Ava Monroe
Blood blisters under nails, also known as subungual hematomas, are usually caused by a crushing or stubbing injury. They can cause symptoms such as intense pain and throbbing as blood collects and becomes trapped under the nail. The blood can turn dark, and the pressure of the hematoma may cause the nail to come off completely. Small hematomas may heal on their own within a few days without treatment or complications. However, larger hematomas may cause issues such as severe pain, and the blood will need to be drained by a doctor within 48 hours of the injury. Without treatment, it may take several months or even years for a hematoma to reabsorb or grow out.
| Characteristics | Values |
|---|---|
| Medical Term | Subungual Hematoma |
| Cause | Trauma to the nail, such as stubbing or crushing |
| Appearance | Brown or black streak or spot on the nail |
| Symptoms | Pain, throbbing, pressure, swelling, discolouration, bleeding |
| Treatment | Drainage (trephination) within 48 hours, elevation, compression, cold compress, stitches, removal of nail |
| Healing Time | Several months to years, depending on the size and location; a new nail may take 4-18 months to grow back |
| Prevention | Rest the digit, use a cool pack, keep the hand or foot elevated, apply compression |
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What You'll Learn
Drainage must occur within 48 hours of injury
Blood blisters under the nails, also known as subungual hematomas, are usually caused by a crushing or stubbing injury. They can cause symptoms such as intense pain and throbbing as blood collects under the nail. If the blood covers a large area of the nail surface, the nail bed may be injured and a doctor may need to remove the entire nail.
If you experience bleeding under your nail, it is recommended that you see your healthcare provider as soon as possible. If it has been less than 48 hours since the injury, a process called trephination can be performed to drain the excess fluid and relieve the pressure. After 48 hours, the blood will start to clot, making drainage difficult. Therefore, drainage must occur within 48 hours of the injury for the best results.
During trephination, a digit block or local anaesthetic is administered so that the patient does not feel pain during the procedure. Then, a healthcare professional will create a small hole in the nail using a cautery device (a tool that uses electricity to produce heat), a hot metal wire, an electrocautery device, or a large-bore needle. The hole created by piercing should be large enough to let the blood drain, which takes about a day or two. During this time, the hole should be covered with sterile gauze.
After the procedure, the patient will need to keep the finger or toe bandaged and elevated and may also need to use cold compresses during the first 12 hours. In some cases, a splint may be recommended for up to 3 days until the tenderness subsides.
It is important to note that nail drainage should not be attempted at home as it can lead to serious infection and permanent damage to the nail or finger. Small hematomas may heal on their own without much issue and home remedies such as elevation, cold compresses, and compression can be used to manage mild cases.
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Trephination is a quick and painless procedure
Blood blisters under the nails, or subungual haematomas, are very common and usually not dangerous. They are caused by a direct blow or crush injury to the distal phalanx, such as dropping something on your toe or finger, and can result in darkened discolouration and intense pain.
If you have a subungual haematoma, it is recommended that you see a doctor within the first 48 hours of your injury. This is because the blood begins to clot after this amount of time, making drainage difficult. Trephination is a quick and relatively painless procedure that can be performed within this timeframe to drain the blood and relieve the pressure and pain. During trephination, a local anaesthetic is administered to the affected digit, and a small hole is made in the nail using a cautery device, a large-bore needle, or a special tool designed for trephination. The procedure only takes a few seconds and causes little to no pain. After the procedure, a bandage is applied, and the patient is instructed to keep the digit clean and dry.
While trephination is a safe and common procedure, there is a small risk of developing an infection or minor injury to the nail bed. It is important to note that trephination should only be performed by a healthcare professional, as 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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Hematomas can cause severe pain and throbbing
Blood blisters under the nails, also known as subungual hematomas, are very common. They occur when an injury breaks open blood vessels under the nail, causing blood to collect and become trapped with no escape route. This build-up of blood causes intense pain and throbbing due to the pressure exerted between the nail and the nail bed. The pain can be severe and is usually the result of a crushing or stubbing injury.
Subungual hematomas can cause the nail to turn purple, blue, black, or brown as the blood may turn dark over time. The pressure may also cause the nail to come off partially or completely, a process known as avulsion. Before avulsion occurs, individuals may choose to relieve the pain and pressure by draining the hematoma. This procedure, called trephination, involves creating a small hole in the nail to allow the blood to flow out. It is important to note that drainage is most effective within the first 48 hours after the injury, as the blood begins to clot after this time frame, making drainage difficult.
Trephination can be performed quickly and relatively painlessly in a medical setting. Local anaesthesia is administered to numb the area, and then a small hole is made using a cautery device (a tool that uses electricity to generate heat), a large-bore needle, or a laser. The procedure typically takes about one to two days, during which the drainage hole should be covered with sterile gauze. Trephination helps prevent situations where the nail needs to be removed or falls off on its own.
In some cases, individuals may not need to seek medical care or drain the hematoma. Small hematomas that do not cause significant pain can often heal on their own without complications. The trapped blood will eventually be reabsorbed, and the discolouration will fade, although this process can take several months or even years. During this time, individuals can care for their injured nail by keeping the affected area clean, applying vaseline, and using a non-stick bandage.
While subungual hematomas are usually not dangerous, it is important to monitor for any concerning symptoms. If the pain is severe, prolonged, or accompanied by other symptoms such as swelling or inability to move the finger or toe, it is recommended to seek medical attention. Additionally, if there is severe bleeding or damage to the nail bed, medical treatment should be sought. In rare cases, discolouration under the nail without a known injury could indicate melanoma, a type of skin cancer, so it is important to consult a healthcare professional for an accurate diagnosis.
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Fingernails regrow in 8–12 weeks; toenails in 6–18 months
Blood blisters under the nail, also known as subungual haematomas, are usually caused by a crushing or stubbing injury. They can cause the nail to turn purple, blue, or black. The pressure from the blood building up under the nail can cause pain.
If you experience bleeding under your nail, it is recommended to see a healthcare provider as soon as possible, ideally within 48 hours of the injury. After this time, the blood will start to clot, making drainage difficult. Drainage can be performed relatively painlessly by a healthcare professional. Doctors recommend draining subungual haematomas when they cause pain or make up 50% or more of the nail.
If the nail falls off due to the pressure of the haematoma, it may take a considerable amount of time for it to grow back. Fingernails typically take 4 to 6 months to fully grow back, while toenails can take anywhere from 12 to 18 months. Nails that grow back may have ridges or other abnormalities.
It is important to note that you should not attempt to drain a subungual haematoma at home. Home methods such as using a heated pin or paper clip to make a hole in the nail may cause infection and permanent damage to the nail or finger. Always seek medical advice if you are experiencing pain or other symptoms.
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Hematomas may heal on their own in months or years
Blood blisters under the nail, also known as subungual hematomas, are very common and usually aren't dangerous. They are caused by direct trauma to the nail, which breaks the blood vessels underneath, causing blood to collect and become trapped. The blood can turn dark over time, and the pressure of the hematoma may cause the nail to come off completely.
Subungual hematomas on the fingernails heal more quickly, with new nails growing out within around 6–9 months. Toenails take longer to grow back, with a range of 6–18 months. Nails that grow back may have ridges or other abnormalities.
To aid healing, you can try home remedies such as elevating your hand or foot, using a cold compress for pain and swelling, and applying compression to slow the bleeding under the nail.
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Frequently asked questions
A blood blister under the nail is called a subungual hematoma.
Small subungual hematomas that cause mild pain can heal without treatment in a few days. Larger hematomas may take several months or even years to reabsorb without trephination.
You should see a doctor within the first 48 hours of the injury. After this time, the blood will start to clot, making it difficult to drain. You should also see a doctor if you experience severe pain, bleeding that doesn't stop, or signs of infection.
