Liam Carter
Blood under the nail, medically known as a subungual haematoma, is usually caused by a crushing or stubbing injury. The blood can cause the nail to discolour, turning from red to purple to dark brown and black. The pressure of the blood can cause the nail to fall off, but this can be prevented by draining the blood. This procedure, called trephination, involves piercing the nail to allow the blood to drain. It must be performed within the first 48 hours after the injury, before the blood clots, and can be done quickly and painlessly by a doctor.
| Characteristics | Values |
|---|---|
| What is it called? | Subungual hematoma |
| What causes it? | Bleeding under the nail due to a crushing or stubbing injury |
| What are the symptoms? | Darkened discolouration, black spots, pressure, pain, throbbing |
| When to see a doctor? | When the injury is at the base of the nail, when the affected area continues to collect blood, when experiencing extreme pain, when there are other symptoms like swelling or inability to move the finger or toe, when the hematoma makes up 25% or more of the nail, when home measures don't give relief |
| Treatment options | Drainage/trephination, removal of the nail, decompression |
| How long does it take to heal? | A few weeks for the wound to heal, 4-6 months for a fingernail to grow back, 12-18 months for a toenail to grow back |
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Draining the blood
Draining blood from under a nail, also known as nail trephination, is a procedure to relieve pain and pressure caused by a subungual hematoma. A subungual hematoma is a bruise that occurs when there is bleeding under the nail, often due to a crushing or stubbing injury. Over time, the blood may turn dark, and the pressure may cause the nail to come off completely.
To perform nail trephination, a small hole is made in the nail to allow the blood to drain out. This can be done using a hot metal wire, an electrocautery device, a carbon laser, or a spinning, large-bore needle. The procedure is relatively quick and painless since the nail plate lacks nerves. The hole created should be large enough to let the blood drain, which typically takes about a day or two. During this time, the wound should be covered with sterile gauze, and the finger or toe should be bandaged and elevated. Cold compresses may also be used to reduce pain and swelling.
It is important to see a doctor before deciding whether to drain a subungual hematoma. Drainage is recommended when the hematoma causes pain or covers 25% to 50% or more of the nail. If the injury is at the base of the nail, or if there are other symptoms such as swelling or inability to move the finger or toe, it is important to seek medical attention as there may be a fracture.
Nail trephination should be performed within the first 48 hours after the injury, as the blood begins to clot after this time, making drainage difficult. If the nail is not drained and falls off due to the pressure, it may take between 4 to 6 months for a fingernail and 12 to 18 months for a toenail to fully grow back. In some cases, the nail may not grow back or may have abnormalities.
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Healing time
The healing time for a subungual hematoma (blood under the nail) depends on the treatment used. If left untreated, the affected nail will usually fall off on its own after several weeks, as the pooled blood separates it from its nail bed. A new fingernail can regrow in as little as 8 weeks, while a toenail may take up to 18 months to grow back. Nails that regrow may have ridges or other abnormalities.
If the injury is treated with nail trephination or decompression, a procedure in which a small hole is made in the nail to drain the blood, the wound should heal within a few weeks. The hole is created using a hot metal wire, an electrocautery device, a carbon laser, or a large-bore needle. This procedure can help prevent the need for complete nail removal. After the procedure, the nail is typically bandaged, and the patient is instructed to keep the finger or toe bandaged and elevated for the first 12 hours. In some cases, a splint may be recommended for up to 3 days until the tenderness subsides.
It's important to note that drainage procedures must be performed within the first 48 hours after the injury, as the blood begins to clot after this time frame, making drainage difficult. Small hematomas may heal on their own without causing significant issues. However, larger hematomas can result in intense pain and pressure on the nail, which may lead to partial or complete nail avulsion (separation of the nail from its nail bed).
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Trephination
If you experience bleeding under your nail, it is important to see a healthcare provider as soon as possible. They will be able to determine the best course of treatment and perform the procedure in a safe and sterile environment.
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Home treatment
If you have dried blood under your fingernail, known as a subungual haematoma, there are some home treatments you can try. A subungual haematoma is usually caused by a crushing or stubbing injury, which causes bleeding under the nail. This can result in darkened discolouration, such as black spots, and can cause intense pain and throbbing as blood collects under the nail.
If the subungual haematoma is small, you may not need to seek medical care or drain the haematoma. You can treat it by elevating your hand or foot, using a cold compress for pain and swelling, and applying compression to slow the flow of blood to the area.
If the affected area continues to collect blood, you experience extreme pain, or the injury is at the base of the nail, it's best to see a healthcare provider. You should also seek medical attention if you have other symptoms like swelling or an inability to move your finger or toe, as you may have a fracture.
If you have to get your nail removed, the wound should heal within a few weeks, but it may take about six months for your nail to grow back. Follow your healthcare provider's instructions for how to care for your injured nail. Some general advice for caring for your injured nail includes removing the bandage after two days and gently washing around the wound twice a day, then covering it with Vaseline and a non-stick bandage.
Please note that you should not attempt to drain a subungual haematoma at home. Using home methods such as a heated pin or paper clip to make a hole in the nail may cause infection from bacteria entering the wound. Infections can often cause much more damage than the simple injury they stem from.
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Regrowing the nail
Regrowing a fingernail after a subungual hematoma takes around eight weeks, while a toenail may take six months to regrow fully. If the nail bed and surrounding tissues are injured, the new nail may take longer to grow back and may not look normal. There is also a small chance that the nail may not grow back at all if the nail matrix is damaged.
It is important to follow your healthcare provider's instructions on how to care for your injured nail. Some general advice includes removing the bandage after two days and gently washing around the wound twice a day, then covering it with Vaseline and a non-stick bandage.
To speed up the healing process and ensure the best possible outcome for your nail, it is recommended to see a doctor within the first 48 hours of the injury. After this time, the blood begins to clot, and drainage becomes more difficult. Drainage can be performed quickly and relatively painlessly, usually using one of two methods: cautery or needle.
In the cautery method, a heated wire (electrocautery device) or carbon laser is used to burn a hole in the nail. The heat is then dissipated by contact with the hematoma, preventing injury to the nail bed. The needle method involves using a needle to make a hole in the nail. After either procedure, the nail will need to be kept bandaged and elevated, and cold compresses may be recommended during the first 12 hours.
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Frequently asked questions
A subungual hematoma is the medical term for dried blood under the fingernail, which can happen when an injury causes bleeding under the nail.
Small hematomas may heal on their own without treatment. Larger hematomas may cause intense pain or other symptoms such as feeling pressure on the nail. To treat this, doctors may recommend draining the hematoma, also known as trephination, which involves making a small hole in the nail to allow the blood to drain.
You should see a doctor before deciding whether to drain a hematoma. Doctors recommend draining subungual hematomas when they cause pain or make up 25-50% or more of the nail. It is best to see a doctor within the first 48 hours after the injury, as the blood begins to clot after this amount of time, making drainage difficult.
A new fingernail can regrow in as little as 8 weeks, but it may take up to 6 months for the nail to grow back completely. Toenails may take between 12 and 18 months to grow back.
