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Paper text:
glomus tumor was first described by wood as early as 1821 , but the characteristic histological description was given by masson .
they are mostly located in the subungual region but occur less frequently in other nail unit region and extradigital sites .
characteristic triad of symptoms of temperature sensitivity , severe pain and localized tenderness can be noted in 63 - 100% of the patients .
a 36-year - old female was referred from surgery department , with history of pain in the left thumb since 10 years .
she noticed splitting of nail 3 years back , which gradually progressed to involve the whole length of nail .
, there was a small swelling with indistinct margins just behind the proximal nail fold .
there was also longitudinal split in the nail which was extending from the free end of the nail plate to the proximal nail fold [ figures 1 and 2 ] .
no color changes either in the nail plate or in the proximal nail fold were noted .
intraoperatively , a semitranslucent mass of 2 mm  3 mm size was found . it was excised and sent for histopathological examination .
these tumor cells had sharply punched out round to oval nucleus and well - defined borders . there were some dilated vessels with clusters of tumor cells in their walls [ figure 3 ] .
fullness in posterior nail fold region glomus tumor during exploration tumor cells invading vessel wall ( magnification 10 )
subungual location is the preferred site for digital glomus tumor , but can occur in other areas also . in our patient ,
the site involved was in posterior nail fold region , which is a rare occurrence .
reported the same in only one of his 28 glomus tumor patients evaluated by magnetic resonance ( mr ) imaging .
the most common site in his study was the reticular dermis of nail bed in rest of the patients .
our patient had the classical triad of symptoms - temperature sensitivity , severe pain and localized tenderness .
bhaskaranand and navadgi reviewed different clinical tests to diagnose glomus tumors and opined that cold sensitivity test is the most accurate test to diagnose glomus tumors .
positive cold sensitivity is also reported by vasisht et al . in 84% of their patients .
erythronychia and distal onycholysis were seen in all the glomus tumor patients studied by dominguez - charit et al .
noted the same in 76% of patients and only 24% of his patients had blue blush of nail in their study .
radiographic examination was inconclusive in our patient and the same was reported by bhaskaranand and navadgi in their study .
use of high resolution magnetic resonance imaging ( hr - mri ) and high variable frequency ultrasound ( hvfus ) in preoperative assessment will help in the outcome of surgical treatment .
bhaskaranand and navadgi employed the use of double tourniquet , one at the mid arm and the other at the base of digit , for better visualization of the tumor during exploration .
patient was followed up and it was noticed that she had recurrence of pain after 6 months
small size and difficulty in locating the tumor by traditional methods were the contributory factors .
but due to their high cost , glomus tumors continue to cause diagnostic difficulty to the treating physician because of their small size and lack of simple cost - effective investigation .
glomus tumor is a benign tumor arising from the neuromyoarterial plexus concentrated beneath the nail . 
 this plexus is an arteriovenous anastomosis functioning without the intermediary capillary bed . 
 etiology is not exactly known . 
 it is debilitating to the patient because of the chronicity of symptoms and lack of proper investigation which will help in identifying the tumor at an early stage . 
 we report a case of glomus tumor situated in the proximal nail fold region and causing longitudinal splitting of nail .