Noah Sinclair
Blood under the nail, also known as a subungual hematoma, can be alarming. It is usually caused by a crushing or stubbing injury that breaks open blood vessels under the nail, causing blood to collect and become trapped. This can result in darkened discoloration, pressure, and pain. Depending on the size and location of the hematoma, as well as the severity of the pain, different treatments are available. Small hematomas may heal on their own without treatment, while larger hematomas may require medical attention and drainage to relieve pressure and pain. It is important to seek medical advice to determine the best course of action and prevent further complications.
| Characteristics | Values |
|---|---|
| Medical Term | Subungual Hematoma |
| Cause | Blood vessels under the nail break open due to injury, causing blood to collect and become trapped in one spot |
| Symptoms | Darkened discolouration, intense pain, throbbing, pressure |
| Treatment | Ice, elevation, compression, over-the-counter anti-inflammatories, decompression (trephination), cautery |
| Home Treatment | Ice, elevation, compression, over-the-counter anti-inflammatories |
| When to See a Doctor | Within 48 hours of injury, if there are symptoms of fracture, severe pain, swelling, inability to move the finger or toe, or if the injury is at the base of the nail |
| Regrowth Time | Fingernail: 4-8 weeks to several months; Toenail: 6-18 months |
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What You'll Learn
See a doctor if you have concerns
If you have concerns about dried blood under your nail, it's important to see a doctor or healthcare provider for proper advice and treatment. A subungual hematoma, or bleeding under the nail, can be caused by a variety of factors, including injuries, tight shoes, or repetitive stress. While small hematomas may not require medical treatment, it's always best to seek professional advice to make an informed decision.
If you experience symptoms such as severe pain, pressure, or discoloration without a known cause, it's crucial to see a doctor. They may perform an examination, take X-rays, and determine the best course of treatment. In some cases, they may recommend decompression or trephination, which involves creating a small hole in the nail to drain the blood and relieve pressure. This procedure is typically done under local anaesthesia to numb the area and prevent pain.
Additionally, if you notice any signs of infection, extreme trauma, or a cut or laceration, don't hesitate to seek medical attention. A doctor can assess the severity of the injury and provide the necessary treatment to prevent further complications. They may also prescribe antibiotics or other medications to address the infection and promote healing.
Moreover, if you have concerns about the appearance of your nail after the injury, it's advisable to consult a doctor. Damage to the nail matrix, which is where your nails form, can result in permanent changes to the shape or structure of your nails. A doctor can evaluate the extent of the damage and provide guidance on nail care during the healing process. They may also recommend protective measures, such as splints or special bandages, to protect the affected area and promote proper healing.
While home remedies such as resting, icing, compression, and elevation can be used to encourage healing, it's important to prioritize your health and well-being by seeking professional medical advice whenever you have concerns or if your symptoms persist or worsen.
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Drainage methods
If you have bleeding under a large area of the nail surface, your doctor may need to remove the entire nail. However, if the area of bleeding is very small, the nail will usually fall off on its own after several weeks.
If you experience severe pain or pressure, your doctor may recommend nail trephination, also called decompression or cautery. This procedure involves using a heated wire (electrocautery device), a carbon laser, or a large-bore needle to burn or pierce the nail plate for drainage. The nail plate lacks nerves, so this process is relatively painless. The hole created should be large enough to let the blood drain, which can take about a day or two. During this time, the hole should be covered with sterile gauze.
It is important to note that nail drainage should only be performed by a medical professional and within the first 48 hours after the injury, as the blood begins to clot after this time, making drainage difficult. Home methods, such as using a heated pin or paper clip, are not recommended as they may cause infection.
Before performing drainage, your doctor may numb the affected finger or toe with a nerve block. After the procedure, the wound should be gently washed twice a day, then covered with Vaseline and a non-stick bandage.
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Home remedies
If you have dried blood under your nail, it is called a subungual hematoma. It happens when blood vessels break open under the nail, causing blood to collect and become trapped. It can cause pain, throbbing, and pressure.
If the affected area continues to collect blood, you are in extreme pain, or the injury is at the base of the nail, it is best to see a healthcare provider. You should also see a doctor if you have other symptoms like swelling or inability to move the finger or toe, as you may have a fracture.
If the subungual hematoma is small and the pain is mild, it will usually resolve without treatment. Home remedies such as resting, icing, applying compression, and elevation can also encourage healing. Here are some detailed steps you can take:
- Ice: Use an ice pack or a cold compress to reduce swelling and pain.
- Compression: Apply pressure, such as a wrap, to the area immediately to reduce the amount of blood that can pool.
- Elevation: Keep the affected hand or foot elevated above your heart to reduce swelling.
- Over-the-counter medication: Take over-the-counter anti-inflammatories like aspirin, ibuprofen (Advil, Motrin), or naproxen to help with minor pain.
Remember, it is important to contact a doctor if you have any concerns or if home measures do not provide relief. Nail drainage, for example, can only be performed within the first 48 hours after your injury, so seek medical attention if the injury is recent and bothering you.
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When to leave it alone
In most cases, a subungual hematoma is a minor injury, and the pain gets better within a few days. Small hematomas may heal on their own without causing much concern. You can manage the symptoms of mild cases by elevating your hand or foot, applying a cold compress to reduce pain and swelling, and using compression to slow the bleeding under the nail.
If the blood covers a very small area of the nail surface, you may not need to drain the hematoma at all. The blood will clot within 48 hours of the injury, making drainage difficult. Over time, the blood may turn dark, and the pressure of the hematoma may cause your nail to come off completely. The nail will usually fall off on its own after several weeks because the pooled blood has separated it from its bed. A new fingernail can regrow in as little as eight weeks, while a toenail may take up to 18 months to fully grow back.
However, it's important to see a doctor before deciding to leave a hematoma untreated. They may recommend draining the hematoma if it causes pain or covers 50% or more of the nail. Your doctor can perform a simple decompression procedure, also known as trephination, to relieve the pressure and pain. This involves numbing the affected area and using a heated wire or carbon laser to burn a small hole in the nail, allowing the blood to drain.
It's important to seek medical attention if you experience severe pain, broken bones, deep cuts, or damage to the nail bed or surrounding tissues. Do not attempt to drain the hematoma at home, as it may lead to infections and further complications.
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What causes subungual hematoma
Subungual haematoma, or bleeding under the nail, is usually caused by a crush injury to the distal phalanx, such as getting a finger trapped in a door. This direct blow causes bleeding to develop under the nail, which results in painful pressure being applied to the nail bed. This is known as a subungual haematoma.
The injury may also be accompanied by distal phalanx fractures, nail avulsion, or fingertip avulsions. The most common symptom is severe, throbbing pain. Other symptoms include discoloration of the nail, and in some cases, deformation of the finger or toe. If there is no injury and you notice a darkened area under the nail, it is important to see a doctor to rule out other possible causes, such as a tumour or melanoma.
Subungual haematomas can usually be relieved with a simple procedure called trephination, which involves making a small hole in the nail to allow the blood to drain out. This can be done with a heated wire (electrocautery device), a carbon laser, or a needle. The procedure is quick and painless and can be performed by a doctor or in an emergency department.
If the bleeding covers a large area of the nail surface, the nail bed may be injured, and the entire nail may need to be removed. In this case, stitches may be required to repair the nail bed, and the new nail may take longer to grow back.
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Frequently asked questions
A subungual hematoma occurs when an injury breaks open blood vessels under the nail, causing blood to collect and become trapped.
If the affected area is small, you may not need to seek medical care. You can treat it at home by applying a cold compress to the area to reduce pain and swelling, and using a compression wrap to reduce the amount of blood that can pool.
If you have a large affected area, experience extreme pain, or have other symptoms such as swelling or an inability to move the finger or toe, you should see a doctor as soon as possible, but no later than 48 hours after the injury, as the blood will begin to clot after this time, making drainage difficult.
