Noah Sinclair
A subungual hematoma is a type of injury that occurs when blood pools under the nail plate, causing discoloration and pain. This is usually the result of sudden trauma to the nail, such as crushing or stubbing it. While most bruised fingernails and toenails heal without any issues, the pressure caused by the pooled blood can be extremely painful. In such cases, a simple drainage procedure can be performed to relieve the pain and aid healing. However, it is important to note that this procedure should not be attempted at home and that medical care should be sought.
| Characteristics | Values |
|---|---|
| What is it called? | Subungual Hematoma |
| What causes it? | Direct trauma to the nail, such as crushing or stubbing |
| What are the symptoms? | Swelling, nail discolouration, pain, and bleeding below the nail plate |
| Should you drain it at home? | No, seek medical care |
| When should you drain it? | When it causes pain or makes up 25%-50% or more of the nail |
| What does the procedure involve? | Administering pain relief, draining by applying gentle pressure with a heated needle/cautery device/specialized laser, covering the area with a bandage, and keeping it clean and dry |
| What are the risks? | A small risk of infection |
| What are the alternatives? | Ice, elevation, and over-the-counter anti-inflammatories |
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Drainage procedure
A bruised fingernail or toenail is typically caused by blunt or crush trauma. This results in a subungual hematoma, where blood collects under the nail, causing pressure and pain. While this injury usually isn't serious unless there is additional damage, you should consider seeking medical attention if the pain worsens over a few hours. A healthcare provider can perform a simple draining procedure to relieve the pressure and provide relief.
The drainage procedure, also called trephination, involves making a small hole in the nail to allow the blood to flow out. It can be performed quickly and relatively painlessly in a doctor's office or urgent care centre. It is recommended when the hematoma is causing pain or covers 50% or more of the nail.
It is best to see a doctor within the first 48 hours of the injury, as the blood begins to clot after this time, making drainage difficult. During the procedure, your doctor will bandage your nail and may recommend keeping your finger or toe bandaged and elevated, along with using cold compresses, for the first 12 hours. They may also suggest using a splint until the tenderness subsides.
After the procedure, it is important to keep the area clean and dry. The nail may bleed a bit right after drainage, but this should stop soon after. Your nail may still look discoloured for several weeks, but the bruise will gradually fade as your nail grows back.
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Pain relief
A bruised fingernail or toenail is known as a subungual hematoma. It is usually caused by blunt or crush trauma, which results in blood collecting under the nail. This can be extremely painful due to the pressure generated by the pooled blood.
If you are experiencing intense pain, you should seek medical care. A healthcare provider can perform a simple procedure called trephination, which involves draining the hematoma to relieve pressure and provide pain relief. This procedure can be done quickly and relatively painlessly in a doctor's office or urgent care center. During the procedure, a doctor may administer a digital block, which is a form of local anaesthetic. They will then drain the hematoma by applying gentle pressure to the nail with a heated needle or cautery device, or by using a specialized laser. You may hear a "pop" sound when the needle reaches the blood under the nail. The doctor will ensure that the hole is large enough for continual drainage, and additional holes may be necessary for larger hematomas. They will then milk, or squeeze, the nail to help the blood flow out.
After the procedure, you will need to keep the affected area bandaged and elevated, and you may need to 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 keep the wound clean and dry while it heals.
Most bruised fingernails and toenails heal without complications, and any pain should ease within a few days, or right away after drainage. However, it is important to be aware that there is a small risk of infection after the procedure. If you are experiencing intense pain or other symptoms, such as a change in colour of the hematoma, and home measures such as ice and over-the-counter anti-inflammatories do not provide relief, you should contact a doctor for further advice.
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Trephination
A subungual haematoma is a bruised fingernail or toenail that occurs when there is bleeding and bruising under the nail bed's surface, usually due to a crushing or stubbing injury. While this is typically a minor injury, it can be extremely painful due to the pressure generated by the pooled blood under the nail.
It is recommended that you see a doctor within the first 48 hours of the injury for the best results, as the blood begins to clot after this time, making drainage difficult. If the haematoma is small and does not cause pain, you may not need to drain it at all. However, if the pain gets worse or you have signs of infection, you should seek medical care immediately.
After the procedure, it is important to keep the area clean and dry while it heals. Your nail may still bleed a bit right after drainage, but this should stop quickly. It is normal for your nail to remain discoloured for several weeks, and it may take between 4 to 6 months for a fingernail and 12 to 18 months for a toenail to grow back completely. During this time, your nail may have ridges or other abnormalities.
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Healing time
A subungual haematoma is a bruised fingernail or toenail resulting from blunt or crush trauma. Blood collects under the nail, causing pressure and
The healing time for a subungual haematoma varies depending on the severity of the injury and whether or not the blood is drained. If left untreated, a haematoma may take several months to reabsorb or grow out. Nails that grow back may have ridges or other abnormalities.
If the blood is drained, the pain and pressure should be relieved almost immediately. The drainage procedure, called trephination, can be performed quickly and relatively painlessly in a doctor's office or urgent care centre. It is best to have the procedure done within the first 48 hours of the injury, as the blood will begin to clot after this time, making drainage difficult.
After drainage, the nail may still look discoloured for several weeks, but the bruise will gradually disappear as the nail grows back. It typically takes between 4 and 6 months for a fingernail to grow back, and 12 to 18 months for a toenail.
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Risks and complications
While most bruised fingernails and toenails heal without any complications, there are certain risks and complications associated with the procedure of draining blood from under a bruised fingernail. Firstly, it is important to note that you should never attempt to drain a subungual hematoma at home and should always seek medical care. Drainage of blood is recommended only when the hematoma is causing pain or makes up a significant portion of the nail. If left untreated, the pressure of the hematoma may cause your nail to come off completely.
One possible risk and long-term complication of a subungual hematoma is a nail bed laceration (cut). If the trauma is severe, the nail bed laceration can be stitched closed after the nail is partially or completely removed. If the skin beneath the nail is lacerated, it may not heal properly without nail bed repair, leading to potential nail deformity and permanent abnormalities. In some cases, the nail may fall off as part of the natural healing process, even if medical attention is sought.
Another complication associated with the drainage procedure is a small risk of infection. It is recommended to keep the area clean and dry after the procedure to prevent any infection. Additionally, there may be some bleeding right after draining the blood, but it should stop soon after.
It is important to seek medical attention within the first 48 hours of the injury, as the blood begins to clot after this time frame, making drainage more difficult. The decision to drain the hematoma also depends on its size; smaller hematomas may not require drainage and can heal on their own.
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Frequently asked questions
A subungual hematoma is a bruised finger or toenail that develops after sudden trauma to your nail, like dropping a heavy object on your finger or toe.
In most cases, you should not attempt to drain a bruised fingernail at home and should instead seek medical care. A healthcare provider can perform a simple draining procedure to relieve the pressure and provide relief.
Doctors recommend draining subungual hematomas when they cause pain or make up 50% or more of the nail. If you have a fractured finger, doctors may recommend drainage if the hematoma makes up 25% or more of your nail.
