The authors discuss an interesting case of a Pacinian corpuscle neuroma in the thumb of an elderly woman who presented with severe digital pain. The pain was initially attributed to osteoarthritis of the interphalangeal joint of the thumb. The clinical signs were very subtle. The patient had complete pain relief following excision of the tumour. Pacinian corpuscle neuromas are rare, with only about 70 cases reported in the literature. The histology, presenting features and associated conditions are discussed in detail. In addition to a neuroma or glomus tumour, Pacinian corpuscle hyperplasia should be considered in the differential diagnosis of digital or palmar pain of unknown etiology.