Noah Sinclair
The human body is a complex system, and often, the state of one's health is reflected in various ways on the skin, hair, and nails. One such phenomenon is known as a splinter hemorrhage, which occurs when small amounts of blood from damaged blood vessels become visible through the nail, creating a splinter-like line. This can happen on both finger and toenails and is usually the result of an injury or trauma. In some cases, however, it may be indicative of underlying health issues, such as bacterial endocarditis, vasculitis, systemic diseases, or even diabetes. While there is no specific treatment for these hemorrhages, it is important to seek medical advice if they occur without an apparent cause, as they could signal the presence of a more serious condition.
| Characteristics | Values |
|---|---|
| What are they called | Splinter hemorrhages |
| Appearance | Dark red or brown lines along the nail groove that resemble a splinter |
| Causes | Trauma or injury to the nail, bacterial endocarditis, vasculitis, systemic diseases (e.g. rheumatoid arthritis, lupus, scleroderma), fungal infection of the nail, diabetes, Raynaud's disease, antiphospholipid syndrome, nonsteroidal anti-inflammatory drugs, aspirin, warfarin, chemotherapy medications |
| Treatment | No specific treatment necessary; the mark will disappear as the nail grows out. In cases caused by an underlying condition, treatment may vary and a doctor's advice should be sought. |
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What You'll Learn
Blood clots under the fingernails
Blood under the fingernail, or subungual haematoma, can be caused by injury or trauma to the nail. This can be from stubbing a toe, hitting your finger with a hammer, or slamming your finger in a car trunk. It can also be caused by wearing shoes that are too tight. This can result in darkened discolouration, such as black spots, and pressure and pain. If the blood is pooling under a large area of the nail surface, the nail bed may be injured and a doctor may need to remove the nail and use stitches to repair the nail bed.
If the blood is pooling, and you are experiencing extreme pain, or the injury is at the base of the nail, it's best to see a healthcare provider. You should also seek medical attention if you have other symptoms like swelling or an inability to move the finger or toe, as you may have a fracture. If you see a healthcare provider within 48 hours, the blood can be drained to relieve pressure. This can be done by piercing the nail plate with a hot metal wire, an electrocautery device, or a large-bore needle.
If the blood is pooling under a small area of the nail, you may not need to seek medical care. You can treat it by applying a cold compress to the area to reduce swelling and inflammation, or by taking over-the-counter pain medication.
In some cases, blood under the fingernail can indicate an underlying disease or disorder, such as bacterial endocarditis, vasculitis, systemic diseases, fungal infection of the nail, diabetes, or Raynaud's disease. If there is no known cause for the bleeding, you should see a doctor for further evaluation.
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Horizontal and vertical nail ridges
Ridges in your fingernails can be harmless and are usually a typical sign of ageing. However, they can also indicate a health problem or nutrient deficiency. Vertical ridges are more common in older adults and are often a sign of ageing. Horizontal ridges, on the other hand, can point to issues like malnutrition, serious nail injury, or Beau's lines. Beau's lines are horizontal ridges or dents in your nails that occur when something interrupts your nail growth. Chemotherapy, damage from using artificial or acrylic nails, and injuries to your nail, such as slamming your finger in a door, are all possible causes of Beau's lines. Peripheral vascular disease (PAD), severe illnesses with high fevers, such as COVID-19, measles, or pneumonia, and nutritional deficiencies can also cause Beau's lines. Zinc deficiency can cause these lines, as well as white spots on your nails, while iron deficiency can cause vertical nail ridges and koilonychia (spoon nails).
If you have nail ridges, it is important to determine if there is a medical cause that requires treatment, especially if you have horizontal nail ridges. Treating or managing the underlying medical condition or nutrient deficiency will usually allow smoother, healthier nails to grow in. However, it is important to note that it takes time for nails to grow out, and it may take several months to see a change in your nails. If you have horizontal ridges caused by an illness or other short-term issue, the ridges should grow out with the nail plate over time. While there is no guaranteed way to prevent nail ridges, seeing a healthcare provider can help you treat the underlying cause.
If you develop nail ridges, your provider can work with you to identify and address the underlying cause. It is important to inform your provider of any new ridges or lines in your nails, as well as any other nail changes, such as changes in shape or colour. While you may not need treatment, you won't know until you find out what's causing the ridges. Treating the underlying cause can help you grow smoother nails. For example, if you have developed Beau's lines due to diabetes, successfully managing your blood sugar may reduce these horizontal fingernail ridges. Similarly, treating skin conditions like eczema with moisturisers or topical ointments can help reduce symptoms and improve nail health. If nutrient deficiencies are the cause, altering your diet or taking supplements can help boost your levels and improve nail health.
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Palmar digital vein thrombosis
There are veins in your fingernails, and thrombosis of the palmar digital veins is a rare condition that can occur in them. It is characterised by the formation of blood clots in the small veins of the fingers or palms, resulting in lesions that can be painful and tender. This condition typically affects women between the ages of 35 and 65, with only around 36 cases reported in medical literature since 1936.
The aetiology of palmar digital vein thrombosis is not yet fully understood, but several factors are believed to contribute to its development. The anatomy of the palmar digital venous system, which includes arborized veins, venous arches, and deep and superficial axial veins, plays a role. The palmar veins are small in diameter and enclosed in fine connective tissue and fat, making them more susceptible to collapse with age.
Additionally, repeated mechanical trauma or compression to the hands, such as through household chores or wearing rings, can increase the risk of thrombus formation. In some cases, there may be no apparent trigger, and the condition may be associated with underlying medical issues or hypercoagulability of the blood.
Treatment options for palmar digital vein thrombosis include conservative management or surgical excision of the thrombosed varix. A diagnosis can be made through clinical suspicion and confirmed with histological and radiological examinations.
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Subungual hematoma
Subungual haematoma, or splinter haemorrhage, is a common injury where blood collects under a fingernail or toenail. It is usually caused by a crush injury to the distal phalanx, such as getting a finger caught in a door, or stubbing a toe. This can cause the nail bed to be injured, and blood to pool under the nail. This condition can be extremely painful, as the pooled blood puts pressure on the nail bed.
The primary symptom of a subungual haematoma is a small amount of bleeding underneath a nail, which can cause a dark red or brown line to appear along the nail groove. This line closely resembles a splinter and is why the condition is often called a splinter haemorrhage. The injury may also be accompanied by distal phalanx fractures, nail avulsion, or fingertip avulsions.
If you experience a subungual haematoma, you should first determine whether or not you have also broken any bones or damaged the nail bed or surrounding tissues. If you have, you should seek medical attention immediately. If not, the injury is usually not serious and can be treated at home. To reduce swelling and inflammation, you can apply a cold compress to the area and take over-the-counter pain medication.
If the pain is severe, you can go to a doctor to have the blood drained. This procedure is called decompression or trephination and involves burning or drilling a small hole in the nail to release the blood and relieve the pressure. However, there is a small risk of infection, and the nail may fall off as a result. In most cases, the injury will heal on its own as the nail grows out, which can take several months.
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Hand and finger anatomy
The human hand is composed of many different bones, muscles, and ligaments that allow for a large amount of movement and dexterity. The hand includes the wrist, palm, and fingers. The wrist acts as a pivot point, allowing the hand to move in almost any direction. The hand and wrist are structured to allow humans to move, flex, and rotate the wrist joint and to use the hand to grab and touch objects.
There are 27 bones within the wrist and hand. The wrist itself contains eight small bones, called carpals, which join with the two forearm bones, the radius and ulna, forming the wrist joint. The carpals connect to the five metacarpals, which form the palm of the hand. One metacarpal connects to each finger and thumb. Small bone shafts called phalanges line up to form each finger and thumb. Each finger has three phalanges, separated by two joints, except for the thumb, which has only two phalanges and one interphalangeal joint.
The hand has 34 muscles, which are soft tissue made of stretchy fibre. Intrinsic muscles inside the hand work with extrinsic muscles near the outside of the hand and in the forearm to give the hand its strength and dexterity. Each finger has six muscles controlling its movement: three extrinsic and three intrinsic. The thumb and little finger are connected to small muscles originating from the carpal bones of the wrist, which enable movement of these fingers and allow the thumb to move across the palm.
Ligaments are tough bands of connective tissue that connect the bones to support them and keep them in place. The volar plate is the strongest ligament in the hand and prevents hyperextension of the PIP joint. Each finger joint has two collateral ligaments on either side, preventing the abnormal sideways bending of the joints.
The hand also contains many blood vessels and nerves. The two main blood vessels of the hand and wrist are the radial and ulnar arteries, which supply the hand and wrist area with blood. The three main nerves responsible for hand and wrist movement are the radial nerve, the median nerve, and the ulnar nerve.
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Frequently asked questions
Yes, there are veins in your fingernails. The palmar veins run through the fingers and are surrounded by connective tissue and fat.
A blood clot under the fingernail is known as subungual hematoma. It can cause the nail to turn red or purple, which may later darken to brown or black. The nail may also feel tender or sore. Small clots may go away without treatment, but it is still recommended to see a doctor to prevent permanent damage to the finger and more serious consequences if the clot breaks apart and enters the bloodstream.
Symptoms of a blood clot in the finger include one or more firm, blue bumps on the palm side of the finger, and swelling or discoloration. Blood clots can be mildly to severely painful.
If you suspect you have a blood clot in your finger, see a doctor as soon as possible. They will be able to tell the difference between a bruise and a clot and advise on the best course of treatment.
