right liitle finger

Tumour removed by transungular approach

Case 3

A 22-yr-old girl presented to u.s.a. with painful right ring finger tip for 2 years [Tabular array/Fig-4a]. Love's pivot test was positive with typical history of increased hurting during winter months. Excision was done and histopathology revealed a subungual glomus tumour [Table/Fig-4b].

Glomus tumour correct ring finger tip

Low power magnification of glomus tumour (Haematoxilin - Eosin stain) showing sheets of glomus cells. Blood vessels (white pointer), stroma (blackness arrow)

Discussion

Glomus tumours that were described kickoff by Masson in 1942, tin can occur anywhere in the skin or soft tissue, and the most common site is the finger. The tumour usually presents equally a painful, firm, purplish lone nodule of the extremities, virtually unremarkably in the nail bed [1]. It is a rare neoplasm, ii% of all paw tumours.

Normal glomus bodies are establish in the dermal retinacular layer of the skin and thought to aid in the thermoregulation of peel circulation and to exist highly concentrated in the finger tips, particularly below the nail bed [ii]. Glomus trunk (MASSON) is a neuromyoarterial glomus, which is an arteriovenous anastomosis functioning without an intermediary capillary bed & surrounded by a sheathing of connective tissue (structures chosen Sucquet – Hoyer canals).

They are solitary tumours commonly found in the distal phalanx in a paraungual or subungual location. They present with a archetype triad of paroxysmal pain, pinpoint tenderness, and cold hypersensitivity. Changes in temperature, palpation, and touching may cause pain and hypersensitivity [3].

Specific Tests

Diagnostic clinical tests included Love' sign, Hildreth' sign and transillumination. Dear' sign i.e. pressure applied over the lesion with the tip of a pencil eliciting excruciating hurting [4]. Hildreth' sign i.e. the indicate pain macerated afterwards slowly insufflating a brachial cuff [5].

Investigations

Transillumination [6], Magnetic resonance imaging (MRI) [7] and US are useful tools to confirm the tumour location. MRI shows a low signal on T1 and a high signal on T2. As long as there is no bony erosion, plain X-rays cannot be helpful except in long standing cases where bony erosions are evident [eight].

Treatment

In key (subungual) lesions, a direct transungular approach was performed by removing the nail plate and incising the blast bed longitudinally to explore the underneath tumour. In peripheral lesions, a lateroungual arroyo was preferred, where a lateral incision was washed close to and parallel to the nail margin accompanied with partial blast removal if necessary.

Notes

Financial or Other Competing Interests

None.

References

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Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4253213/

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