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Published in Ashfaq A Marghoob, Ralph Braun, Natalia Jaimes, Atlas of Dermoscopy, 2023
Amélie Boespflug, Félix Pham, Ralph P. Braun, Luc Thomas
A structureless purple to blue spot observed through the nail plate is associated with one of two conditions: The presence of a blue nevus of the nail unit or a glomus cell tumor. In the latter, the pressure of the dermo scope on the nail plate can trigger the characteristic “electric” pain associated with this neoplasm. There are three well-described clinical tests that can help diagnose glomus tumors:Love's test: This test is considered suggestive of the presence of a glomus tumor if the pressure applied using the head of a pin or the tip of a paperclip reproduces pain on the affected fingertip. This test can also help locate the tumor.Hildreth's test: This test is considered suggestive of the presence of a glomus tumor if the tenderness observed during the Love's test disappears when the physician applies a tourniquet to the digit involved.The cold sensitivity test requires that the physician expose the finger to cold by, say, placing the finger in an ice bath. This exposure will elicit increased pain in a patient who has a glomus tumor.
Chromonychia
Published in Archana Singal, Shekhar Neema, Piyush Kumar, Nail Disorders, 2019
Michela Starace, Aurora Alessandrini, Bianca Maria Piraccini
Glomus tumor is an uncommon tumor of the neuromyoarterial glomus bodies located in the nail bed dermis. It is a painful benign nail tumor, occurring most commonly in the subungual area of the first and second fingernails. The classic triad of symptoms that typically exceed clinical signs includes intense, paroxysmal pain, pinpoint tenderness; cold sensitivity; and irradiation of pain along the same arm.7
Cancer Pain
Published in Gary W. Jay, Practical Guide to Chronic Pain Syndromes, 2016
Chemotherapy-induced painful peripheral neuropathies are increasing in importance, in part, due to the increasing numbers of neurotoxic agents being used (Table 3). These sensory neuropathies are bilateral, affecting distal areas in a stocking—glove distribution. Patients experience significant paresthesias and dysesthesias, with cold sensitivity and, often, proprioceptive changes (9). Functional impairment occurs as sensory changes lead to difficulties with normal tasks, particularly those requiring fine tactile sensation such as buttoning or picking up small items. Proprioceptive changes lead to safety concerns, as these individuals are at risk for falls and dropping items. They cannot sense the temperature of bath water, for example, leading to burns. For most, but not all chemotherapeutic agents, neuropathies occur in a dose-dependent fashion, and there is often a delay of approximately two weeks from administration to onset of pain (10). Little is known about the true prevalence, risk factors, time to resolution, and potential for persistent pain.
Barriers and facilitators associated with musculoskeletal complaints in individuals with upper limb absence – focus group results and a scoping review
Published in Disability and Rehabilitation, 2023
Anneliek A. Peters, Sietke G. Postema, Michiel F. Reneman, Corry K. van der Sluis
The FG participants did not mention any factors from this category. Participants who were sensitive to cold were about 4.4 times more likely to have chronic pain compared to individuals without cold sensitivity (LOE 4) [20]. Participants with higher fatigue scores were more likely to report chronic pain (LOE 4) [20]. A low pain score was a predictor for higher disability (LOE 4) [6]. Pain prior to the amputation was correlated to back and neck pain (LOE 4) [32], the correlation with RLP and non-amputated limb pain was not statistically significant (LOE 4) [32]. Neck pain was reported to be more bothersome contralateral to the amputation in one study (LOE 4) [7], but not in another (LOE 4) [8]. Sleep quantity and quality were suggested to have a relationship with pain (LOE 5) [33]. Comorbidity and degree of deficiency, i.e., how many limbs were affected, did not show a significant result (LOE 4) [6,8,20]. Disability was higher for individuals with ULA and MSCs compared to controls with MSCs (LOE 4) [6]. Disability was also higher for people experiencing severe back pain and people with moderate and severe neck pain [33]. Correlations with other types of pain were also found in two studies (LOE 4) [31,33].
Human vulnerability and variability in the cold: Establishing individual risks for cold weather injuries
Published in Temperature, 2022
François Haman, Sara C. S. Souza, John W. Castellani, Maria-P. Dupuis, Karl E. Friedl, Wendy Sullivan-Kwantes, Boris R. M. Kingma
The main causes of NFCI are the sustained exposure to cooling temperatures between 25°C and 10°C and/or wet conditions. The feet are the most at risk; however, NFCI can affect any body part. Overall, NFCI diagnosis is based on comprehensive history, general examination, and injury classification. NFCI are classified in four different stages according to the exposure duration to cold temperatures, skin color, and other specific symptoms. In case of suspected NFCI, the patient should be first evacuated from the cold and/or wet environment if possible and subsequently receive immediate and additional management. Prevention is still the major way of avoiding long-term consequences such as cold sensitivity. Frostbite is mainly related to the exposure to temperatures close to tissue freezing point (−0.55°C). The diagnosis of frostbite starts with a clinical approach and is followed by the injury classification. Frostbite can be clinically differentiated into superficial (first and second levels.) and deep (third and fourth levels). Imaging exams to evaluate the level of tissue damage should be performed in deep cases of frostbite. Although there are different treatments available (e.g. iloprost and tPA), the first management is highly determinant of prognosis. Clearly, preventing and mitigating risks of CWI is key when exposed to cold conditions. Much work remains to clearly understand how individual morphological, physiological, and psychological differences can modulate cold responses and the risk of developing cold weather injuries.
Extradigital glomus tumor of the anterior knee
Published in Case Reports in Plastic Surgery and Hand Surgery, 2020
Patients with glomus tumors classically present with a triad of pinpoint tenderness, paroxysmal pain, and cold hypersensitivity. Localization of the lesion can be performed with Love’s test by applying pressure to the suspected area with the head of a pin or paperclip, eliciting intense pain. Love’s pin test has a sensitivity of 100% and accuracy of 78% [6]. If a tourniquet or blood pressure cuff is utilized proximal to the lesion in Hildreth’s test, the tenderness is abolished. Hildreth’s test has a sensitivity of 71% and specificity of 100% with 78% accuracy [6]. Cold sensitivity was found to be 100% sensitive, specific, and accurate [6]. Subjective symptoms typically exceed clinical signs and it is not uncommon for patients to see multiple providers, sometimes over multiple years, prior to obtaining the correct diagnosis. Patients have been wrongly referred to psychiatrists due to misdiagnosed glomus tumor where no nail or skin alteration was visible, and no proper workup performed. Clinically, glomus tumors can be confused with neuromas, arthritis, gout, eccrine spiradenomas, and leiomyomas which can all be readily distinguished from glomus tumors histologically and immunohistochemically [4].