Liam Carter
Blood under the nail, or subungual hematoma, is usually caused by a crushing or stubbing injury. This results in blood pooling under the nail plate, causing pain and discoloration. The blood can be drained by a doctor, who will use a heated wire, cautery device, or laser to burn a hole in the nail. This procedure is called trephination. If you experience bleeding under your nail, it is important to contact a doctor for advice on medical treatments.
| Characteristics | Values |
|---|---|
| Medical term | Subungual hematoma |
| Cause | Blunt or crush trauma to the nail, such as stubbing or wearing tight shoes |
| Symptoms | Severe, throbbing pain, discoloration, swelling |
| Treatment | Drainage of blood by a doctor, home remedies such as icing, elevation, and anti-inflammatories |
| When to see a doctor | If there is severe pain, bleeding that doesn't stop, signs of infection, or deep injury at the base of the nail |
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What You'll Learn
When to seek medical attention
Subungual hematoma, or bleeding under the nail, is usually caused by blunt or crush trauma to the nail. It is generally not a cause for concern, but medical attention should be sought if:
- There is intense pain or pain that worsens over time.
- There is a deep cut and/or bleeding that won't stop.
- There is a possibility of a broken bone.
- There are signs of infection after drainage, such as red/discoloured skin around the nail, swelling, pus, or fever.
- The pain returns after treatment.
It is important to seek medical attention within the first 48 hours of the injury, as the blood begins to clot after this time, making drainage more difficult. Doctors may recommend draining the hematoma if it is causing pain or covers a significant area of the nail. This procedure, called trephination, involves making a small hole in the nail to allow the blood to drain out. While small hematomas may not require medical treatment, it is always best to consult a doctor before making that judgement.
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Home remedies for pain relief
A subungual hematoma is a bruised fingernail or toenail that may cause severe, throbbing pain. It occurs when blood vessels under the nail break open due to trauma, and blood collects and becomes trapped under the nail. While most cases of subungual hematoma will heal on their own, home remedies can help manage pain and encourage healing. Here are some home remedies for pain relief:
Rest
It is important to rest the affected finger or toe and avoid using it as much as possible. This will help reduce further injury and promote healing.
Ice
Applying ice packs or cold compresses can help reduce swelling and pain. It is recommended to ice the area for 20 minutes at a time, with at least 20-minute breaks in between. Make sure there is a barrier, such as a thin towel, between the ice and your skin to prevent ice burns.
Compression
Applying pressure to the area, such as with a wrap, can help reduce blood flow to the area and slow down the bleeding under the nail. This can help relieve pain and reduce swelling.
Elevation
Keep the affected hand or foot elevated above the level of your heart to reduce swelling and pain. This will help reduce the pressure caused by the pooled blood and provide some relief.
Over-the-counter pain relievers
Pain relievers such as aspirin, Advil, or Motrin can help reduce discomfort, swelling, and pain. These medications can be taken orally to help manage mild to moderate pain associated with subungual hematomas.
It is important to note that while these home remedies can provide pain relief, they may not be sufficient for more severe cases. If the pain is intense or persistent, or if there are signs of infection, it is recommended to seek medical attention. In some cases, a doctor may recommend draining the hematoma or removing the nail to relieve pressure and promote healing. Do not attempt to drain the hematoma at home, as it can lead to infections or further injury. Always consult with a medical professional before attempting any treatment.
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Draining the blood
Draining blood from under a nail, also known as nail trephination, is a quick outpatient procedure that can be performed at a doctor's office or urgent care centre. It is used to treat subungual hematoma, which is the medical term for blood pooling under the nail bed's surface due to a crushing or stubbing injury. While small subungual hematomas may not require medical treatment, larger hematomas can cause extreme pain due to the pressure generated by the pooled blood.
To drain the blood, the doctor will first clean the affected area with soap and water to remove any dirt or debris, and then apply a wound-cleansing solution such as chlorhexidine or iodine. The doctor will then use a needle, an electrocautery device, or a carbon laser to burn a small hole in the middle of the bruised area of the nail, releasing the built-up blood and relieving the pressure and pain. The procedure is relatively painless, and you will be able to go home right away.
After the procedure, it is normal to experience drainage through the hole in the nail for up to 36 hours. You should keep the area clean and dry, and follow your doctor's instructions for changing bandages. In some cases, you may need to milk or squeeze the nail to help the blood flow out of the hole, and then elevate the hand or foot.
While nail trephination is a safe procedure, there is a small risk of developing an infection or experiencing a minor injury to the nail bed. It is important to watch for signs of infection, such as increased pain, swelling, redness, warmth, red streaks, or pus draining from the nail. If you experience any of these symptoms, or if your pain does not subside after the procedure, you should contact your doctor.
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Potential complications
While subungual hematomas are typically minor injuries that rarely lead to complications, there are some potential risks to be aware of. Here are some possible complications that can arise from a subungual hematoma (bleeding under the nail):
- Infection: One potential complication is the development of a bacterial infection in the injured area. Complications are more likely if the injury is severe, especially if there is damage to the bone or surrounding tissues. It is important to monitor the affected area for any signs of infection, such as redness, swelling, warmth, or discharge, and seek medical attention if these occur.
- Fracture: A fracture or broken bone could be an additional injury associated with a subungual hematoma. It is crucial to get an X-ray done to rule out any fractures or other injuries that may require further treatment or splinting.
- Nail Loss: Damage to the nail matrix, which is responsible for regrowing the nail, can occur. If the nail matrix is damaged, the nail may fall off, and it may grow back with a different shape or not grow back at all.
- Prolonged Pain: While pain from a subungual hematoma typically resolves within a few days, in some cases, it may persist or be severe. If the pain is severe or lasts longer than expected, it could indicate an underlying issue, and it is recommended to consult a healthcare provider for further evaluation and management.
- Permanent Nail Damage: Attempting to drain the hematoma by yourself can lead to permanent damage to your nail or finger. It is strongly advised against performing self-drainage due to the risk of infection and permanent damage. Instead, seek professional medical assistance for proper drainage procedures, such as nail trephination, which involves creating a small hole in the nail under local anesthesia.
It is important to closely monitor your symptoms and seek medical attention if you experience any unusual pain, swelling, or other concerning symptoms.
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Healing and recovery
A subungual hematoma is a minor injury that usually gets better in a few days. However, it may take months or even years for a subungual hematoma to heal completely. A new nail typically grows out within 6–9 months, but this timeline can vary from person to person.
If you have a subungual hematoma, it's important to examine the affected area and determine whether medical attention is required. Small hematomas may not need medical treatment, but it's always best to consult a doctor before making that judgment.
To encourage healing, you can try home remedies such as resting the affected digit, icing the area, applying compression, and elevating the hand or foot. Over-the-counter anti-inflammatories like aspirin, Advil, or Motrin can also help with minor pain.
If you experience severe pain, bleeding that doesn't stop, signs of infection, or a subungual hematoma that doesn't go away on its own, it's important to contact a doctor for advice on medical treatments. They may recommend draining the hematoma to relieve the pressure and pain. This procedure, called trephination, involves making a small hole in the nail to allow the blood to drain. It can be performed quickly and relatively painlessly in a medical setting.
After the procedure, it's important to keep the wound clean and dry while it heals. You may experience drainage for a few days, and the area may be wrapped with a bandage. Be sure to contact a doctor if you experience any symptoms of infection, such as fever, warmth at the injury site, pus, or swelling.
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Frequently asked questions
You can drain the blood by creating a hole in your nail with a hot, straightened paper clip. This procedure should only be carried out if you are in pain.
Straighten a paper clip and heat one tip in a flame until it is red-hot. Place the tip on your nail and let it melt through. Do not push or apply pressure on the paper clip as you could accidentally touch the skin under your nail.
As soon as the hole is complete, blood will escape and the pain will be relieved. Soak the finger in warm, soapy water for 10 minutes, 3 times a day for 2 to 3 days.
The pain and pressure may build back up again in a few days. If this happens, repeat the procedure using the same hole. If the pain does not go away, you may have a more serious injury and should contact your doctor.
Signs of a more serious injury include increased pain, swelling, redness, or warmth around the nail, red streaks leading from the nail, and pus draining from the nail. If you notice any of these symptoms, contact your doctor immediately.
