Noah Sinclair
Blood under the nail, also known as a subungual hematoma, occurs when an injury breaks open blood vessels under the nail, causing blood to collect and become trapped. This can happen to both fingernails and toenails and is usually caused by a crushing or stubbing injury. Over time, the blood may turn dark, and the pressure may cause the nail to come off completely. 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 without trephination.
| Characteristics | Values |
|---|---|
| Medical Term | Subungual Hematoma |
| Cause | Trauma to the nail, such as crushing or stubbing |
| Symptoms | Bleeding, swelling, nail discolouration, pain, pressure |
| Treatment | Drainage within 48 hours of injury, elevation, compression, cold compress |
| Healing Time | Several months to years, depending on the size and location of the hematoma |
| Prevention | Rest the digit, keep the area clean and dry |
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What You'll Learn
What is a subungual hematoma?
A subungual hematoma is a bruised fingernail or toenail that develops after sudden trauma to the nail. It occurs when an injury breaks open blood vessels under the nail, causing blood to collect and become trapped. This can lead to swelling, nail discolouration, and severe throbbing pain. The blood under the nail may turn from red to purple to dark brown or black over time, and the pressure of the hematoma may cause the nail to come off completely.
Subungual hematomas are typically caused by crushing or stubbing injuries, such as dropping a brick on your toe or hitting your finger with a hammer. They can also be caused by wearing shoes that are too tight. The injury can damage the nail matrix, where the nails form, which may result in the nail not growing back or looking different when it does.
Small subungual hematomas may heal on their own without treatment. However, if there is severe damage to the nail bed or if the pain is unmanageable, medical treatment is necessary. Doctors may recommend draining the hematoma, a procedure called trephination, if the hematoma causes pain or covers more than 50% of the nail. This procedure involves making a small hole in the nail to allow the blood to flow out. It must be performed within 48 hours of the injury, before the blood clots and makes drainage difficult.
To encourage healing, individuals can rest the affected digit, use a cool pack, keep the hand or foot elevated, and apply compression to slow the bleeding. It can take several months or even years for a subungual hematoma to reabsorb or grow out without trephination. During this time, the nail may still look discoloured, but the bruise will gradually disappear as the nail grows back.
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When to see a doctor
Blood under the nail is called a subungual haematoma. This occurs when an injury breaks open blood vessels under the nail, causing blood to collect and become trapped. A subungual haematoma can cause severe throbbing pain, and the blood under the nail may turn dark over time. The pressure of the blood can also cause the nail to come off completely.
Within 48 hours of the injury
It is recommended to see a doctor within the first 48 hours after the injury. The blood begins to clot after this amount of time, making drainage difficult. If you see a doctor within this time frame, they can drain the excess fluid and relieve the pressure.
If you are experiencing pain
Larger haematomas can cause intense pain. If home measures such as using a cold compress or elevating your hand or foot do not relieve your pain, you should contact a doctor. Doctors recommend draining subungual haematomas when they cause pain or make up 50% or more of the nail.
If you are experiencing other symptoms
See a doctor if you have other symptoms such as swelling or an inability to move the finger or toe. You might have a fracture. If the injury is at the base of the nail, it's also best to see a healthcare provider.
If the haematoma does not heal
A minor subungual haematoma usually heals over time without treatment. However, if the haematoma does not heal and you are concerned, it is important to contact a doctor.
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How to drain blood at a doctor's office
If you are experiencing pain or discomfort due to a subungual hematoma (blood pooling under the nail bed's surface), it is recommended that you seek medical attention. A doctor will be able to assess the severity of the injury and determine if drainage is necessary.
When you visit the doctor's office, they will first examine the affected nail and evaluate the extent of the injury. If drainage is recommended, they will typically perform the procedure right away.
To drain the blood from under the nail, the doctor may use one of the following methods:
- Cautery: The doctor will use a heated wire (electrocautery device) or a carbon laser to burn a small hole in the nail. This method is quick and usually painless. The heated wire is cooled by the contact with the hematoma, preventing injury to the nail bed.
- Needle: A needle is used to create a small hole in the nail, allowing the blood to drain out. After this procedure, the doctor will bandage the nail.
After the drainage procedure, it is important to follow the doctor's instructions for aftercare. Keep the area clean and dry, and follow their instructions for changing any bandages. The nail may continue to look discolored for several weeks, but this is normal, and the bruise will gradually fade as the nail grows out.
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. Home drainage methods are not recommended as they may cause infection. If you experience increased pain, swelling, redness, or other signs of infection, contact your doctor immediately.
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Home remedies for pain relief
Blood pooling under the nail, known as a subungual hematoma, is usually caused by a crushing or stubbing injury. The blood may turn dark over time, and the pressure may cause your nail to come off completely. Before that happens, you can relieve the pain and pressure by draining the hematoma, a procedure called trephination. This should be done by a doctor within the first 48 hours of the injury, as the blood begins to clot after this time.
If you are experiencing pain due to a subungual hematoma, here are some home remedies for pain relief:
- Elevation and cold compress: Elevating your hand or foot and using a cold compress can help alleviate pain and reduce swelling.
- Compression: Applying compression can help slow the bleeding under the nail.
- Soaking in warm water: Soaking the affected area in warm or room-temperature soapy water for up to 20 minutes at a time may help reduce swelling and ease the pain.
- Epsom salts: Adding Epsom salts to the warm water may provide additional relief.
- Massaging: Massaging the side where your skin meets the nail can help reduce inflammation.
- Apple cider vinegar: Soak the affected area in a mixture of warm water and apple cider vinegar (1/4 cup) for up to 20 minutes daily, then dry thoroughly. Apple cider vinegar has antimicrobial, anti-inflammatory, and pain-relieving properties.
It is important to note that these remedies are for pain relief and may not address the underlying cause, such as an ingrown toenail or hangnail. If you are experiencing pain due to an ingrown toenail, you can try the following home remedies:
- Soaking in warm water: Soak your feet in warm, soapy water for 10 to 20 minutes, 3 to 4 times a day until the toe improves.
- Cotton or dental floss: After each soaking, place fresh bits of cotton or waxed dental floss under the ingrown edge of the toenail. This will help the nail grow above the skin edge.
- Petroleum jelly and bandaging: Apply petroleum jelly (Vaseline) to the tender area and bandage the toe.
- Choose sensible footwear: Wear open-toed shoes or sandals until your toe feels better.
- Pain relievers: Take non-prescription pain relievers such as acetaminophen (Tylenol) or ibuprofen (Advil, Motrin IB) to ease the toe pain.
If home remedies do not provide relief, it is important to consult a doctor or healthcare professional for further advice and treatment options.
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How long does it take to heal?
The healing time for a subungual hematoma, or blood under the nail, can vary depending on several factors, including the severity of the injury and the treatment method. Here is some information on how long it takes to heal:
Small Hematomas
Small subungual hematomas may heal on their own without any medical intervention. The trapped blood will eventually be reabsorbed, causing the discolouration to disappear. This natural healing process can take several months or even years, with some sources estimating 6-9 months for the new nail to grow out completely. Hematomas on fingernails tend to heal faster than those on toenails.
Medical Drainage
If the hematoma is causing pain or covers a significant portion of the nail, medical drainage may be recommended. It is important to see a doctor within the first 48 hours of the injury, as the blood begins to clot after this time frame, making drainage more difficult. The drainage procedure, known as trephination, provides quick relief by releasing the built-up blood. After the procedure, the nail may continue to bleed a bit, but this should stop within a day or two. The nail may still appear discoloured for several weeks, gradually growing out over time.
Nail Regrowth
In cases where the nail falls off due to the pressure of the hematoma, it may take 4-6 months for a fingernail to regrow and 12-18 months for a toenail. Nails that regrow may have ridges or other abnormalities.
Complications
If there is severe damage to the nail bed or underlying bone, healing may take longer, and the nail may regrow malformed or cracked. In some cases, the nail may not regrow at all. It is important to monitor for signs of infection or other complications and seek medical attention as needed.
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Frequently asked questions
A subungual hematoma is a bruised fingernail or toenail that develops after sudden trauma to your nail, causing blood to pool under the nail plate and leading to discoloration, pressure, and pain.
Blood under the nail, or a subungual hematoma, can take months or even years to heal and for the new nail to grow out. However, it is important to note that medical attention should be sought within 48 hours of the injury, as the blood begins to clot after this time, making drainage difficult.
If the subungual hematoma is small and the pain is mild, it may heal over time without treatment. However, if there is severe pain or damage to the nail bed, or if there are other symptoms such as swelling or inability to move the finger or toe, it is recommended to seek medical treatment within 48 hours to drain the excess fluid and relieve the pressure.
