Liam Carter
A subungual hematoma, or a bruise under the nail, is usually caused by trauma or injury to the nail, such as a heavy object falling on the finger or toe. This results in blood collecting and becoming trapped under the nail, causing severe pain and throbbing. Treatment for a bruised nail depends on the severity of the injury. Mild cases can be treated at home with ice and pain relievers, while severe cases may require medical care, such as draining the blood through a procedure called trephination. It is important to seek medical attention within two days of the injury to prevent potential complications and ensure proper healing.
| Characteristics | Values |
|---|---|
| What is it called? | Subungual hematoma |
| What causes it? | Direct trauma to the nail, such as crushing or slamming |
| What does it look like? | Red, purple, blue, black, or brown |
| What are the symptoms? | Swelling, nail discoloration, throbbing pain |
| What to do at home? | Apply ice, rest, elevate, take pain relievers |
| When to seek medical care? | If pain gets worse, or if there are signs of infection, fracture, or other injuries |
| What is the treatment? | Drainage procedure (trephination) to relieve pressure and pain |
| What are the risks? | Infection, nail loss, permanent deformity |
| How long to heal? | 6-12 months for the nail to grow back |
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What You'll Learn
Bruise diagnosis: subungual hematoma
A subungual hematoma is a bruise that forms under the nail after trauma. It is a common injury that can be very painful but is usually not dangerous. The pain typically subsides within a few days, but the nail discolouration will take weeks or months to grow out.
Subungual hematomas are caused by direct trauma to the nail, such as something crushing or slamming it. This damages the blood vessels under the nail plate, causing bleeding and pooling of blood under the nail. The pressure from the blood buildup causes pain and can lead to nail discoloration, nail sensitivity, and separation of the nail plate from the nail bed.
To diagnose a subungual hematoma, a healthcare provider will closely examine the affected finger or toe, including the nail plate and the surrounding skin. They may ask you to move or bend your finger or toe to evaluate the extent of the injury. Imaging tests, such as X-rays or ultrasounds, may be necessary to check for broken bones or other underlying injuries.
The treatment for a subungual hematoma depends on the severity of the injury. For minor injuries, home care may be sufficient, including applying ice to the area to reduce swelling and pain. However, if the pain worsens or other symptoms develop, it is important to seek medical care. In some cases, a simple drainage procedure called trephination may be performed to relieve pressure and pain. If there is additional damage, such as a broken bone or deep cut, more extensive treatment may be required, including surgical repair and removal of the nail plate.
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Home treatment: ice and painkillers
If you have a bruised nail, you can treat it at home with ice and painkillers. A bruised nail, or subungual hematoma, occurs when blood collects under the nail due to trauma or injury. This can cause severe throbbing pain, swelling, nail discolouration, and pressure.
To treat a bruised nail at home, you can apply ice wrapped in a soft cloth or towel to the affected area. Do not put ice directly on your skin. Keep the ice on the bruise for about 10 minutes at a time, several times a day. This will help to reduce swelling and ease the pain. As an alternative to ice, you can use a bag of frozen vegetables, such as peas.
In addition to ice, you can take pain relievers to help alleviate any discomfort. If your bruise is mild, home treatment with ice and painkillers may be sufficient. However, if your bruise is severe or covers more than 25% of your nail, you may need urgent medical care or surgery.
It is important to note that a bruised nail will take time to heal completely. The bruise will gradually grow out over several weeks or months, and it can take up to 6-12 months for the nail to completely grow out and return to its normal colour. During this time, you can care for your bruised nail by keeping it clean and protected.
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Medical treatment: trephination
A subungual haematoma is a bruised fingernail or toenail resulting from blunt or crush trauma. Blood collects under the nail, causing pressure and pain. Trephination is a safe and effective treatment for this condition. It involves creating a small hole in the nail to release the trapped blood and ease the pain. Here is a step-by-step guide to the procedure:
Trephination is a simple and quick procedure that can be performed by a healthcare provider. It is important to note that this procedure should be done within 24 to 48 hours of the injury, as blood within a subungual haematoma will likely clot after this time frame, making trephination ineffective.
Step 1: Patient Preparation
Obtain consent from the patient after explaining the procedure and potential complications, which include loss of the nail, re-accumulation of haematoma, and infection.
Step 2: Anaesthesia (optional)
If the patient is anxious or unable to be reassured, anaesthetize the distal finger with a digital block.
Step 3: Trephination Techniques
There are several techniques for performing trephination:
- Electrocautery: Use a handheld electrocautery device at a 90-degree angle to the nail to make a hole through the nail over the central area of the haematoma. This technique involves applying gentle pressure until a "give" is felt and blood is released.
- Needle: Use an 18-gauge needle or a large-bore needle at a 90-degree angle over the central area of the haematoma. Rotate the needle in a drilling fashion to create a hole. Smaller gauge needles may be used in children, but multiple holes may be needed.
- Heated Paperclip: If no other supplies are available, heat a paperclip over a flame until it is red hot. Touch the heated paperclip to the nail at a 90-degree angle to burn a hole through the nail.
- Insulin Needle: Instead of using a cautery device or large-bore needle, insert a 29-gauge insulin needle underneath the nail at the distal hyponychium. Advance it proximally and parallel to the nail plate with gentle suction on the syringe until the haematoma drains into the syringe.
Step 4: Dressing the Wound
After the trephination, the patient will experience immediate relief from pain and pressure. The provider will then apply a sterile bandage and provide instructions on how to care for the finger or toe as it heals. It is important to keep the area clean and dry, and to avoid soaking the injured nail to prevent infection.
Step 5: Follow-up Care
Inform the patient that drainage through the hole may continue for 24 to 36 hours. Advise them to look out for signs of infection, such as warmth, redness, increasing swelling, fever, or re-accumulation of the haematoma with pain. Provide instructions for re-evaluation if these signs occur.
Trephination is a safe and effective method for treating subungual haematomas, and it can provide quick relief from the pain and pressure associated with bruised nails.
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Prevention: keep nails short
Keeping your nails short is a good way to prevent nail injuries and the development of subungual haematomas (bruised nails). Short nails are less likely to get caught on something and suffer trauma.
To keep your nails short, trim them regularly with clean nail clippers, scissors, or a nail file. Aim for a smooth, uniform length and shape. Be careful not to cut your nails too short, as this can lead to ingrown nails and other issues. Ideally, you want to leave a small amount of white nail showing.
If you have difficulty trimming your nails, consider asking a friend, family member, or healthcare professional for assistance. It is important to use the right tools and techniques to avoid injuring your nails or the surrounding skin.
Maintaining short nails is especially important for those who engage in physical activities or sports that involve repetitive stress or trauma to the hands or feet, such as soccer, dance, and long-distance running. In these cases, keeping your nails short can reduce the risk of nail injuries and subsequent bruising.
Additionally, short nails are easier to keep clean, which is important for preventing infections. Clean nails are less likely to harbour bacteria and other microorganisms that can cause nail infections or other health issues. So, keeping your nails short and clean is a good way to maintain nail health and prevent injuries that could lead to bruising.
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Complications: infection and nail loss
Infection
If a nail injury leads to a break in the skin or nail, germs can enter the body and cause an infection. Soaking the injured nail should be avoided, as this can lead to infection. Signs of infection include:
- Redness or red streaks in the skin
- Skin or nail feeling warm to the touch
- Swelling or significant pain
- Fever or feeling unwell
- Pus
If any of these symptoms are present, seek medical attention. Antibiotics may be required, but only a healthcare professional can determine this.
Nail loss
If there is damage to the nail matrix (the cells that regrow the nail), the nail may fall off. While the nail will likely grow back, it may be misshapen.
In cases of severe injury, such as a broken bone or deep cut, the nail plate may need to be removed to surgically repair the tissues underneath. This can support the proper healing of the nail.
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Frequently asked questions
A subungual hematoma is a bruise that forms under the nail after trauma. It involves bleeding below the hard part of your nail, which leads to swelling, nail discoloration and pain.
If you have a bruised nail but no other apparent damage, you should be able to care for yourself at home by applying ice to the area. If you have severe pain, seek medical care.
A healthcare provider may recommend a simple procedure called trephination. This is the drainage of the hematoma to relieve pressure.
It will take 4 to 6 months for a new fingernail to grow back, and 12 months for a toenail.
You can take some steps to lower your risk by being aware of where your hands and feet are when you close doors, avoiding going barefoot or wearing open-toed shoes when lifting heavy objects, and avoiding distractions when using hammers or other tools.
