Liam Carter
Blood under the fingernail, or subungual hematoma, is usually caused by a crushing or stubbing injury that breaks open blood vessels under the nail. This results in blood collecting and becoming trapped under the nail, causing pain and pressure. While small hematomas may not require medical attention, larger ones can be drained by a doctor to relieve pain and pressure. This involves creating a small hole in the nail with a laser or needle to allow the blood to drain out.
| Characteristics | Values |
|---|---|
| Medical Term | Subungual Hematoma |
| Cause | Blood vessels under the nail break open due to injury, causing blood to collect and become trapped |
| Symptoms | Darkened discolouration, intense pain and throbbing |
| Treatment | Drainage (trephination) performed by a doctor; home remedies such as resting, icing, applying compression, and elevation; over-the-counter anti-inflammatories |
| When to See a Doctor | Within 48 hours of injury; if there is severe pain, swelling, or inability to move the finger or toe; if there are signs of infection; if there is severe damage to the nail bed; if the bleeding is severe or accompanied by extreme physical trauma |
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What You'll Learn
See a doctor to drain blood
If you are experiencing severe throbbing pain from blood trapped under your fingernail, you may need to see a doctor to drain the blood safely. While minor procedures can be performed at home, a doctor should be consulted to ensure the procedure is carried out properly and to prevent further injury or infection.
A doctor will be able to assess the severity of the injury and determine the best course of action. They may recommend a simple drainage procedure, which involves creating a small hole in the nail to release the built-up blood. This can provide immediate relief from the throbbing pain caused by the pressure under the nail.
The doctor will begin by cleaning the area around the nail to reduce the risk of infection. They will then use a sterilized tool, such as a heated paper clip or a small, sharp instrument, to carefully create a tiny hole in the nail. This hole will allow the trapped blood to escape and drain out from under the nail.
In some cases, the doctor may apply a topical anesthetic to numb the area before performing the procedure, especially if the injury is more complex or the nail is severely damaged. This will help ensure that you remain comfortable throughout the process. After the procedure, they may also recommend or prescribe medication to manage any pain or inflammation and provide guidance on caring for the nail as it heals.
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Home remedies to avoid
It is important to note that you should not attempt to drain a subungual hematoma 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 cause much more damage than the initial injury.
If the affected area continues to collect blood, you are experiencing extreme pain, or the injury is at the base of the nail, it is best to see a healthcare provider. You should also seek medical attention if you have injured a nearby joint, if more than a quarter of the nail is discoloured, or if there are signs of infection such as pus, redness, or heat around the nail.
Small hematomas may heal on their own without much issue. To reduce symptoms, you can try elevating your hand or foot, using a cold compress for pain and swelling, and applying compression to slow the bleeding under the nail. You can also take over-the-counter anti-inflammatories such as aspirin, Advil, or Motrin for minor pain.
If home measures don’t give you relief, you should contact a doctor for further advice and treatment.
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Signs you need to see a doctor
Blood under the fingernail or toenail, also known as a subungual hematoma, is usually caused by a crushing or stubbing injury. This can cause severe, throbbing pain due to the pressure of blood collecting between the nail and the nail bed. While small hematomas may not require medical treatment, there are several instances where you should see a doctor.
Firstly, if you notice any signs of infection, such as increased pain, swelling, redness, or warmth around the nail, red streaks leading from the nail, or pus draining from the nail, you should seek medical attention. These could indicate a more serious infection that requires treatment.
Secondly, if you have not had any apparent injury but notice a darkened area under your nail, it is recommended to consult a doctor. This is to rule out any other possible causes, as there may be underlying issues that require medical attention.
Additionally, if you experience a severe blow to your finger or toe, it is crucial to seek immediate medical attention. This is especially important if the finger or toe is deformed, as you may have broken bones or damage to the nail bed or surrounding tissues. Such injuries can be complex and require prompt assessment and treatment.
Lastly, while minor hematomas may heal on their own, it is advisable to see a doctor within the first 48 hours of the injury. They can examine the extent of the hematoma and determine if drainage is necessary. If left untreated, the blood may turn dark, and the pressure may cause your nail to come off completely. Draining the hematoma can provide relief from pain and pressure and can be performed safely and quickly in a medical setting.
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What is a subungual hematoma?
A subungual hematoma is a common injury that occurs when there is bleeding under a fingernail or toenail, usually due to a crush injury to the nail. It can cause intense pain and throbbing as blood collects and puts pressure on the area between the nail and the nail bed. This pressure can be extremely painful.
The most common symptom of a subungual hematoma is severe, throbbing pain. Other symptoms include a darkened area under the nail, known as the perionychium, which is composed of the nail fold, the paronychium, the hyponychium, the nail bed, and the nail itself. If there is bleeding under a large area of the nail, it may indicate an injury to the nail bed, which can require medical attention.
Small subungual hematomas may not need medical treatment. To treat a small hematoma at home, ice and elevate the area to reduce swelling, and take over-the-counter anti-inflammatories to manage minor pain. If the pain is severe, a doctor may perform a procedure called trephination or decompression, which involves creating a hole in the nail to drain the blood and relieve pressure. This can be done with a heated wire, a carbon laser, or a needle. The procedure is typically quick and painless, and the doctor will bandage the area afterward.
It is important to note that if there are no signs of injury but there is a darkened area under the nail, it is recommended to see a doctor to rule out other possible causes, as it could be due to a tumor or other underlying condition. Additionally, if there are any signs of infection, such as pus, redness, or heat around the nail, medical attention should be sought. In some cases, an X-ray may be necessary to check for bone fractures or other injuries.
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How to prevent nail loss
Blood under a fingernail or toenail is called a subungual hematoma. It is usually caused by a crushing injury, such as closing a finger in a door, or by a blow to the nail, like dropping a heavy object on your toe. Repeated trauma to the toenails, such as running in shoes that are too tight, can also cause subungual hematomas.
To prevent nail loss, it is important to relieve the pain and pressure caused by a subungual hematoma by draining the blood trapped under the nail. This procedure, called trephination, can be performed by a doctor or healthcare provider. It involves using a heated wire (electrocautery device), a carbon laser, or a heated needle to burn a small hole (3 to 4 millimetres thick) in the nail, allowing the blood to drain out. The procedure is quick and relatively painless and can provide immediate relief from pain and pressure.
If you are not comfortable with performing trephination at home, you should seek medical care. It is recommended that you see a doctor within the first 48 hours of the injury, as the blood begins to clot after this time, making drainage difficult. Your doctor will evaluate the extent of the injury and decide on the best course of treatment. They may recommend X-rays to check for any underlying bone fractures or tissue tears.
After the drainage procedure, it is important to keep the affected area clean and dry. You may need to change the bandages and use cold compresses during the first 12 hours after the procedure. The nail may still look discoloured for several weeks, but this is normal, and the discolouration will gradually disappear as the nail grows back.
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Frequently asked questions
A subungual hematoma is a medical term for blood under the fingernail or toenail, which is usually caused by a crushing injury.
If the affected area continues to collect blood, you experience extreme pain, or the injury is at the base of the nail, it is best to see a doctor as soon as possible, and no later than 48 hours after the injury. Small hematomas may not require medical treatment and can be treated with ice and over-the-counter anti-inflammatories.
Doctors may recommend draining subungual hematomas when they cause pain or cover 50% or more of the nail. This procedure, called trephination, involves making a small hole in the nail with a laser or needle to allow blood to drain. Afterward, the area may be wrapped with a bandage and may continue to drain for up to 3 days.
Yes, there is a risk of infection or further injury to the nail bed. In rare cases, melanoma, a type of skin cancer, can occur under a nail and may look similar to a subungual hematoma. If you have concerns about the appearance of blood under your nails or if a hematoma does not heal, be sure to contact a doctor.
