Q: I am 36 years old and it has been almost 10 years that I have pain in my right index finger. The location of the pain is a single point but the effect of the pain is felt in the surrounding areas too. It is quite bothersome. The pain does not go down. It remains constant for almost one minute and then starts going down gradually. The pain is stabbing and unbearable. It feels like a blade or a piece of glass is penetrating the nerve and muscle from inside. This happens mostly when I catch something, when I clap, open the lock by using a key or when I hold something tightly by this finger. I have visited several orthopaedic surgeons and tried several therapies including the ‘Depo-Medrol’ injection twice. Now, I'm totally fed-up and I want to know what is happening to me and also it’s right treatment.

A:This is an unusual but readily recognised small tumour encountered in the fingertips. This is the Glomus tumour. The name only contains the word tumour and you need not to be afraid of it. It is complete curable. Although it is most commonly seen in and under the nail, it is also encountered in other parts of the finger (in your case). The classic picture at presentation is – - middle age presenting episodes of severe pain in a specific area (pin point area). - that specific area (as in your right index finger top portion) is made worse by cold temperature. - mostly present to a doctor with complaints of severe pain while shaking hands with friends, accidental touch against any object during their daily activities It is an arterio-venous anastomosis surrounded by structures called Sucquet-Hoyer canals and containing glomus cells and smooth muscle. The point to be emphasised is the difficulty in diagnosis (as in your case) and importance of close attention to the patient histories (3 points I have mentioned before). X-rays may show erosion with smooth sclerotic border of the involved bone because of the long standing nature and the pressure effects they had caused over the bone. MRI will help in delineating small lesions and planning the surgical incision. Treatment is complete excision (surgery). 100% pain free after surgery is the characteristic nature of the tumour. The recurrence is rare in complete excision. There is no role for steroid injections or any medications.