Isla Bennett
A subungual hematoma is a bruised fingernail or toenail that develops after sudden trauma to the nail, such as dropping a brick on your toe or getting your finger slammed in a door. The injury can cause severe throbbing pain and discoloration of the nail as blood collects under the nail. While a minor subungual hematoma usually heals over time without treatment, doctors recommend draining the hematoma when it is painful or makes up 50% or more of the nail. Drainage must be performed within 48 hours of the injury, after which the blood will begin to clot, making drainage difficult. The time it takes for a hematoma to reabsorb depends on its size, and it may take several months or even years for the nail to grow back completely.
| Characteristics | Values |
|---|---|
| Time taken to heal without treatment | Several months to years |
| Time taken to heal with drainage | Several months |
| Time taken for a new nail to grow back | 4-6 months for fingernails, 12-18 months for toenails |
| Time taken to perform drainage | Within 48 hours of injury |
| Time taken for pain to subside | A few days |
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What You'll Learn
Trephination: a procedure to drain the hematoma
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 is usually the result of a direct blow or crush injury to the fingertip, such as getting a finger pinched in a doorway, or dropping a heavy object on your toe.
Trephination is a quick, outpatient procedure that can be performed in a variety of settings, including emergency rooms and urgent care clinics. It is a simple procedure that involves making a small hole in the hard part of the nail (nail plate) to drain the blood and relieve the pressure and pain. This procedure should only be performed by a healthcare provider as attempting it at home can lead to infections or further injury to the nail bed.
During the procedure, the doctor will first anaesthetise the distal finger with a digital block if the patient is anxious. Then, they will stabilise the operating hand on the same surface as the patient's hand. If using a cautery device, they will place it over the centre of the hematoma and apply mild pressure until the blood comes out, which usually takes less than a second. If using a needle, they will use a rotating motion with moderate pressure to drill through the nail. Alternatively, a 29-gauge insulin needle can be inserted underneath the nail and advanced proximally and parallel to the nail plate with gentle suction on the syringe until the hematoma drains into it.
After the procedure, the patient may experience drainage through the hole for up to 36 hours, which is normal and temporary. The area should be bandaged and kept clean and dry while it heals. The patient should follow up with their provider if they experience any signs of infection, such as fever, warmth, redness, swelling, or pus. It is important to note that the nail will still look discoloured for several weeks after trephination, but this is also normal, and the discolouration will gradually grow out with the nail.
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Home remedies: ice, elevation, and over-the-counter painkillers
A subungual hematoma is a bruised fingernail or toenail that may cause severe, throbbing pain. It occurs when an injury breaks open blood vessels under the nail, causing blood to collect and become trapped in one spot. This can happen when something crushes or slams the nail, causing trauma.
If the hematoma is small and the pain is mild, it usually resolves without treatment. Home remedies can help manage minor subungual hematomas while the injury heals. Here are some home remedies that can aid in healing and provide relief:
Ice
Applying ice to the affected area can help reduce swelling and pain. It is recommended to use ice for the first 24 to 48 hours following the injury. Ice should be placed on the injury site for 10 to 20 minutes at a stretch every few hours. It is important to wrap the ice in a soft cloth before applying it to the skin to avoid frostbite.
Elevation
Keeping the affected hand or foot elevated can help reduce swelling. This is done by raising the hand or foot above the level of the heart, which reduces the flow of blood to the area and helps to decrease inflammation.
Over-the-counter painkillers
Over-the-counter anti-inflammatories such as aspirin, Advil, or Motrin can help reduce discomfort and swelling. However, it is important to choose the right medication depending on the patient's health condition. For instance, ibuprofen is not recommended for patients taking anticoagulation medications due to the risk of gastrointestinal bleeding.
In addition to these home remedies, resting the affected digit and applying compression wraps can also aid in the healing process. While these remedies can provide relief and encourage healing, it is important to note that severe cases of subungual hematoma may require medical treatment, such as drainage procedures performed by a healthcare professional.
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Medical treatment: drainage and surgery
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 is usually caused by a direct blow or crush injury to the fingertip, such as getting a finger pinched in a doorway, or dropping a brick on your toe.
If you experience intense pain or pain that worsens over time, it is recommended that you seek medical care. A doctor may recommend a simple procedure called trephination, which involves draining the hematoma to relieve pressure. This procedure is typically recommended when the hematoma is painful and makes up 50% or more of the nail. For fractured fingers, drainage is recommended if the hematoma covers 25% or more of the nail. It is important to see a doctor within the first 48 hours after injury, as the blood begins to clot after this time, making drainage difficult.
During the trephination procedure, the doctor will make a small hole in the nail with a laser, electrocautery tool, or needle. The patient can expect to bleed from the site, and complications may include loss of the nail, re-accumulation of the hematoma, and infection. After the procedure, the patient may be instructed to keep the wound clean and dry, and to avoid soaking the affected area. The patient should also be aware that blood may continue to ooze from the hole for 1 to 3 days.
In some cases, especially when there is a deep cut or laceration, or other injuries such as a broken bone, surgery may be necessary to remove the nail plate and repair the tissues underneath. This can support the proper healing of the nail and help prevent further issues.
It is important to note that nail drainage and surgery should only be performed by medical professionals and should not be attempted at home.
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Healing time: up to 6-9 months for a new nail
A subungual hematoma is a bruised fingernail or toenail that develops after sudden trauma to your nail. It is caused by a direct blow or crush injury to the distal phalanx, such as getting a finger pinched in a doorway. Blood pools under the nail plate, causing discoloration and intense pain or throbbing.
If you have a subungual hematoma, it is important to seek medical care, especially if you have intense pain or pain that worsens over time, or if you have a deep cut and/or bleeding that won't stop. Your doctor may recommend a simple procedure called trephination, which involves draining the hematoma to relieve pressure and pain. This procedure should be done within 48 hours of the injury, as the blood will start to clot after this amount of time, making drainage difficult.
After trephination, it is important to keep the wound clean and dry while it heals. You may experience drainage for a few days after the procedure. Contact a doctor if you experience any symptoms of infection such as fever, warmth at the injury site, pus, or increasing swelling. Other possible risks include loss of your nail or re-accumulation of the hematoma.
It can take up to 6-9 months for a new nail to completely grow out and return to its normal colour. During this time, the nail may be malformed or cracked, and it may fail to regrow in some cases. To promote healing, you can take steps such as resting the digit, using a cool pack, keeping the hand or foot elevated, and applying compression. Over-the-counter pain relievers can also help to reduce discomfort and swelling.
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Complications: nail loss, infection, and melanoma
A subungual hematoma is typically harmless and often heals without treatment in several months. However, in rare cases, complications such as nail loss, infection, and melanoma can occur.
Nail Loss
If there is severe damage to the nail bed, the nail may fail to regrow or become malformed or cracked when it does grow back. This can happen when the trauma that caused the hematoma results in further damage. Therefore, it is important to seek medical care to treat the hematoma and any associated injuries and prevent nail loss.
Infection
Infection is a potential complication of a subungual hematoma, especially if drainage of the hematoma is attempted at home. Signs of infection include red or discolored skin around the nail, swelling, purulent drainage, and fever. If any of these symptoms are present, it is important to seek medical care promptly.
Melanoma
Melanoma of the nail, or subungual melanoma, is a rare form of skin cancer that can develop under the fingernail or toenail. Unlike other skin cancers, it is not related to sun exposure. It first appears as a black or brown band along the length of the nail, extending from the nail matrix to the end. Over weeks or months, additional changes in pigmentation may occur.
Due to the similar characteristics between subungual hematoma and melanoma, including a blue-white color, it can be challenging to differentiate between the two. Therefore, it is crucial to seek medical attention if there is any concern about the appearance of blood under the nail. A dermatologist will perform a thorough examination of the nail and may use diagnostic tools such as dermoscopy or imaging studies to confirm the diagnosis and rule out melanoma.
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Frequently asked questions
A minor subungual hematoma usually heals over time without treatment. The trapped blood will eventually be reabsorbed, and the dark mark will disappear. This can take a number of months or years.
A subungual hematoma is a bruised fingernail or toenail that develops after sudden trauma to your nail. It is caused by a direct blow or crush injury to the distal phalanx, for example, getting a finger pinched in a doorway.
A simple drainage procedure called trephination can ease your pain and support healing. However, you should never attempt this at home. Instead, seek medical care.
Patients usually complain of pain and discoloration of the nail. The pressure of the blood underneath the nail's surface may also cause the nail to fall off partially or completely.
