Noah Sinclair
Blood under the nail, or subungual haematoma, is usually caused by a traumatic injury, such as slamming your finger in a door or dropping something on your toe. The injury causes blood to collect and become trapped under the nail, resulting in darkened discolouration and pressure and pain. While small haematomas may not require medical attention, larger ones can be intensely painful and may require a doctor to drain the blood within the first 48 hours of injury.
| Characteristics | Values |
|---|---|
| Medical Term | Subungual hematoma |
| Cause | Bleeding below the hard part of the nail (nail plate) due to sudden trauma, such as crushing or stubbing injuries, or repetitive pressure over time |
| Symptoms | Swelling, nail discoloration (black-and-blue or dark marks), pain, nail sensitivity, and nail separation from the nail bed |
| Treatment | Drainage procedure performed by a medical professional; home remedies like rest, icing, compression, and elevation for minor cases; medical treatments for more severe cases |
| Prevention | N/A |
| Healing Time | Varies; can take several months to years for the nail to grow back and for the injury to heal completely |
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What You'll Learn
What is a subungual hematoma?
A subungual hematoma is a bruised fingernail or toenail that develops after sudden trauma to the nail. This could be from blunt force trauma, such as hitting your finger with a hammer, or crush injuries, like dropping a heavy object on your toe. Subungual hematomas can also occur from repetitive pressure over time, like running in shoes that are too tight and press on a toenail.
The injury damages the blood vessels just under the nail plate, causing blood to pool and put pressure on the nail, which may lift it up from the tissues underneath (the nail bed). This pressure can cause severe pain and throbbing, and the blood may turn dark over time. The colour may change from red to purple to dark brown to black.
The pressure of the blood underneath the nail's surface may cause the nail to fall off partially or completely (avulsion). Accumulating pressure beneath the nail can lead to severe discomfort. If the trauma caused additional damage, like a broken bone or deep cut, further treatment and time to heal may be needed.
Doctors can drain subungual hematomas through a simple procedure called trephination, which relieves the pressure and pain by creating a small hole in the nail to allow the blood to flow out. Drainage is recommended when the hematoma is painful or makes up 50% or more of the nail. It is important to seek medical care and not attempt to drain a subungual hematoma at home, as this may cause infection.
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How does blood pool under the nail?
A subungual hematoma is the medical term for a bruised nail, which occurs when blood pools under the nail plate. This is usually caused by blunt force trauma, such as crushing or stubbing injuries, that break open blood vessels under the nail. The blood collects and becomes trapped under the nail, causing pressure and pain. This pressure can cause the nail plate to separate from the nail bed, leading to further discomfort.
The pooling blood can cause the nail to turn black and blue, and the colour may change over time as the injury heals. In some cases, the pressure may cause the nail to come off completely, a process known as avulsion. Before avulsion occurs, individuals may choose to relieve the pain and pressure by draining the hematoma. This procedure, called trephination, involves creating a small hole in the nail to allow the blood to flow out.
Trephination can be performed by a doctor or healthcare provider, who may numb the affected area before using a special lance or drill to create the hole. The procedure is typically quick and relatively painless. It is recommended for subungual hematomas that cause significant pain or make up a large portion of the nail.
For minor subungual hematomas, individuals can manage symptoms by icing and elevating the affected area to reduce swelling. Over-the-counter anti-inflammatories can also be taken to alleviate minor pain. In most cases, subungual hematomas are not serious and will heal over time without treatment. The trapped blood will eventually be reabsorbed, and the dark mark will disappear, although this can take several months or even years.
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When to drain and when to leave alone?
A subungual hematoma is a bruised fingernail or toenail that develops after sudden trauma to your nail, like hitting your fingertip with a hammer or dropping a heavy object on your toe. This results in blood pooling under the nail plate, causing it to lift up from the nail bed and leading to swelling, nail discolouration, and pain.
Small hematomas may heal on their own without causing major problems. Doctors recommend draining subungual hematomas when they are painful or make up 50% or more of the nail. If you have also fractured your finger, doctors recommend drainage if the hematoma makes up 25% or more of your nail.
If the trauma has caused additional damage, like a broken bone or deep cut, you will likely need further treatment and more time to heal. Drainage can be performed quickly and relatively painlessly in a doctor's office or urgent care centre. It is important to seek medical care if you are in any doubt about the severity of your injury.
Remember that nail drainage can only be performed within the first 48 hours after your injury. The blood begins to clot after this amount of time, making drainage difficult. You should not attempt to drain your hematoma at home as it may cause infection from bacteria entering the wound.
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How to drain blood from under the nail?
If you have bleeding under a large area of the nail, you must seek medical attention. Your doctor may decide to remove the entire nail and use stitches to repair the nail bed. In less severe cases, a doctor may perform nail trephination, a quick outpatient procedure that involves making a small hole in the hard part of your nail to drain the blood and relieve pressure and pain. This procedure should only be performed by a healthcare professional as attempting it yourself may lead to infection or further damage.
If you are unable to see a doctor, you can try soaking the affected finger in warm, soapy water for 10 minutes, three times a day for two to three days. This may help to drain the blood and reduce pain and pressure. However, if your pain does not go away, you must consult a doctor as you may have a more serious injury.
To prevent infection, keep the area dry and clean, and watch for signs such as increased pain, swelling, redness, warmth, red streaks, or pus around the nail. If you notice any of these symptoms, seek medical attention immediately.
It is important to act quickly as the nail trephination procedure works best within 24 to 48 hours of the injury.
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Home remedies and when to see a doctor
Subungual hematoma is the medical term for a bruised nail caused by bleeding below the nail plate. This can be the result of blunt force trauma, such as crushing or stubbing your finger or toe, or repetitive pressure, like running in tight shoes. The injury causes blood to pool under the nail, leading to swelling, discoloration, and pain. While small hematomas may not require any treatment, larger ones can be intensely painful and may require drainage to relieve the pressure.
Home remedies
If you have a subungual hematoma, there are some home remedies that can encourage healing:
- Rest the affected digit.
- Use a cool pack or cold compress to reduce pain and swelling.
- Keep the hand or foot elevated to reduce swelling.
- Apply compression to slow or stop the bleeding and reduce blood pooling under the nail.
When to see a doctor
While most subungual hematomas heal on their own, you should see a doctor if:
- The injury is severe, or you are in any doubt about its severity.
- You experience severe pain, or the pain gets worse.
- The bleeding does not stop.
- There are signs of infection.
- The hematoma does not heal or goes away and returns.
- There is severe damage to the nail bed, or the nail falls off.
- There are other symptoms, such as swelling or an inability to move the finger or toe, which could indicate a fracture.
- The injury affects a baby or child.
Doctors can perform a simple drainage procedure, also known as trephination, to relieve pain and pressure. This involves making a small hole in the nail to allow the blood to flow out. It is important not to attempt this procedure at home, as it can cause infection or further injury to the nail bed.
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Frequently asked questions
Subungual hematoma is the medical term for a bruised nail, which is caused by bleeding below the hard part of the nail (nail plate).
Subungual hematoma is caused by direct trauma to the nail, such as blunt force trauma or crush injuries. It can also be caused by repetitive pressure, like running in shoes that are too tight.
If you experience severe pain, bleeding that does not stop, signs of infection, or a subungual hematoma that does not heal, it is recommended to seek medical attention.
Small subungual hematomas may not require any treatment and can heal on their own within a few months. Home remedies such as rest, icing, compression, and elevation can be used to encourage healing. For larger hematomas, drainage may be performed by a healthcare professional to relieve pain and pressure.
Drainage of a subungual hematoma involves making a small hole in the nail to allow the blood to flow out. This procedure, also known as trephination, is typically performed by a doctor or healthcare provider and is relatively quick and painless.
