Abstract
Background
Glomus tumours are benign tumours which most frequently affect the upper extremities, often the subungual regions of the digits. The classic triad of presenting symptoms include cold hypersensitivity, point tenderness and paroxysmal pain. The absence of a visible lesion or a lack of a complete triad of symptoms, renders these lesions notoriously difficult to diagnose. The aim of this study is to analyse the referral pathways and misdiagnosis rates in relation to management of upper limb glomus tumours at our institution and compare this to the international experience.
Methods
We conducted a retrospective review of all glomus tumours treated at our institution over a twenty year period. Medical records, radiological imaging and histopathology reports were reviewed to identify patient, disease and treatment-related factors. A literature review of published case series of upper limb glomus tumours was performed to assess referral pathways, management and misdiagnosis rates.
Results
Twenty three upper limb glomus tumours were treated at our institution between 2000 and 2022. The mean age of diagnosis was 52.56 years (27-63 years) with a male preponderance 17/23 (74%). The overall rate of misdiagnosis was 70% based upon histological request forms at the time of surgery. The lowest rates of misdiagnosis were associated with management by hand surgery specialists. Eight published case series were identified in the literature with misdiagnosis a common phenomenon. Referral to hand surgeons appears to improves diagnostic accuracy. We present an evidence-based algorithm to recommend optimal management which may guide clinicians and improve patient outcomes.

Key words: Glomus Tumour, Upper extremities, Diagnostic Errors