Liam Carter
A subungual hematoma is a common injury that occurs when there is bleeding and bruising under the fingernail or toenail, often caused by blunt force or crush injuries. This can result in swelling, nail discolouration, and intense throbbing pain. While small hematomas may heal on their own, larger hematomas can cause extreme discomfort and pressure on the nail. To relieve this pressure, the blood can be drained from the hematoma, either by a medical professional or at home with a drill bit. This article will explore the various methods to relieve pressure from a fingernail and provide guidance on managing nail injuries.
| Characteristics | Values |
|---|---|
| Cause | Direct trauma to the nail, such as crushing or stubbing |
| Symptoms | Pain, nail discoloration, nail sensitivity, separation of the nail plate from the nail bed |
| Treatment | Drainage of the hematoma, elevation of the hand or foot, cold compress, antibiotics, pain relievers, stitches, removal of the nail plate |
| Prevention | Being aware of the location of hands and feet when closing doors, avoiding barefoot or open-toed shoes when lifting heavy objects |
| Healing Time | 7-10 days for the nail bed to heal, 4-6 months for a new fingernail to grow, 12-18 months for a toenail |
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What You'll Learn
Draining the blood pocket
The procedure involves making a small hole in the nail to allow the blood to flow out. This can be done by applying gentle pressure with a heated 18-gauge needle, a cautery device, or a laser. A drill bit can also be used, but it is important to twist it slowly into the nail by hand, furthest from the cuticle, to avoid causing further damage. You may hear a "`pop`" sound when the tool penetrates the nail and reaches the blood pocket.
Once the hole is made, the blood will begin to flow out. Additional holes may be necessary for large hematomas. To facilitate the drainage, you can milk or squeeze the nail. It is important to ensure that the hole is 3 to 4 millimetres thick to allow for continual drainage. After draining, elevate the hand or foot and cover the affected area with a dry bandage or dressing. Keep the wound clean and dry while it heals.
The amount of time it takes for a hematoma to reabsorb depends on its size. Without drainage, it may take several months for a fingernail hematoma to reabsorb or grow out, and a toenail hematoma may take up to 18 months. Nails that grow back may have ridges or other abnormalities.
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Using ice to reduce swelling
Using ice is a common way to reduce pain and swelling after an injury. If you have concerns about how long you should ice a specific injury, or you are not noticing any improvement, be sure to reach out to a healthcare provider.
To use ice to reduce swelling, start by wrapping some ice in a thin towel or a clean cloth. This will prevent cold injury to the skin. Then, rest your finger on top of the ice compress or pack. Keep your finger elevated above the level of your heart. This will slow the flood of blood to the site, reducing inflammation and easing throbbing pain.
While icing, it's important to keep the ice moving and not allow it to sit in one spot. This will prevent frostbite, which can cause swelling and blisters. You can also perform an "ice massage" by moving the ice around in a circular motion.
Only ice for up to 10-20 minutes at a time. Allow the area to warm for at least 30 minutes before icing again. Repeat as often as needed, as long as the area is warm to the touch and has normal sensation before repeating.
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Taking pain relievers
If you are experiencing pain from a finger or toenail injury, there are a few over-the-counter (OTC) pain relievers that can help. These include:
- Ibuprofen (Advil, Motrin)
- Naproxen
- Acetaminophen (Tylenol)
- Aspirin
These medications can help reduce inflammation and associated pain. It is important to follow the recommended dosage on the bottle or as directed by your healthcare provider. If you have a history of heart disease, high blood pressure, kidney disease, or stomach ulcers, it is advisable to consult your healthcare provider before taking these medications.
In addition to OTC pain relievers, you can also apply ice to the injured finger or toenail. Wrap an ice pack or a bag of ice in a clean cloth and apply it to the affected area for 15 to 20 minutes at a time, several times a day. This will help reduce pain, swelling, and inflammation.
If the pain is severe and there is a significant build-up of blood under the nail, your healthcare provider may recommend a procedure called trephination or nail trephination. This involves creating a small hole in the nail with a laser, heated paper clip, or needle to drain the blood and relieve pressure and pain. This procedure should only be performed by a healthcare professional or under their guidance to avoid infections or further injury to the nail bed.
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Elevating the hand or foot
For adults, this can be done by resting the injured finger on top of a covered ice compress or pack. This will help to avoid putting weight on the injury. Elevating the injured hand or foot slows down the flow of blood to the site of the injury, which in turn reduces inflammation and pain.
In the case of a child, it is recommended that the child raises their injured hand or foot above the level of their heart. This will help to ease their pain and slow down the bleeding.
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Applying a bandage
If you have a smashed or injured finger, you may experience a subungual hematoma, which is a fancy way of saying that you have a bruised nail. This can be caused by blunt force trauma, like hitting your nail with a hammer, or crush injuries, like slamming your finger in a door. Symptoms include severe or throbbing pain, nail discoloration, nail sensitivity, and separation of the nail plate from the nail bed.
If you are experiencing a subungual hematoma, you may be able to care for it at home by applying a bandage. Here is a step-by-step guide on how to do this:
- Before applying a bandage, it is important to assess the severity of the injury. If the injury is serious, or if there is a cut or tear in the nail, seek medical attention immediately.
- If the injury is minor and the nail is still attached to the nail bed, you can proceed with cleaning the wound. Use mild soap and water to gently clean the area, being careful not to apply too much pressure to the injured finger. Remove any jewelry, such as rings, from the affected finger to prevent further injury or swelling.
- Dry the area thoroughly. Ensure that your hands are clean to avoid introducing bacteria to the wound.
- Apply a thin layer of antibiotic ointment to the injured area. This will help prevent infection and promote healing.
- Choose an appropriate bandage size. The bandage should be large enough to cover the injured area and secure enough to stay in place.
- Wrap the bandage firmly, but not too tightly, around the finger. Start at the base of the finger and work your way up, ensuring that the bandage is smooth and free of wrinkles.
- Secure the bandage in place. You can use tape or a bandage clip to ensure that it does not unravel.
- Change the bandage daily or as directed by your healthcare provider. It is important to keep the wound clean and dry to prevent infection.
- If the injury is on your dominant hand, you may need assistance with applying the bandage. Ask a friend or family member to help you, or use medical tape to secure the bandage in place.
- Elevate your hand above the level of your heart to help reduce throbbing pain and swelling. This will also help slow down the bleeding under the nail.
It is important to note that this guide is for minor injuries only. If you are experiencing severe pain, heavy bleeding, or any other concerning symptoms, seek medical attention immediately. Do not attempt to drain the blood or relieve the pressure build-up on your own unless instructed to do so by a healthcare professional.
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Frequently asked questions
A subungual hematoma is a type of injury to your fingernail or toenail, also known as a bruised nail. It involves bleeding below the hard part of your nail, which can lead to swelling, nail discoloration, and pain.
A subungual hematoma is usually caused by a crushing or stubbing injury, such as hitting your finger with a hammer, or dropping a heavy object on your toe. It can also be caused by repetitive pressure over time, such as running in shoes that are too tight.
You can relieve the pressure and pain from a subungual hematoma by draining the hematoma. This can be done by making a small hole in the nail to allow the blood to flow out. It is recommended to see a doctor as soon as possible for this procedure, but it can also be done at home using a drill bit or heated pin method.
For larger hematomas, or if the bone is broken, the nail may need to be removed and the nail bed repaired. Antibiotics may be prescribed to prevent infection. Over-the-counter pain relievers, such as ibuprofen or naproxen, can also help reduce pain and swelling.
