Sophia Delgado
Blood under the nail, known as a subungual hematoma, is a common injury that can be painful and cause discolouration. This occurs when blood vessels under the nail break and start to bleed, with the blood becoming trapped and causing pressure and pain. While small hematomas may not require drainage, larger ones can cause intense pain and pressure, and may even cause the nail to fall off. It is important to seek medical attention within 48 hours of the injury, as drainage becomes difficult once the blood starts to clot.
| Characteristics | Values |
|---|---|
| Medical Term | Subungual Hematoma |
| Description | Bleeding under the nail |
| Cause | Direct trauma to the nail, such as blunt force trauma, crush injuries, or repetitive pressure over time |
| Symptoms | Discoloration, pain, swelling, throbbing pain, pressure on the nail |
| Treatment | Drainage procedure (trephination) performed by a healthcare professional within 48 hours of injury; keeping the area clean and dry; home remedies for pain and recovery |
| Complications | Nail loss, nail regrowth with a different shape, infection, permanent damage to the nail or finger |
| Prevention | N/A |
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What You'll Learn
What is a subungual hematoma?
A subungual hematoma is a bruised fingernail or toenail that may cause throbbing pain. It occurs when blood pools under the nail plate, causing discoloration and lifting the hard part of the nail from the tissues underneath. Direct trauma to the nail, such as blunt force or crush injuries, typically causes this condition. The injury damages the blood vessels under the nail plate, leading to bleeding and swelling.
Subungual hematomas are usually minor injuries, and the pain typically subsides within a few days. However, the pressure from the pooled blood can cause severe discomfort. If needed, a healthcare provider can perform a simple draining procedure called trephination to relieve the pressure and provide relief. This procedure involves creating a small hole in the nail using a cautery device or a needle to allow the blood to escape. It is important to perform trephination within 48 hours of the injury before the blood starts to clot.
While most subungual hematomas heal without complications, it is important to keep the area clean and dry to prevent infection. In some cases, the nail may still look discolored for several weeks, and complete regrowth of a healthy nail can take several months. Although rare, complications such as nail loss or permanent nail deformity can occur due to damage to the nail matrix or germinal matrix.
Subungual hematomas should not be drained at home as it can lead to serious infection and permanent damage to the nail or finger. If you experience severe pain, signs of infection, or other concerning symptoms, it is important to seek medical attention. A physical examination, including imaging tests, can help assess the extent of the injury and determine the appropriate treatment.
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What causes blood under the nail?
Blood under the nail, or subungual haematoma, is usually caused by some form of injury or trauma to the nail. This can be caused by something crushing or slamming the nail, stubbing the toe, wearing tight shoes, or repetitive stress from movements such as running.
Subungual haematomas occur when blood vessels under the nail break open, causing blood to pool and become trapped underneath the nail. This can cause severe, throbbing pain due to the pressure of the blood collecting between the nail and the nail bed. The pressure from the pooling blood can also cause the nail to lift up from the tissue underneath.
While subungual haematomas are typically minor injuries, they can be extremely painful. They usually heal on their own within a few months, and the pain typically subsides within a few days. However, if the pain is severe or lasts longer, it is recommended to seek medical attention to check for infection, fracture, or other injuries.
In some cases, a healthcare provider may need to perform a simple draining procedure called nail trephination to relieve the pressure and pain. This procedure involves creating a small hole in the nail to allow the blood to escape. It is important to note that attempting to drain a subungual haematoma at home can lead to serious infection and permanent damage to the nail or finger.
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How to treat blood under the nail
Blood under the nail, or subungual haematoma, is usually caused by blunt force trauma, such as slamming your finger in a door or dropping something on your toe. This can cause severe throbbing pain and can be treated in several ways.
Firstly, it is important to note that you should not try to drain a subungual haematoma yourself as this can lead to serious infection and permanent damage to your nail or finger. Instead, a healthcare professional can perform a simple draining procedure called nail trephination, which involves creating a small hole in the nail to allow the blood to escape and relieve pressure and pain. This procedure should be done within 48 hours of the injury, before the blood starts to clot.
To care for your nail at home, you should keep the area clean and dry, and follow your doctor's instructions for changing any bandages. You can also take over-the-counter anti-inflammatories, such as aspirin or ibuprofen, to help with minor pain.
In some cases, if there is bleeding under a large area of the nail surface, the entire nail may need to be removed and the nail bed repaired with stitches. If the nail bed or surrounding tissues are injured, the new nail may take longer to grow back and may not look normal.
Most subungual haematomas heal well over time, but it can take several months for the nail to regrow completely.
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When to seek medical attention
Blood under the nail, or subungual haematoma, is usually caused by a traumatic injury. Examples include stubbing your toe, hitting your finger with a hammer, or slamming your finger in a car trunk. Unless the area of bleeding is very small, the nail will usually fall off on its own after several weeks because the pooled blood has separated it from its bed.
If you experience any of the following, seek medical attention:
- Deformity of the finger or toe
- Injury to a nearby joint
- More than a quarter of the nail is discoloured, or there is continuing, intense pain
- Signs of infection, such as pus, redness, or heat around the nail, or a red streak extending from the wound
- Inability to move the finger or toe
- The injury is at the base of the nail
- The affected area continues to collect blood
Your doctor will examine your nail and may take an X-ray to check for a bone fracture or other injuries.
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How to prevent blood under the nail
Blood under the nail, or subungual haematoma, is typically caused by direct trauma to the nail, such as blunt force or crush injuries. This can include stubbing your toe, hitting your finger with a hammer, or dropping something heavy on your toe. Subungual haematomas can also be caused by repetitive pressure, such as wearing tight shoes that press on the toenails.
To prevent blood from pooling under the nail, it is important to avoid any activities or situations that may cause direct trauma to the nails. This includes taking precautions during activities that involve heavy objects or potential crushing hazards. Wearing properly fitted shoes can also help prevent blood from pooling under the toenails due to repetitive pressure.
Additionally, it is crucial to seek medical attention if you experience any injuries to your nails. A healthcare provider can assess the severity of the injury and perform a simple drainage procedure if needed to relieve pressure and promote healing. Attempting to drain the blood at home is not recommended as it can lead to infection and permanent damage.
In summary, preventing blood from pooling under the nail involves avoiding direct trauma to the nails, wearing properly fitted shoes, and seeking medical attention for any nail injuries. By taking these precautions, you can reduce the risk of experiencing a subungual haematoma and its associated complications.
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Frequently asked questions
A subungual hematoma is a bruised fingernail or toenail that may cause throbbing pain and can lead to the nail falling off.
Blood is removed from under the nail through a procedure called nail trephination, where a small hole is made in the nail to allow the blood to drain.
It is recommended to see a doctor within the first 48 hours after the injury, as the blood will start to clot after this time, making drainage difficult.
No, you should not attempt to drain a subungual hematoma at home as it can lead to serious infection and permanent damage to your nail or finger.
If you experience bleeding under your nail, see a healthcare provider as soon as possible. They will be able to assess the injury and determine if drainage is necessary.
