Noah Sinclair
The nail bed contains many nerve endings and blood vessels, which give nails their pink tinge. When there is trauma to the nail, these blood vessels can break and start to bleed, causing a subungual hematoma, or blood under the nail. This can be very painful and requires medical attention if it is large, causing a lot of pain, or accompanied by additional injuries. Treatment may involve draining the hematoma, which should be done within 48 hours of the injury, or removing part or all of the nail.
| Characteristics | Values |
|---|---|
| What is it called? | Subungual hematoma |
| What does it involve? | Bleeding below the hard part of the nail (nail plate), leading to swelling, nail discoloration, and pain |
| What causes it? | Direct trauma to the nail, such as something crushing or slamming it, which damages the blood vessels under the nail plate |
| What does it look like? | The nail may appear red, purple, black, blue, brown, or a combination of these colours |
| What are the symptoms? | Severe, throbbing pain |
| When to drain it? | Within 48 hours of the injury, as the blood will start to clot after this time frame, making drainage difficult |
| How to drain it? | Clean the area, administer pain relief or anesthetic, apply gentle pressure to the nail with a heated needle, cautery device, or laser, ensure the hole is 3-4mm thick, and milk (squeeze) the nail to help the blood flow out |
| When to see a doctor? | If there is a lot of pain, bleeding through or around the nail, additional injuries to the finger or toe, or a serious injury to the base of the nail |
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What You'll Learn
Subungual hematoma (blood under the nail)
Subungual hematoma, or blood under the nail, occurs when blood vessels under the nail break open, causing blood to pool and become trapped underneath the nail. This is usually caused by sudden trauma to the nail, such as blunt force or crush injuries. The blood under the nail can cause intense pain and throbbing, and the pressure from the pooled blood may cause the nail to lift up from the nail bed.
Subungual hematomas can be very painful and are often accompanied by nail discoloration, with the nail appearing red, purple, black, blue, brown, or a combination of these colours. The pain and discoloration typically resolve within a few days, but it can take several months for the hematoma to fade completely and for a healthy nail to regrow. In some cases, the nail may fall off or grow back with a different shape.
If you have a subungual hematoma, it is important to seek medical attention if you experience severe pain, bleeding that does not stop, signs of infection, or if the hematoma does not heal. Home remedies such as rest, icing, compression, and elevation can encourage healing and reduce discomfort and swelling. Over-the-counter pain relievers can also be taken to reduce pain and swelling.
In more severe cases, medical treatment may be necessary. A doctor may perform a simple drainage procedure, called decompression or trephination, to relieve the pressure and pain. This should be done within 48 hours of the injury, as the blood will start to clot after this time, making it harder to drain. If there is damage to the nail bed or surrounding tissues, the nail may need to be removed and stitches may be required to repair the nail bed.
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Nail injuries and their symptoms
Nail injuries are quite common and can occur when the nail is cut, torn, smashed, bruised, or separated from the skin. These injuries can be complex and may result in permanent deformity, even after proper repair. There are five main categories of nail injuries:
Slicing or Cutting
This can be caused by knives, box cutters, or machinery, resulting in a laceration or cut to the nail, nail bed, cuticle, or lateral nail folds. There is usually visible blood on the skin, and the nail may appear mangled, depending on the severity of the injury.
Tearing or Ripping
This can occur when stubbing a toe or catching a fingernail on an object. It may result in a nail avulsion, where a portion of the nail is lifted off the nail bed or sticks out from the base of the nail (cuticle). This type of injury often results in blood around the nail and may be associated with a laceration.
Subungual Hematoma (Nail Bruise)
A subungual hematoma is a collection of blood under the nail, typically appearing as a red or purple-black colour that fades to blue over a few weeks. It is caused by trauma to the nail, such as a blow to the nail or closing the finger in a door. The entire finger or toe may throb and be painful to touch or move.
Fingertip Amputation
This involves the removal of a portion of the fingertip, including part or all of the nail. The bone may or may not be visible, and there is often significant bleeding and pain associated with this type of injury.
Bone Fracture
A fracture of the bone under the nail, known as a distal tuft fracture, can occur in conjunction with crushing injuries to the nail. An X-ray is usually required to diagnose this type of injury unless there is an obvious deformity at the end of the finger.
It is important to seek medical attention for more serious nail injuries, especially if there is severe bleeding, pain, or potential bone fracture. In some cases, drainage of blood under the nail may be necessary to relieve pressure and pain. Most nail injuries will heal over time, but proper care and treatment are essential to prevent complications and ensure proper regrowth of the nail.
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Treating a subungual hematoma at home
A subungual hematoma is a collection of blood under the nail, usually caused by sudden trauma to a fingernail or toenail. It can be extremely painful due to the pressure generated by the pooled blood.
Small (less than 25% of the nail bed) and painless subungual hematomas usually heal over time without treatment. The trapped blood will eventually be reabsorbed, and the discolouration will disappear. This can take a number of months or even years.
If the subungual hematoma covers more than 25% of the nail bed or is causing pain, a doctor may recommend evacuation via trephination or nail removal. Trephination is a quick procedure that involves making a small hole in the nail to drain the hematoma and relieve pain and pressure. It can be performed using an electric cautery, a heated paperclip, or a needle.
While trephination is generally safe, it is recommended to seek medical advice before attempting any procedure at home, as it can cause infections or further injury to the nail bed.
Home remedies can help manage minor subungual hematomas and encourage healing. These include:
- Rest: Rest the affected finger or toe and avoid using it where possible.
- Ice: Apply an ice pack wrapped in a towel to reduce swelling and pain.
- Compression: Apply pressure to the area, such as a wrap, to reduce the amount of blood that can pool.
- Elevation: Keep the affected hand or foot elevated to reduce swelling.
- Over-the-counter pain relievers: Take anti-inflammatory medications such as aspirin, Advil, or Motrin to reduce discomfort and swelling.
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When to see a doctor
In the event of a nail injury, it is important to know when to seek medical attention. While minor cuts and scrapes can be treated at home, more serious injuries may require a visit to the doctor or urgent care center. Here are some guidelines on when to see a doctor for a nail injury:
- Deep cuts and/or bleeding that won't stop: If you have a deep cut that is bleeding profusely and doesn't stop after applying pressure with a clean cloth, it is important to seek medical attention. This could indicate a serious injury that requires professional treatment.
- Broken bone: If you suspect that a bone under the nail is broken, it is crucial to seek medical care. A broken bone can be indicated by an obvious bend or deformity at the end of the finger or toe. An X-ray may be needed to confirm the diagnosis.
- Infection: If you notice signs of infection, such as redness, swelling, pus, or fever, it is important to see a doctor. Infections can lead to serious complications if left untreated.
- Poor healing or increased risk of infection: Individuals with certain conditions, such as diabetes, poor circulation, AIDS, or those undergoing chemotherapy, may have a higher risk of infection or poor healing. In such cases, it is advisable to seek medical advice to ensure proper wound care and monitoring.
- Subungual hematoma (nail bruise): While small hematomas can often be managed at home, larger bruises may require medical attention. If the bruise is causing severe, throbbing pain or covers more than 25% of the nail, it is recommended to see a doctor. They may create a small hole in the nail to drain the blood and relieve pressure.
- Nail avulsion: If a portion of the nail is lifted off or sticking out from the nail bed, it is important to seek medical care. This type of injury often involves bleeding and may be associated with lacerations or fractures.
- Distal tuft fracture: This type of fracture occurs when there is an injury to the bone under the nail, often due to crushing injuries. An X-ray may be needed to diagnose this condition, and medical attention should be sought to ensure proper healing.
It is always better to err on the side of caution when it comes to nail injuries. If you are unsure about the severity of your injury or if your symptoms persist or worsen, don't hesitate to seek medical advice from a qualified healthcare provider.
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Draining a subungual hematoma
Subungual hematomas are common nail bed injuries caused by blunt or sharp trauma to the fingers or toes. They can result in significant discomfort due to increased pressure under the nail. Drainage of a subungual hematoma, also known as trephination, is indicated when there is a painful hematoma and the nail edges are intact. The procedure does not typically require routine anaesthesia, although a digital block may be considered for pain control.
To prepare for the procedure, the patient should rest their finger in a comfortable position. The clinician should then cleanse the affected area with a povidone-iodine solution or a mild antibacterial wound cleanser. It is important to ensure that the finger or toe is free of any neurovascular compromise and that there is no evidence of tendon disruption.
For the drainage procedure, a cautery device or a large-bore needle can be used. If using a cautery device, apply mild pressure to the centre of the hematoma until blood is released from the incision. Alternatively, use a rotating motion with a large-bore needle to carefully drill through the nail. Make sure to only minimally contact the nail bed after penetrating the nail plate.
It is important to note that multiple holes may be necessary to facilitate adequate drainage. Additionally, the nail may fall off in the week following the procedure but should regrow as long as the germinal matrix is intact. Ineffective drainage may occur if the hole created is not large enough, or if the nail penetration tool is not advanced deep enough.
In summary, draining a subungual hematoma involves cleansing the affected area, creating a hole at the base of the nail or the centre of the hematoma, and ensuring adequate drainage to relieve pressure and discomfort.
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Frequently asked questions
If you have a deep cut and/or bleeding that won't stop, you should seek medical attention. Your healthcare provider may make a hole in the nail to drain the blood and relieve the pressure and pain.
A bruised nail is called a subungual hematoma. It involves bleeding below the hard part of the nail (nail plate), which can lead to swelling, nail discolouration, and pain.
Try to remain calm as your dog will sense your stress and mirror your attitude. You can try to stop the bleeding by applying a cold rag and holding it in place.
Signs of infection include pus, redness, or heat around the nail, or a red streak extending from the wound. If you notice any of these symptoms, contact your healthcare provider promptly.
