Noah Sinclair
Smashing your finger can be extremely painful and cause swelling, stiffness, and bruising. In some cases, blood can pool beneath the fingernail, resulting in what is called a subungual hematoma. This can cause severe pain and throbbing, and the pressure can lead to the fingernail falling off. While most smashed fingers don't require medical treatment, it's important to know when to seek help. If there are signs of a fracture, the injury looks severe, or the pain and swelling persist, it's best to see a doctor. Here are some ways to treat a smashed finger and relieve pain and swelling:
| Characteristics | Values |
|---|---|
| First steps | Manage the pain and swelling |
| Ice application | Apply ice for 15 minutes at a time, a couple of times an hour for the first few hours |
| Elevation | Raise the injured finger above the heart to slow blood flow and reduce throbbing |
| Pain relievers | Take over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs) like Advil (ibuprofen) and Aleve (naproxen) |
| Move your finger | Keep using the finger to promote circulation |
| Clean the wound | Wash the finger thoroughly with soap and water |
| Drainage | A doctor may perform decompression or trephination to allow the underlying blood to drain, relieving pressure and pain |
| Medical attention | Seek medical attention if there are signs of a fracture, the injury looks severe, or the pain and swelling persist |
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What You'll Learn
Manage pain and swelling with ice, elevation, and OTC pain medication
A smashed finger can be extremely painful, and the pain may last for a few days or weeks. In most cases, a smashed finger won't require medical treatment, but it's important to know when to seek medical attention. Severe pain, stiffness, or a deep wound that may require stitches are all reasons to see a doctor.
If the injury is not severe, the first step in treating a smashed finger is to manage the pain and swelling. This can be done by using ice, elevation, and over-the-counter (OTC) pain medication. Here are some detailed instructions for managing pain and reducing swelling:
Ice
Applying ice to the affected area can help reduce pain and swelling. Wrap an ice pack in a clean cloth and apply it to the finger for 15 minutes at a time, a couple of times an hour for the first few hours. Do not apply ice to the finger for more than 15 minutes at a time to prevent cold injury to the skin.
Elevation
Raising the injured finger above the level of the heart slows down the blood flow to the finger, which helps to reduce throbbing and swelling. Keep your finger elevated as much as possible during the first few days after the injury.
OTC Pain Medication
There are medications available over the counter that can help alleviate pain and reduce inflammation. These include oral medications such as aspirin, ibuprofen, or naproxen. Additionally, topical creams containing medication and natural ingredients can be applied directly to the affected area to reduce swelling and inflammation.
It is important to keep the injured finger clean and to avoid any activities that cause pain or discomfort. In most cases, a smashed finger will start to feel better within a few days of using these at-home treatments. However, if the pain and swelling persist or the injury appears to be severe, it is important to seek medical attention.
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Keep the wound clean
Keeping the wound clean is essential to prevent infection and promote healing. Here are some steps to follow:
Wash the injured finger or toe with mild soap and water as soon as possible after the injury. This will help remove any dirt, debris, or bacteria that may have been introduced during the injury. Make sure to remove any rings from the injured finger before it starts to swell.
If there is bleeding under the nail, you can try to stop it by applying pressure with a clean cloth, paper towel, or gauze. You can also run the injured area under cold water or apply an ice pack to help reduce swelling and stop the bleeding. Keep the wound elevated above the level of the heart to help slow down the bleeding and reduce throbbing pain.
If there is a cut or tear on the skin, clean it gently with soap and water, and consider using an antiseptic solution or ointment to prevent infection. Cover the wound with a sterile dressing or bandage, and change it regularly to keep it clean and dry.
If the nail is damaged or there is bleeding under the nail, it is important to monitor for signs of infection. These may include redness, heat, pus, or a red streak extending from the wound. If you notice any of these signs, seek medical attention promptly.
In some cases, the doctor may recommend a procedure called decompression or trephination to drain the blood from under the nail and relieve pressure and pain. After this procedure, it is crucial to keep the wound clean and dry, following your doctor's instructions for changing bandages and using cold compresses or elevation.
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Seek medical attention if the injury is severe or the pain and swelling persist
If the pain and swelling persist or the injury is severe, it is important to seek medical attention. A doctor may recommend decompression, also known as trephination, to drain the underlying blood and relieve pressure and pain. This procedure involves numbing the affected finger with a nerve block and then using a heated wire, carbon laser, or needle to create a hole in the nail for drainage. Following the procedure, the doctor will bandage the finger, which should be kept elevated and may require cold compresses for the first 12 hours. In some cases, a splint may be recommended for a few days until the tenderness subsides.
It is important to seek medical attention if you are unable to move your finger or if there are signs of a fracture, such as a cracking sound at the time of injury or the piercing of the skin with a bone fragment. A broken finger is often difficult to differentiate from a sprained or jammed finger, but the severity and duration of symptoms are key indicators. With a broken finger, the pain, swelling, and difficulty moving the finger will be more intense and long-lasting.
Additionally, seek medical care if there is a deep wound that may require stitches, if there is trouble controlling bleeding, or if there are signs of infection such as pus, redness, or heat around the nail. If more than a quarter of the nail is discolored or there is continuing intense pain, it is important to see a doctor. An X-ray may be necessary to check for bone fractures or other injuries.
While most smashed fingers can be treated at home with ice, elevation, and over-the-counter pain relievers, it is always better to err on the side of caution and seek medical attention if you are unsure about the severity of the injury.
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Drainage of blood with a cautery or needle procedure
If you have a smashed finger with blood under the nail, you should seek medical attention. A doctor will be able to assess the injury and determine if any treatment is required.
If the blood under your nail, also known as a subungual hematoma, is causing you pain or covers a large area, your doctor may recommend draining the blood. This procedure is known as trephination.
Cautery procedure:
- The doctor will use a heated wire (electrocautery device) or carbon laser to burn a small hole in the nail, allowing the blood to drain out.
- The procedure is quick and painless. The heated tip of the wire is cooled by the contact with the hematoma, preventing injury to the nail bed.
- It is important to control the tip of the cautery device as it passes through the nail plate to ensure contact with the nail bed.
- Do not use a hot cautery with artificial nails, as they can be flammable.
Needle procedure:
- The doctor will use a needle to carefully drill through the nail, creating a hole for the blood to drain out.
- A 29-gauge insulin needle with an attached syringe can be used to insert underneath the nail, advancing it proximally and parallel to the nail plate with gentle suction until the hematoma drains into the syringe.
- With a needle, use a rotating motion with moderate pressure to create the hole.
After either procedure, it is important to keep the finger bandaged and elevated during the first 12 hours. Cold compresses and a splint may also be recommended to reduce tenderness and swelling. Drainage through the hole may continue for 24 to 36 hours.
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Regrowth of the nail
If you have a smashed finger with blood under the nail, it is likely that you have experienced a subungual haematoma. This is a pool of blood that collects under the nail after an injury, causing it to separate from its nail bed. In most cases, this injury isn't serious, but it can be very painful. If the area of bleeding is large, the nail will usually fall off on its own after several weeks.
The regrowth of the nail will depend on whether it is a fingernail or toenail. A new fingernail can regrow in as little as eight weeks, while a toenail may take up to six months to fully regrow. If there has been any damage to the nail bed or surrounding tissues, the new nail may take longer to grow back and may not look normal.
You can expect the following when you seek medical attention for your injury:
- Your nail will be examined, and X-rays may be taken to check for any fractures or other injuries.
- A procedure called trephination may be performed to drain the blood from the haematoma and relieve the pressure and pain. This involves numbing the affected finger with a nerve block and then using a heated wire (electrocautery device), a carbon laser, or a needle to create a small hole in the nail.
- After the procedure, your doctor will bandage your nail, and you will need to keep your finger elevated and use cold compresses for the first 12 hours. In some cases, a splint may be recommended for a few days until the tenderness subsides.
It is important to seek medical attention if you experience any signs of infection, such as pus, redness, or heat around the nail, or if you have intense and continuing pain.
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Frequently asked questions
This is called a subungual hematoma.
Stop what you're doing to prevent further injury. Calmly assess the damage and decide whether you need medical attention.
You can treat a smashed finger by applying ice, elevating the finger, keeping the injury clean, and using over-the-counter (OTC) pain relief.
Seek medical attention if you are experiencing persistent bleeding, if you think your finger is broken, or if you have a deep wound that may require stitches. You should also seek medical attention if the pain and swelling don't subside or if there are signs of a fracture.
Your doctor may perform decompression, also called trephination, to drain the blood and relieve pressure and pain. They may numb your finger with a nerve block before using a heated wire, carbon laser, or needle to make a hole in the nail.
