Caleb Foster
Blood buildup under the nail, also known as a subungual hematoma, is a common injury that occurs when blood vessels under the nail break and start to bleed. This often happens when the nail experiences a direct or indirect trauma, such as being crushed or slammed. The blood gets trapped under the nail, causing pain and sometimes discoloration. While small hematomas may not require medical treatment, larger hematomas can be extremely painful and may require a procedure called trephination to drain the blood and relieve the pressure. This procedure should be performed by a medical professional within 48 hours of the injury, as attempting to do it yourself can lead to serious infections and permanent damage to the nail or finger.
| Characteristics | Values |
|---|---|
| Medical term | Subungual hematoma |
| Cause | Direct trauma to the nail, such as crushing or slamming |
| Symptoms | Severe throbbing pain, nail discoloration (blue, purple, black, brown), nail deformation |
| Treatment | Drainage procedure (trephination), rest, ice, pain medication, elevation, anti-inflammatories |
| Timeframe for treatment | Within 48 hours of injury, before blood clots |
| Home remedies | Rest, ice, pain medication |
| Risks of drainage procedure | Infection, permanent nail damage |
| Regrowth timeframe | Fingernail: 8 weeks; Toenail: 6 months |
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What You'll Learn
Drain blood with a cautery device
If you have bleeding under a large area of the nail surface, the nail bed may be injured. In this case, a doctor may need to remove the entire nail and use stitches to repair the bed. This condition is called a subungual hematoma. It usually occurs when the nail gets crushed in an injury. The blood under the nail can cause throbbing pain.
To relieve the pain, a doctor may perform decompression, also called trephination, which allows the underlying blood to drain. The doctor may numb the affected finger or toe with a nerve block and then use a cautery device. The doctor uses a heated wire (electrocautery device) or carbon laser to burn a hole or holes. The heated tip of the wire is cooled by contact with the hematoma, which prevents injury to the nail bed. This is a quick and painless procedure.
After the procedure, your doctor will bandage your nail. You will need to keep the finger or toe bandaged and elevated and may also need to use cold compresses during the first 12 hours after decompression.
It is recommended that you visit a doctor within the first 48 hours of the injury for the best results. The blood begins to clot after this amount of time, making drainage difficult.
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See a doctor for decompression
If you are experiencing blood buildup under your nail, you may have what is known as a subungual hematoma. This is a bruised fingernail or toenail that develops after sudden trauma to your nail, such as hitting your fingertip with a hammer or dropping a brick on your toe. It can cause severe throbbing pain due to the pressure of blood collecting between the nail and the nail bed.
If you are experiencing a subungual hematoma, you should seek medical attention. Your doctor may perform a simple drainage procedure called decompression or trephination, which allows the underlying blood to drain, relieving pressure and pain in the affected area. Before the procedure, your doctor may numb the affected finger or toe with a nerve block to prevent any pain during the process.
Decompression can be performed using a heated wire (electrocautery device) or a carbon laser to burn a hole or holes in the nail. The heated tip of the wire is cooled by contact with the hematoma, which prevents injury to the nail bed. This method is called cautery.
The main complication associated with decompression is a small risk of infection in the residual hematoma. Therefore, it is important to carefully consider the benefits and risks of the procedure with your doctor before proceeding.
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Treat pain with ice and anti-inflammatories
A subungual haematoma is a bruised fingernail or toenail that occurs when blood vessels under the nail break open, causing blood to collect and become trapped under the nail. This can be caused by something crushing or slamming the nail, such as stubbing your toe, wearing tight shoes, or repetitive stress from movements like running.
If you have a subungual haematoma, you can treat the pain with ice and anti-inflammatories. To do this, wrap some ice in a soft cloth and apply it to the affected area. This will help to reduce swelling and pain. You can also try over-the-counter anti-inflammatories like aspirin, Advil, or Motrin for minor pain. Be sure to keep the affected hand or foot elevated to further reduce swelling.
If the pain is severe or lasts longer than a few days, seek medical attention. Your doctor may recommend a simple procedure called trephination, which involves draining the haematoma to relieve pressure and pain. This procedure needs to be done within 48 hours of the injury, before the blood starts to clot.
Most subungual haematomas heal well over time, but it can take several months for the blood to fade completely and for a healthy nail to regrow. In some cases, the nail may fall off before a new one grows back. Complications can also arise, such as nail loss or discoloration of the nail.
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Avoid home treatments to prevent infection
Blood buildup under the nail, also known as subungual haematoma, is a common injury that can result from blunt force trauma, crush injuries, or repetitive pressure. While it usually doesn't lead to complications, there is a possibility of developing a bacterial infection.
To prevent infection, it is important to avoid home treatments and seek medical advice. Here are some reasons why you should refrain from attempting to treat a subungual haematoma at home:
Potential for Further Injury: Treating a subungual haematoma involves proper medical techniques and tools. Attempting to drain the blood or relieve pressure at home may result in further injury to the nail bed or surrounding tissues. This can increase the risk of infection and prolong the healing process.
Infection Risk: Any break in the skin, including injuries to the nail and cuticles, provides an opportunity for bacteria to enter and cause an infection. By avoiding home treatments, you lower the risk of introducing bacteria to the affected area.
Proper Assessment and Treatment: A doctor will not only address the subungual haematoma but will also assess the surrounding structures, such as the bones and tissues, for any additional injuries. They can order X-rays or other tests to ensure that you receive comprehensive care.
Safe Drainage Techniques: Decompression or trephination techniques performed by a doctor can effectively relieve pressure and drain the blood. These techniques involve the use of specialised tools, such as heated wires (electrocautery devices) or lasers, which are carefully applied to prevent injury to the nail bed.
Personal Care Advice: A medical professional can provide you with personalised advice on how to care for your injury at home after the initial treatment. They may instruct you on the use of ice, elevation, anti-inflammatory medications, and cold compresses to manage pain and swelling.
In summary, while subungual haematomas often heal without complications, seeking professional medical care is crucial to prevent infection and ensure proper healing. Avoid home treatments and consult a doctor or seek emergency care, especially if you experience severe pain, deformation, or signs of infection, such as pus, redness, or heat around the nail.
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Keep the area clean and dry
Keeping the affected area clean and dry is crucial after draining blood from under your nail to prevent infection and promote healing. Here are some detailed steps to ensure proper aftercare:
Cleaning the Area:
- Soak the affected finger or toe in warm, soapy water for 10 minutes, three times a day, for 2 to 3 days. This helps remove any blood residue and prevents the buildup of germs.
- You can use a mild soap or a gentle, antibacterial cleanser. Avoid using harsh chemicals or abrasive cleaning tools, as they may irritate the skin.
- Ensure that you dry the area thoroughly after soaking, including the areas around the nail. Use a clean, soft towel and pat gently to avoid applying pressure to the nail.
Maintaining Dryness:
- Keep the affected area elevated whenever possible, especially during the first 24 to 48 hours. Elevation promotes proper drainage and reduces swelling, which helps keep the area dry.
- Avoid activities that may cause excessive sweating in the initial healing phase. Sweating can increase the moisture around the nail, providing a favourable environment for bacterial growth.
- If you need to apply bandages, follow your healthcare provider's instructions for changing them regularly to maintain dryness and absorb any fluid discharge.
Other Considerations:
- Be vigilant for signs of infection, such as increased pain, swelling, redness, or warmth around the nail. Also, look for red streaks extending from the nail or pus draining from it. Contact your doctor if you notice any of these symptoms.
- Avoid attempting to drain the blood yourself. While there is a procedure involving a paper clip and a flame, it is unsafe and may cause accidental injury to the skin under the nail.
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Frequently asked questions
A subungual hematoma is a bruised fingernail or toenail that may cause severe, throbbing pain. It usually happens if the nail gets crushed in an injury.
If the hematoma is small and isn't causing pain, you can treat it at home with rest, ice, and over-the-counter pain medication. However, if you have a large hematoma, severe pain, or any additional injuries, you should seek medical care for drainage and additional treatment.
You should never attempt to drain a subungual hematoma at home. Your doctor may perform a simple drainage procedure called nail trephination or decompression, which involves creating a small hole in the nail to allow the blood to escape and relieve pressure and pain.
