Liam Carter
Blood under the nail, also known as a subungual hematoma, can be a painful injury. It occurs when blood vessels under the nail break open, causing blood to collect and become trapped under the nail. This can happen due to a crushing injury, stubbing your toe, or even wearing tight shoes. Small hematomas may not require medical attention and can be treated at home with ice and elevation. However, if the hematoma is large and causing severe pain, it may need to be drained by a doctor within the first 48 hours after the injury. The time it takes for a hematoma to reabsorb depends on its size, with complete healing taking several months or even years. Nails that grow back may have ridges or other abnormalities, and in some cases, the nail may not regrow at all.
| Characteristics | Values |
|---|---|
| Medical Term | Subungual Hematoma |
| Cause | Bleeding under the nail due to an injury |
| Symptoms | Darkened discoloration, pain, throbbing, swelling, inability to move the finger or toe |
| Treatment | Drainage within 48 hours of injury, elevation, cold compress, applying compression, rest |
| Regrowth Time | 4-6 months for fingernails, 6-18 months for toenails |
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What You'll Learn
Drainage methods
Blood under the nail, or subungual haematoma, 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. Small haematomas may heal on their own, but larger ones may cause intense pain and pressure. If home remedies such as elevating the affected area, using a cold compress, and applying compression do not provide relief, you should contact a doctor for the next steps.
Nail trephination is a quick, outpatient procedure that drains blood from a bruised nail. It involves making a small hole in the nail plate to relieve pressure and pain. This procedure can be performed within the first 2 days of injury, after which the blood begins to clot, making drainage difficult. It is important to note that only a healthcare provider should perform this procedure, as trying to do it yourself may lead to infection or further damage.
During the procedure, the provider will first clean the nail and the surrounding area with soap and water to remove any dirt or debris. They will then apply a wound-cleansing solution, such as chlorhexidine. Next, they will use a needle, an electrocautery device, or a special tool designed for trephination to make a small hole in the nail, just deep enough to release blood.
After the procedure, you may notice drainage through the hole in your nail for the next 24 to 36 hours, which is normal and temporary. Keep the area dry and clean, and follow your provider's instructions for changing bandages and caring for your finger or toe.
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Healing time
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 received. Here is an overview of the healing process and the typical time frames involved:
Initial Treatment
Within the first 48 hours of the injury, it is recommended to seek medical attention. During this time, a healthcare provider can drain the excess blood and relieve the pressure under the nail. This procedure, known as trephination, involves creating a small hole in the nail to allow the blood to drain out. It is important to note that drainage becomes more difficult after 48 hours as the blood starts to clot.
Healing Process
After the initial treatment, the healing process for a subungual hematoma can take several months or even years, depending on the size and location of the hematoma. Small hematomas may heal on their own without any issues, while larger ones may cause intense pain and require additional medical attention. During the healing process, it is important to keep the affected area clean and dry, and elevate the hand or foot to reduce swelling.
Nail Regrowth
If the nail falls off due to the pressure of the hematoma, it may take some time for a new nail to grow back. A new fingernail typically takes around 8 weeks to 6 months to regrow, while a toenail may take 6 to 18 months. In some cases, the new nail may have ridges or other abnormalities, and there is a possibility that the nail may not grow back at all.
Complications
In some cases, there may be complications that affect the healing process. For example, if there is severe damage to the nail bed or surrounding tissues, the nail may take longer to grow back or may not regrow at all. Additionally, there is a small chance of developing melanoma, a type of skin cancer, under the nail, which can cause a dark mark to form and may require medical attention.
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Pain relief
Blood under the nail, or subungual hematoma, is usually caused by a crushing injury to the finger or toe. This can cause severe, throbbing pain due to the pressure of blood collecting between the nail and the nail bed.
If you are experiencing pain from a subungual hematoma, there are several pain relief options available. Here are some steps you can take to manage the pain:
Over-the-counter pain relievers
Taking an over-the-counter pain reliever like ibuprofen can help alleviate the pain associated with a subungual hematoma. Oral antibiotics are typically not needed for this type of injury.
Drainage
If the hematoma is causing significant pain or covers more than half of the nail, your healthcare provider may recommend draining the blood to relieve the pressure. This procedure, called trephination or decompression, involves creating a small hole in the nail to allow the blood to drain out. It is typically a quick and relatively painless procedure performed by a doctor or healthcare professional. The drainage can provide immediate relief from pain and pressure. After the procedure, it is important to keep the area clean and dry, and follow any instructions provided by your healthcare professional for changing bandages and caring for the affected area.
Soaking
Your healthcare provider may recommend soaking the affected finger or toe in a warm solution with Epsom salts for 15 minutes a day. This can help to drain fluid and alleviate pain.
Numbing
Before performing certain procedures, such as nail removal, your healthcare provider may apply a digital block or nerve block to numb the area and prevent pain.
Elevation and cold compresses
After the drainage procedure, it is recommended to keep the affected finger or toe bandaged, elevated, and, in some cases, use cold compresses during the first 12 hours to reduce pain and swelling.
It is important to note that you should never attempt to drain a subungual hematoma at home and should always seek medical care. If you are experiencing extreme pain, swelling, or inability to move the affected finger or toe, it is best to see a healthcare provider as soon as possible.
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Symptoms
Blood under the nail, or subungual haematoma, is usually caused by a traumatic injury, such as stubbing your toe, hitting your finger with a hammer, or slamming your finger in a car trunk. It can also be caused by wearing shoes that are too tight or by repetitive stress from movements such as running.
- Discolouration: The blood under the nail may cause darkened discolouration, such as black spots. Over time, the blood may turn from red to purple to dark brown or black.
- Pain: The pressure of the blood collecting under the nail can cause intense, throbbing pain.
- Nail avulsion: The pressure of the haematoma may cause the nail to fall off partially or completely.
- Fracture: If you are unable to move your finger or toe, you may have a fracture.
- Swelling: Swelling may occur around the affected area.
- Infection: Signs of infection include fever, warmth at the injury site, pus, or swelling.
In rare cases, a subungual haematoma may indicate melanoma, a type of skin cancer. Melanoma can cause a dark mark to form under the nail, but it does not usually cause pain and is not linked to an injury.
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Causes
Blood under the nail, or subungual haematoma, is usually caused by a crushing or stubbing injury. This can happen when something falls on the nail, or you stub your toe, or even from wearing tight shoes. Repetitive stress from movements such as running can also cause subungual haematoma.
In some cases, the injury may be severe enough to cause broken bones or serious damage to the nail bed and/or surrounding tissues. If the injury is severe, it is important to seek medical attention right away. Deformity of the finger or toe is also a sign of a severe injury that requires immediate medical attention.
If the injury is minor, a subungual haematoma will usually heal over time without treatment. The trapped blood will eventually be reabsorbed, and the discolouration will disappear. This can take a few months or even years, with toenails taking longer to heal than fingernails.
Small haematomas may heal on their own without much issue. Home remedies such as resting, icing, applying compression, and elevation can also encourage healing. However, if the affected area continues to collect blood, you experience extreme pain, or have other symptoms such as swelling or inability to move the finger or toe, it is best to see a healthcare provider.
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Frequently asked questions
A subungual hematoma is a bruise that occurs when blood pools under the nail bed's surface, usually caused by a crushing or stubbing injury.
Small hematomas may heal on their own within a few months. Larger hematomas may require drainage within the first 48 hours after injury for the best results, as the blood begins to clot after this amount of time.
For small hematomas, home remedies such as resting, icing, applying compression, and elevation can encourage healing. For larger hematomas, doctors may recommend draining the hematoma to relieve pain and pressure.
