Isla Bennett
Blood under the fingernail, or subungual hematoma, is usually caused by a traumatic injury that breaks the blood vessels under the nail, causing blood to pool and become trapped underneath. This can be the result of slamming a finger in a door, wearing tight shoes, or repetitive stress from movements such as running. Symptoms include throbbing pain, discoloration, and pressure. Treatment options include home remedies such as resting, icing, applying compression, and elevation to encourage healing. If seen within 48 hours, a doctor can drain the excess fluid to relieve pressure.
| Characteristics | Values |
|---|---|
| What | Subungual Hematoma (Blood Under Nail) |
| Cause | An injury to a nail that breaks blood vessels, causing blood to pool underneath the nail |
| Treatment | Rest, ice, compression, and elevation |
| Treatment | Over-the-counter anti-inflammatories like aspirin, Advil, or Motrin for minor pain |
| Treatment | Drainage of excess fluid by a doctor |
| Treatment | Decompression or trephination by a doctor |
| Treatment | Removal of the nail by a doctor |
| Complications | Small risk of infection in the residual hematoma |
| Complications | Damage to the nail matrix, which can result in the nail not growing back or growing back differently |
| Complications | Melanoma, a type of skin cancer that can occur under a fingernail or toenail |
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What You'll Learn
See a doctor if you have concerns
If you have concerns about dried blood under your fingernail, you should see a doctor as soon as possible. This condition is called a subungual hematoma, and it is usually caused by a traumatic injury, such as stubbing your toe, hitting your finger with a hammer, or even wearing shoes that are too tight. While small hematomas may not need medical treatment, you should still seek medical attention if you have concerns, especially if you are experiencing other symptoms like swelling or an inability to move the affected finger or toe.
Your doctor will examine your nail and may recommend an X-ray to check for any underlying bone fractures or other injuries. Depending on the severity of the hematoma, your doctor may suggest different treatment options. If the bleeding is severe or accompanied by extreme physical trauma, your doctor may recommend medical treatments such as decompression or trephination, which involves creating a hole in the nail to drain the blood and relieve pressure and pain. This procedure is typically performed under local anaesthesia, such as a nerve block or digital block, to numb the affected area.
In some cases, the damage to the nail may be extensive, and there is a small chance that the nail matrix, where your nails form, may have been affected. This could result in the nail not growing back or appearing different when it does grow. To prevent this, your doctor may recommend removing the severely injured nail and using stitches to repair the nail bed. They may also suggest using a splint to protect the area and promote healing.
It is important to be vigilant, as melanoma, a type of skin cancer, can sometimes occur under a fingernail or toenail and present as a dark mark. While melanoma is not usually linked to an injury and is typically painless, it is crucial to consult a doctor if you have any concerns or if the hematoma does not heal. They can provide advice on further diagnostic steps and treatment options.
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Drain the blood
If you have injured your finger or toe, you may notice blood pooling under the nail, causing a subungual hematoma. This can be extremely painful due to the pressure of the blood under the nail. To relieve this pain, you can drain the blood.
When to Drain
It is recommended to drain a subungual hematoma when it is causing you pain or covers 50% or more of the nail. If the hematoma is small, you may not need to drain it at all, but it is always best to consult a doctor. It is also important to note that the blood begins to clot after 48 hours, making drainage difficult.
How to Drain
Draining a subungual hematoma is a procedure that can be performed by a doctor in their office. They will first administer pain relief or a local anesthetic, which is called a digital block. Then, they will use a heated 18-gauge needle, cautery device, or specialized laser to apply gentle pressure to the nail and create a hole for the blood to drain. You may hear a "pop" when the needle reaches the blood. The hole should be about 3 to 4 millimeters thick to allow for proper drainage, and additional holes may be needed for larger hematomas.
Once the hole is created, the doctor will milk or squeeze the nail to help the blood flow out. Finally, they will bandage the area and may recommend keeping your hand or foot elevated to aid in healing.
Home Remedy
While it is always recommended to seek medical advice, a home remedy for draining blood from under a nail involves using a straightened and heated paper clip. Heat the tip of the paper clip in a flame until it is red-hot, then gently place it on the nail without applying pressure. The heat will melt a hole through the nail, allowing the blood to escape. As there are no nerves in the nail itself, this should not be painful. However, it is important to go slowly and be careful not to touch the skin under the nail.
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Relieve pain and pressure
To relieve pain and pressure caused by a subungual hematoma, there are several methods you can try. The first is to ice the affected area with an ice pack or cold compress to reduce swelling and pain. Keep the hand or foot elevated to further reduce swelling. You can also apply pressure to the area with a wrap to reduce the amount of blood that can pool under the nail. Over-the-counter anti-inflammatories such as aspirin, Advil, or Motrin can be taken for minor pain.
If the injury is more serious, you may need to seek medical attention. A doctor may perform a procedure called decompression or trephination, which involves creating a hole in the nail to allow the blood to drain. Before the procedure, the doctor will numb the area with a nerve block or digital block to prevent pain. The hole should be large enough to let the blood drain, which can take about a day or two. During this time, the wound should be covered with sterile gauze.
After the procedure, the doctor will bandage the nail, which will need to be kept bandaged and elevated for the first 12 hours. Cold compresses and splints may also be recommended during this time. There is a small risk of infection following the procedure, so it is important to follow all instructions from your healthcare provider.
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Home remedies
If you have blood under your fingernail or toenail, it is called a subungual hematoma. This is usually caused by a crushing or stubbing injury, such as slamming your finger in a car trunk or wearing shoes that are too tight. If the injury is recent (less than 48 hours old), your doctor may be able to drain the excess fluid and relieve the pressure.
Small hematomas may heal on their own without much issue. To reduce symptoms, you can try some of the following home remedies:
- Elevate your hand or foot to reduce swelling.
- Apply a cold compress to the affected area to help with pain and swelling.
- Apply compression to slow the bleeding under the nail.
- Take over-the-counter anti-inflammatories like aspirin, Advil, or Motrin for minor pain.
If home measures don’t give you relief, you should contact a doctor for the next steps.
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Preventing nail damage
To prevent nail damage, it is recommended to keep your nails short and trimmed straight across. Long nails are more likely to break, tear, and harbour bacteria. Nails that are too thick to cut can be softened by soaking them in salt water, and then applying a cream containing urea or lactic acid.
It is also important to be mindful of how you wash your hands. Scrub your nails with soap every time you wash your hands, and use a nailbrush if possible. Dry your hands and feet thoroughly after washing them, as bacteria and fungi thrive in moist environments.
Avoid biting your nails, as this can introduce viruses and cause infections. If you have a hangnail, cut it off with nail clippers instead of biting or ripping it off with your hands.
When playing sports, it is important to wear protective gear and appropriate shoes to prevent nail injuries.
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Frequently asked questions
Blood under the fingernail, or subungual hematoma, is usually caused by a traumatic injury. You should seek medical attention as soon as possible. If it has been less than 48 hours, a doctor can drain the excess fluid to relieve the pressure.
The first symptom is throbbing pain in the nail area due to the pressure of blood pooling under the nail bed. The second is the discoloration of the nail, which starts as reddish-purple and turns dark brown and black as the blood clots.
A subungual hematoma may heal on its own in a few months. However, it can take up to a year for a toenail to grow out completely, and the nail may be malformed or cracked.
