Noah Sinclair
A subungual hematoma is a bruised fingernail or toenail that may cause severe, throbbing pain. It occurs when blood vessels under the nail break open, causing blood to collect and become trapped under the nail. This can be caused by trauma to the nail, such as dropping something on the toe or finger, or stubbing the toe. While subungual hematomas usually heal on their own within a few months, they can cause complications like nail loss and infection. If you experience severe pain, bleeding that does not stop, signs of infection, or a subungual hematoma that does not go away, it is important to seek medical attention. Drainage procedures can be performed by a doctor to relieve pain and pressure, but this should be done within 48 hours of the injury, before the blood starts to clot.
| Characteristics | Values |
|---|---|
| Healing Time | A minor subungual hematoma usually heals over time without treatment. It can take a few months or years for the trapped blood to be reabsorbed. Subungual hematomas on the fingernails heal faster than those on the toenails. |
| Drainage | Drainage is recommended when the hematoma causes pain or covers a significant portion of the nail. Drainage should be performed by a doctor within 48 hours of the injury, before the blood starts to clot. |
| Treatment | Home remedies such as rest, icing, compression, and elevation can aid in healing. In more severe cases, medical treatments may be necessary. |
| Complications | Complications may include nail loss, infection, and severe damage to the nail bed. |
| Symptoms | Symptoms include severe throbbing pain, discoloration (red, purple, brown, or black), and intense pressure. |
| Causes | Subungual hematomas are typically caused by trauma to the nail, such as crushing or stubbing. They can also be caused by underlying conditions such as melanoma or squamous cell carcinoma. |
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Hematoma drainage
A subungual hematoma is a bruised fingernail or toenail resulting from blunt or crush trauma. Blood collects under the nail, causing pressure and pain. Most subungual hematomas heal well over time without treatment, but there is a risk of complications like nail loss and infection.
Doctors recommend draining subungual hematomas when they cause pain or make up 50% or more of the nail. If you have also fractured your finger, doctors recommend drainage if the hematoma makes up 25% or more of your nail. It is best to see a doctor within the first 48 hours after the injury, as the blood begins to clot after this time, making drainage difficult.
The process of draining a subungual hematoma is as follows:
- Clean the area with alcohol, iodine, or another solution.
- Administer a digital block, which is a form of pain relief or anesthetic. A doctor may or may not use an anesthetic, depending on whether there is additional damage to the finger.
- Drain the hematoma by applying gentle pressure to the nail with a heated 18-gauge needle or cautery device. Some clinics use specialized lasers. You may hear a "pop" sound when the needle reaches the blood under the nail.
- Ensure the hole is 3 to 4 millimeters thick to allow for continuous drainage. Additional holes may be necessary for large hematomas.
- Milk (squeeze) the nail to help the blood flow out of the hole. Then elevate the hand or foot.
- Cover the affected area with a dry bandage or dressing and keep the wound clean and dry while it heals.
After drainage, it is important to keep the wound clean and dry. You may experience drainage from the hole in the nail for 1 to 2 days. Follow-up with a doctor if you experience any signs of infection, such as warmth, redness, increasing swelling, fever, or reaccumulation of the hematoma with pain.
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Healing time
The healing time for a subungual hematoma depends on various factors, including the severity of the injury, the location of the hematoma, and whether it is treated at home or by a medical professional.
Most subungual hematomas will heal on their own within a few months without any treatment. The trapped blood will eventually be reabsorbed, and the dark mark will disappear. However, this process can sometimes take years. Hematomas on the fingernails tend to heal faster than those on the toenails. It typically takes around 6 to 9 months for the new nail to grow out completely and return to its normal colour.
In some cases, medical treatment may be necessary to speed up the healing process and prevent complications. One such treatment is drainage, also known as trephination, which should be performed by a doctor within the first 48 hours after the injury, before the blood starts to clot. During this procedure, a small hole is made in the nail to allow the blood to flow out, relieving pain and pressure. The wound is then covered with a bandage and may continue to drain for up to 3 days.
It is important to note that attempting to drain a subungual hematoma at home using methods such as a heated pin or paper clip can lead to infections and further injury to the nail bed. Therefore, it is always recommended to seek medical advice before making any decisions regarding treatment.
To encourage healing, home remedies such as rest, icing, compression, and elevation can be utilised. Additionally, over-the-counter pain relievers can help manage discomfort and reduce swelling.
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Home remedies
A subungual hematoma is a bruised fingernail or toenail that develops after sudden trauma to your nail, like hitting your fingertip with a hammer or dropping a brick on your toe. It occurs when an injury breaks open blood vessels under the nail, causing blood to collect and become trapped in one spot.
- Resting
- Icing: Wrap ice in a soft cloth and apply it to the affected area to ease swelling and pain.
- Compression: Wrap the affected area with a bandage.
- Elevation: Keep the affected area elevated to reduce swelling.
- Over-the-counter pain relievers: Reduce discomfort and swelling with over-the-counter anti-inflammatories like aspirin, Advil, or Motrin.
It is important to note that while most subungual hematomas heal on their own within a few months, you should contact a doctor if you experience severe pain, bleeding that does not stop, signs of infection, or a hematoma that does not go away.
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Medical treatments
A subungual hematoma is a bruised fingernail or toenail resulting from blunt or crush trauma. Blood collects under the nail, causing pressure and pain.
During the drainage procedure, the doctor will first clean the area and administer pain relief or anesthetic. They will then create a small hole in the nail using a heated needle, cautery device, or laser. The hole should be 3 to 4 millimeters thick to allow for continuous drainage, and additional holes may be necessary for large hematomas. After draining the blood, the doctor will milk (squeeze) the nail to help the remaining blood flow out. Finally, the area will be covered with a dry bandage or dressing, and it is important to keep the wound clean and dry during the healing process.
In some cases, a subungual hematoma may be an indication of a more serious underlying condition, such as melanoma or squamous cell carcinoma. Melanoma can cause a dark mark to form under the nail and is not usually linked to an injury. It is important to contact a doctor if you have concerns about the appearance of blood under your nails or if the hematoma does not heal within a few months. The doctor may examine the nail using dermoscopy, order an X-ray to assess for possible fractures, and look for any signs of subungual melanoma or other conditions.
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Complications
Subungual hematomas are bruises that form under a nail after trauma. They can be very painful but are usually not dangerous. Most subungual hematomas heal well over time without treatment, with the trapped blood eventually being reabsorbed. This can take a number of months or even years.
However, there are some risks and complications to be aware of:
- Infection: Hematomas can get infected, so it is important to keep the area clean and dry while it heals. Signs of infection include warmth, redness, increasing swelling, and fever. If an infection develops, it can cause more damage than the initial injury.
- Nail loss: The pressure of the blood underneath the nail's surface may cause the nail to fall off partially or completely.
- Malformed nail regrowth: If there is severe damage to the nail bed, the nail may be malformed or cracked when it grows back. In some cases, the nail may fail to regrow.
- Ongoing pain: Pain from a subungual hematoma usually goes away within a few days. If pain is severe or lasts longer, it could indicate an infection or other injury, so it is important to seek medical advice.
- Bleeding that won't stop: If there is severe bleeding or bleeding that won't stop, it is important to seek medical advice.
- Misdiagnosis: It is important to get the right diagnosis as a subungual hematoma can be confused with melanoma, which can cause a similar dark mark under the nail. Melanoma does not usually cause pain and is not linked to an injury.
- Inappropriate drainage: While drainage can relieve pain and pressure, it should only be performed by a medical professional and within 48 hours of the injury, before the blood clots. Attempting drainage at home can cause infection or further injury to the nail bed.
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Frequently asked questions
A subungual hematoma is a bruised fingernail or toenail that develops after sudden trauma to your nail, like dropping something on your toe or finger.
Subungual hematomas usually heal on their own within a few months to years. The new nail typically grows out within 6 to 9 months, but this can vary for each person.
Minor subungual hematomas usually heal over time without treatment. Over-the-counter pain relievers can help manage discomfort and swelling. Home remedies like resting, icing, compressing, and elevating the affected area can also aid in healing. For severe cases, medical treatments such as drainage procedures may be necessary.
