Long-Standing Pain and Cold Sensitivity Resembling a Glomus Tumour with Unclear MRI Signals but Without Any Found Glomus Tumour

Department of Translational Medicine - Hand Surgery, Lund University, Malmö, Sweden

A right-handed, 26-year-old female, without previous history of any hand or arm trauma or diseases, with an office job, was referred in 2009 to Department of Hand Surgery because of pain in the ulnar part of the fingertip of the left little finger with severe cold sensitivity for several years. MRI showed signal alterations with a suspicion of a glomus tumour at the site of the symptoms. On exploration, no glomus tumour was found, but precisely at the site of symptoms and MRI signals a few Pacini corpuscles were found, which were resected (normal morphology). The postoperative event was without any problems and no further action was performed despite remaining symptoms in 2012. Remaining symptoms of unchanged character led to a new referral and examinations. MRI in 2012 and 2024 showed similar MRI findings as 2009 (i.e., 3-4 mm well defined oval area of oedema with focal contrast loading; high signaling T2 and iso signaling in T1). Additional symptoms in 2023, which included a minor ulnar nerve entrapment at ipsilateral elbow level. Neurography was normal as well as an MRI of the left elbow. At recent follow ups, remaining pain (pulsatory character) and cold sensitivity in fingertip of left little finger were noted with normal sensation (Semmes-Weinstein monofilament 2.83), pain at a specific point at the ulnar side of the finger pulp (at pressing VAS 8-9/10), no allodynia, a well healed scar, normal strength in ulnar nerve innervated muscles, a slight exaggeration of paresthesia in little finger with elbow flexion and a minor Tinel´s sign at elbow (just proximal to the retroepicondylar groove and at Osborne´s ligament). No relief of symptoms was observed with the “finger-tourniquet test”. In conclusion, a healthy young female with long-standing typical symptoms of glomus tumour and MRI findings, but without any glomus tumour found at exploration.