# Glomus Tumour and Common Hand Tumours

> NEET-PG Orthopaedics glomus tumour and common hand tumours covers Love and Hildreth signs, ganglion, giant cell tumour of tendon sheath and their treatment.

- Canonical URL: https://prepelephant.com/topics/neet-pg/orthopaedics/glomus-tumour-and-hand-tumours
- Exam / course: NEET-PG · Subject: Orthopaedics
- Publisher: PrepElephant (https://prepelephant.com) — Prepared and reviewed by the PrepElephant Academic Review Team
- First published: 2026-10-15
- Last updated: 2026-10-15
- Reference basis: Green's Operative Hand Surgery; Maheshwari's Essential Orthopaedics; Campbell's Operative Orthopaedics
- How to cite: "Glomus Tumour and Common Hand Tumours", PrepElephant, https://prepelephant.com/topics/neet-pg/orthopaedics/glomus-tumour-and-hand-tumours

## Direct answer

A glomus tumour is a benign neoplasm of the glomus body, a neurovascular structure in the nail bed, and it classically causes severe pain that is sensitive to cold and to pressure. Love's pinpoint tenderness and Hildreth's relief of pain with a tourniquet support the diagnosis. Surgical excision, usually through a sub-ungual approach, is curative.

## What you must remember

- **Origin:** the glomus body, a modified arteriovenous shunt (the Sucquet-Hoyer canal) in the dermis, found most densely in the nail bed.
- **Commonest site:** the subungual region of a finger, and the tumour is often a small, blue-red spot under the nail.
- **Classic triad:** paroxysmal pain, exquisite point tenderness and cold sensitivity.
- **Love's sign:** pinpoint tenderness that localises the tumour, which a fine probe can often reproduce under the nail.
- **Hildreth's sign:** relief of pain when a tourniquet is applied proximally, which indicates a vascular lesion.
- **Ganglion:** a cystic swelling arising from a joint or tendon sheath, most often on the dorsum of the wrist, usually painless or mildly aching.
- **Giant cell tumour of tendon sheath:** a benign, nodular synovial lesion around flexor tendons in the hand, the second most common hand tumour after ganglion.

## A pathway for a painful lesion in the hand

A painful nodule in the hand has a short differential, and the examiner's question is usually which history or test separates the lesions. The steps below follow the order in which a clinician narrows the diagnosis.

1. **Take the pain pattern:** a glomus causes paroxysmal pain triggered by cold and pressure, whereas a ganglion usually aches without the same trigger.
2. **Localise the point:** the tumour is found by pinpoint tenderness under or beside the nail, which is Love's sign.
3. **Apply the tourniquet test:** pain relief with proximal ischaemia, which is Hildreth's sign, favours a glomus over a neuroma.
4. **Palpate the swelling:** a ganglion is a firm, cystic and often mobile swelling, most often on the dorsal wrist.
5. **Image the lesion:** MRI defines a glomus as a small, well-defined lesion, while ultrasound helps distinguish a ganglion from a soft tissue mass.
6. **Decide the treatment:** excise a glomus through a sub-ungual approach, and treat a ganglion by aspiration or excision, with excision carrying the lower recurrence.

## Where the exam tries to catch you

Hand tumour questions reward the clinical sign and the right treatment rather than the pathology alone.

- **Trap:** aspirating a symptomatic dorsal wrist ganglion and expecting it to stay away. **Correct:** aspiration has a higher recurrence rate than excision, which is often preferred for symptomatic ganglia.
- **Trap:** treating the Hildreth sign as diagnostic on its own. **Correct:** it supports a vascular lesion, but the triad, the point tenderness and imaging are needed to confirm a glomus.
- **Trap:** calling giant cell tumour of tendon sheath malignant because it is a tumour. **Correct:** it is benign and usually treated by complete excision, with recurrence the main concern.

## Frequently asked questions

### Which clinical sign localises a glomus tumour under the nail?

Love's sign, which is pinpoint tenderness at the site of the tumour, localises a glomus tumour under the nail. A fine probe or the tip of a pen can often reproduce the pain. Localisation like this allows a targeted sub-ungual excision.

### What is the Hildreth sign in a glomus tumour?

Hildreth's sign is relief of pain when a tourniquet is applied proximal to the lesion, which stops blood flow through the glomus. It indicates that the pain is generated by a vascular lesion. The sign supports, but does not alone confirm, the diagnosis of glomus tumour.

### How is a dorsal wrist ganglion treated?

A dorsal wrist ganglion is treated by observation if it is painless, or by aspiration or excision if it is symptomatic. Excision carries a lower recurrence rate than aspiration. The choice depends on symptoms, size and the patient's preference.

### Is giant cell tumour of tendon sheath a malignant tumour?

Giant cell tumour of tendon sheath is a benign, nodular synovial lesion, usually found around the flexor tendons of the fingers. It can recur after excision, and metastasis is exceptionally rare. Complete surgical excision remains the standard treatment.