Noah Sinclair
Crushing your finger or toenail can be extremely painful, and often results in a subungual hematoma, or a blood pocket under the nail. This can cause throbbing pain due to the pressure of blood collecting between the nail and the nail bed. To relieve this pain, a small hole can be made in the nail to drain the blood, a procedure called trephination. This can be done at home with a heated pin or paperclip, but this may cause infection. Alternatively, a doctor can perform the procedure, often using a heated wire or carbon laser to burn a hole in the nail, or a needle to puncture it.
| Characteristics | Values |
|---|---|
| What is it called when there is blood under the fingernail or toenail? | Subungual hematoma |
| What causes it? | A crushing or stubbing injury |
| What are the symptoms? | Severe, throbbing pain, darkened area under the nail |
| What to do? | Elevate the hand or foot, keep the wound clean and dry |
| When to see a doctor? | When there are symptoms of infection, e.g. fever, warmth at the site, pus, or swelling; when there is a broken bone or damage to the nail bed and/or surrounding tissues; when there is no injury but there is a darkened area under the nail |
| What will the doctor do? | Drain the blood, relieve the pressure and pain by creating a small hole in the nail, use stitches or glue to reattach the nail, prescribe antibiotics to prevent infection, provide a splint or special shoe |
| How long does it take for the nail bed to heal? | 7-10 days |
| How long does it take for a new nail to grow? | 8 weeks for a fingernail, 6 months for a toenail |
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What You'll Learn
Draining the blood pocket
The procedure begins with cleaning the affected area with alcohol, iodine, or another antiseptic solution. Then, the doctor will administer a digital block to numb the area and prevent pain.
Decompression, or trephination, is then performed to allow the blood to drain. This can be done in a few ways:
- Cautery: A heated wire (electrocautery device) or carbon laser is used to burn a hole through the nail. The heat is quickly dissipated by the hematoma, preventing damage to the nail bed.
- Needle: A needle is used to make a small hole in the nail.
- Drill bit: A drill bit is used to slowly penetrate the nail and reach the blood pocket without touching the nail bed.
After the procedure, the doctor will bandage the nail and advise you to keep the finger or toe bandaged and elevated for the first 12 hours. You may also be instructed to use cold compresses during this time.
It is important to note that nail drainage must be performed within the first two days of the injury. If you experience any symptoms of infection, such as fever, warmth at the injury site, pus, or swelling, contact your doctor immediately.
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Home methods vs medical treatment
A crushed fingernail can be extremely painful due to the pressure generated by the pooled blood under the nail. This condition is called a subungual hematoma. To relieve the pain, one option is to drain the blood by poking a hole in the nail.
Home Methods
Some sources suggest that it is possible to drain the blood at home. One method is to use a heated pin to make a hole in the nail. However, this can be painful and may cause infection if bacteria enter the wound. Another risk of the heated pin method is that it can cause more pain than necessary.
Medical Treatment
It is recommended to seek medical attention for a subungual hematoma. Draining the nail is a simple, relatively painless procedure that can be performed quickly in a doctor's office or urgent care center. Doctors will first clean the area with alcohol, iodine, or another solution. They may then administer a digital block to numb the area. The doctor will then use a cautery method with a heated wire or carbon laser, or a needle, to make a hole in the nail. This procedure is quick and painless and does not damage the nail bed. After the procedure, the doctor will bandage the nail, and the patient will need to keep the finger or toe bandaged and elevated for the first 12 hours.
In conclusion, while it may be tempting to try a home method to relieve the pain of a subungual hematoma, it is much safer and more effective to seek medical treatment. Doctors can perform the procedure quickly and with minimal pain, and they can also provide follow-up care to prevent infection and ensure proper healing. Additionally, if there is any broken bone or damage to the nail bed or surrounding tissues, medical attention is necessary to address these more serious injuries.
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Pain management
A crushed fingernail can be extremely painful, and the pain may be accompanied by throbbing and intense pressure. This is caused by a build-up of blood under the nail, known as a subungual hematoma. The blood may turn dark over time, and the pressure may cause the nail to come off.
To relieve the pain, one option is to drain the hematoma by making a small hole in the nail to allow the blood to flow out. This procedure, called trephination, can be performed by a doctor and provides quick and immediate relief from pain and pressure. It is relatively painless and can be done in a doctor's office or urgent care center. Doctors recommend draining subungual hematomas when they are painful or make up 50% or more of the nail.
It is important to note that you should not attempt to drain a hematoma at home, as it may cause infection. Home methods such as using a heated pin or paper clip to create a hole can introduce bacteria into the wound. Instead, it is recommended to seek medical attention, especially if the injury is severe or involves broken bones, damage to the nail bed, or surrounding tissues.
To manage the pain before seeing a doctor, you can apply ice inside a cloth for 20 minutes every 2 hours on the first day, then 3 to 4 times a day after that. Keep your hand or foot elevated above the level of your heart to reduce throbbing. Over-the-counter pain relievers such as ibuprofen, naproxen, or acetaminophen can also help, but it is important to consult with a healthcare provider before taking any medication.
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Healing time
If you've injured your fingernail or toenail, you may notice blood pooling under the nail bed's surface. This is called a subungual hematoma and is usually caused by a crushing or stubbing injury. The blood may turn dark over time, and the pressure of the hematoma may cause your nail to come off completely. To relieve the pain and pressure, you can drain the hematoma. This procedure, called trephination, involves making a small hole in the nail to allow the blood to flow out. This can be done quickly and relatively painlessly in a doctor's office or urgent care center.
The healing time for a subungual hematoma can vary depending on the severity of the injury and the treatment method. If you choose to drain the hematoma, the procedure is relatively quick and can provide immediate relief from pain and pressure. However, it is important to keep the wound clean and dry while it heals, and you may experience drainage for some time afterward.
If your fingernail falls off due to the pressure of the hematoma, it will typically take about 4 to 6 months for a new fingernail to grow and replace the lost nail. Toenails take longer to grow back, usually about 12 to 18 months. The new nails may have ridges or other abnormalities, and these changes may be permanent.
In more severe cases, if the bone is broken or the bruise is very large, the nail may need to be removed, and the nail bed will need to be repaired. This can extend the healing time. Additionally, if you experience any symptoms of infection, such as fever, warmth at the injury site, pus, or swelling, you should contact your doctor, as this may require further treatment and delay the healing process.
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Preventing infection
Poke holes in crushed fingernails? Yes, it can be helpful. But it is not recommended to do this at home.
To prevent infection, it is important to keep the wound clean and dry while it heals. Here are some steps to help prevent infection and promote healing:
- See a medical professional: While it may be tempting to try to drain the blood yourself, it is important to leave this to a professional. They will have the sterile tools and knowledge to perform the procedure correctly, reducing the risk of infection.
- Clean the wound: Before performing trephination, a doctor will clean the area with alcohol, iodine, or another antiseptic solution to prevent infection.
- Administer a digital block: A doctor may administer a local anaesthetic to numb the area, which will help with pain relief during the procedure.
- Decompression methods: There are different methods that a doctor may use to create the hole in your nail. They may use a heated wire (electrocautery device) or carbon laser to burn a hole, or they may use a needle. The heated wire method is quick and painless and prevents injury to the nail bed as the tip is cooled by contact with the hematoma.
- Bandage the wound: After the procedure, your doctor will bandage your nail. Keep your finger or toe bandaged and elevated during the first 12 hours after decompression.
- Cold compresses: Use cold compresses during the first 12 hours after the procedure to help reduce swelling and pain.
- Keep the area elevated: Keep your hand or foot elevated above the level of your heart to help reduce throbbing and swelling.
- Antibiotics: Your doctor may prescribe antibiotics to prevent or treat infection.
- Monitor for signs of infection: Contact your doctor if you experience any symptoms of infection, such as fever, warmth at the injury site, pus, or increased swelling.
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Frequently asked questions
A subungual hematoma is a bruise that occurs when there is bleeding under a fingernail or toenail, usually due to a crushing or stubbing injury.
It is recommended to see a doctor, who may perform a procedure called trephination, which involves creating a small hole in the nail to drain the blood and relieve pressure and pain.
No, you should not attempt to drain a subungual hematoma at home as it may cause infection. Home methods such as using a heated pin or paper clip can introduce bacteria into the wound.
You should see a doctor, especially if you experience any symptoms of infection such as fever, warmth at the injury site, pus, or swelling. They will be able to advise on the best course of treatment, which may include draining the hematoma or other measures such as icing the area and taking pain relievers.
