Extradigital glomus tumor of the scapular region presenting as chronic scapular pain with ulnar-hand radiation: a case report.

Introduction and importance: Glomus tumors are benign perivascular neoplasms that typically arise in the subungual region. Extradigital lesions of the trunk and shoulder girdle are uncommon and may be missed because they are small, and their symptoms can mimic musculoskeletal or radicular pain. Case presentation: A 33-year-old woman presented with 3 years of severe, strictly localized right scapular pain with episodic radiation to the ulnar side of the hand. Prior spine imaging was nonexplanatory, and she was repeatedly treated for presumed musculoskeletal or cervical radicular pain. Examination identified a minute, exquisitely tender subcutaneous nodule over the posterior chest wall that reproduced her typical symptoms. Targeted MRI demonstrated a well-defined superficial 6 × 4 × 5-mm lesion that was T1 hypointense, T2 hyperintense, and showed avid enhancement without invasion of underlying muscle or bone. The lesion was excised, and histopathology with immunohistochemistry (smooth muscle actin positivity) confirmed a benign glomus tumor with clear margins. Clinical discussion: Extradigital glomus tumors may lack the full classic triad and can present with misleading radiation patterns. Pinpoint tenderness with site-directed imaging is a high-yield diagnostic approach, and complete excision is usually curative. Conclusion: In chronic, strictly localized scapular/posterior chest wall pain with nonexplanatory spine imaging, clinicians should examine for a focal tender nodule and obtain targeted imaging to avoid prolonged diagnostic delays.