Caleb Foster
Pressing on a fingernail can indicate a variety of health issues. For example, the capillary nail refill test involves applying pressure to the nail bed to monitor dehydration and blood flow to the tissue. The time it takes for blood to return to the tissue after pressure is removed is measured, with a pink colour returning in less than 2 seconds indicating good blood flow. Pressing on the fingernail can also reveal issues such as nail infections, tumours, and iron deficiency. Changes in nail shape, colour, and texture can also indicate various health problems, from skin cancer to fungal infections. While some nail changes may be harmless, it is always recommended to consult a dermatologist or medical professional for a proper diagnosis and treatment.
| Characteristics | Values |
|---|---|
| Purpose | To monitor dehydration and the amount of blood flow to tissue |
| Test | Capillary nail refill test |
| Procedure | Pressure is applied to the nail bed until it turns white, then the time it takes for blood to return to the tissue is measured |
| Normal result | If there is good blood flow to the nail bed, a pink color should return in less than 2 seconds after pressure is removed |
| Abnormal result | Blanch times greater than 2 seconds may indicate poor blood flow |
| Other causes of pain under fingernail | Injury, infection, tumor, ingrown nail, nail fungus, hematoma, paronychia |
| Other signs and symptoms | Curved nails, color change, redness and swelling, nail lifting, pitted nails, spoon-shaped nails, washboard nails |
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What You'll Learn
Capillary refill test
Pressing on a fingernail is a way to perform the capillary refill test (CRT). This test is used to check blood flow to the tissue and monitor dehydration. It can also be used to detect shock in people with life-threatening illnesses or injuries.
The capillary refill test is a quick and simple test that can be performed on the nail beds of the fingers or toes. It is often used in cases where a patient is medically unstable and at risk of shock due to conditions such as anaphylaxis, dehydration, hemorrhage, hyperthermia, hypothermia, severe burns, altered mental state, or dangerously low or high vital signs.
To perform the test, the examiner removes any finger rings and nail polish. They then apply pressure to the nail bed until it turns white, which indicates that the blood has been forced from the tissue under the nail, a process called blanching. Once the tissue has blanched, the examiner releases the pressure and measures the time it takes for blood to return to the tissue, indicated by the nail turning back to a pink colour. A normal refill time is less than two seconds for newborns, about three seconds for adults, and more than three seconds for older adults.
While the capillary refill test is a useful metric, it is important to note that it is subject to examiner variability. Additionally, in rare cases, a finger or toe may not be the best place to perform the test. In such cases, healthcare providers may use the skin near the patient's breastbone (sternum), especially if the patient's body temperature is below average due to hypothermia or cold weather.
The capillary refill test is a valuable tool for healthcare providers, providing a rapid assessment of a patient's circulatory system and guiding further treatment decisions.
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Fingernail pain causes
Fingernail pain can be caused by various conditions, some more serious than others. One common cause of fingernail pain is an infection called paronychia, which affects the skin around the nail. This can be caused by bacteria, such as Staphylococcus aureus, or fungi. Symptoms of paronychia include redness, swelling, warmth, and throbbing pain in the skin around the nail. In some cases, pus may form under the skin next to or underneath the nail. Acute paronychia is typically caused by an injury to the nail area, such as aggressive manicuring or nail-biting, while chronic paronychia is usually caused by inflammation, sometimes with an allergic reaction or a fungal infection.
Another possible cause of fingernail pain is a condition called onycholysis, where the nail lifts up and is no longer completely attached to the nail bed. This can be caused by an injury, such as cleaning under the nails with a sharp object. Onycholysis can also be a sign of an underlying infection.
Curved nails, also known as koilonychia or spoon-shaped nails, can also be a source of fingernail pain. This condition is often associated with iron deficiency and can be treated with proper diagnosis and supplementation.
In some cases, fingernail pain may be indicative of a more serious condition, such as melanoma. If a fingernail or toenail exhibits a new or changing dark streak, it is important to see a dermatologist for a skin cancer check.
Additionally, fingernail pain can be a symptom of psoriatic arthritis, an autoimmune disease that affects the joints and nails. This condition is characterised by swollen, painful, and hot joints, as well as pitted and flaking fingernails.
It is important to note that this information is not exhaustive and should not be substituted for professional medical advice. If you are experiencing fingernail pain, it is always best to consult with a healthcare professional or dermatologist for proper diagnosis and treatment.
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Fingernail colour changes
Fingernails can reveal a lot about a person's health. A change in colour, texture, or shape can indicate a harmless trait or a sign of a disease. While it may not be enough to diagnose a specific illness, a doctor will use this information along with other symptoms and a physical exam to make a diagnosis.
A capillary nail refill test is a quick test done on the nail beds to monitor dehydration and the amount of blood flow to the tissue. Pressure is applied to the nail bed until it turns white, indicating that the blood has been forced from the tissue under the nail. Once the pressure is removed, a pink colour should return in less than 2 seconds if there is good blood flow.
- Dark streaks: A new or changing dark streak under the fingernail or toenail could be a sign of melanoma, the most serious type of skin cancer. It is important to see a dermatologist for an examination.
- White discoloration: When a nail lifts up and is no longer completely attached, it often exhibits white discoloration. This can be caused by injury from cleaning under the nails with a sharp object or an infection.
- Redness and swelling: Redness and swelling around a nail may indicate an infection, which can often be treated with soaks and antibiotics.
- Greenish-black colour: A bacterial nail infection can cause the nail to turn greenish-black. Without treatment, the infection tends to worsen, and pain and tenderness may occur.
- Yellow nails: Yellow nail syndrome, or chromonychia, can be caused by wearing red nail polish without a base coat or smoking. It can also indicate an underlying health issue such as lung disease or rheumatoid arthritis.
- Thin, spoon-shaped nails: Fingernails that dip down in the middle and look like spoons may be a sign of iron deficiency, which can be caused by various factors, including high altitude.
- Dents or pits: Deep depressions in the nails that look like they were made by an ice pick are called nail pitting and could indicate a disease that affects the entire body, such as alopecia areata.
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Fingernail shape changes
Fingernails can undergo various shape changes, and while some of these may be harmless, others could indicate an underlying health issue. Here are some common fingernail shape changes and what they could mean:
Curved Nails
Nails that curve downward, often accompanied by swollen fingertips and a spongy feel when pressed, are known as "clubbing". This condition can develop gradually and may be a harmless trait that runs in families. However, it can also indicate the presence of a disease, especially if other symptoms are present. Clubbing is associated with disorders that affect oxygen levels in the blood, such as heart or lung problems, and can be a sign of more serious conditions like cancer or infections.
Spoon-shaped Nails
Spoon-shaped nails, or koilonychia, are characterised by thin nails that dip down in the middle. This shape change is often associated with iron deficiency, which can be caused by various factors, including high altitude and certain dietary deficiencies. Spoon-shaped nails may also be accompanied by raised ridges.
Pitted Nails
Pitting, or the presence of small dents or depressions on the nail surface, could indicate a systemic disease that affects the entire body. Conditions associated with pitted nails include alopecia areata, where individuals experience hair loss, and psoriasis, an autoimmune disease that affects the skin.
Ridges
The appearance of ridges or grooves in the centre of the nails, known as "washboard nails" or onychotillomania, could be a result of the habit of picking or pushing back the cuticles. Many people are unaware that they do this, and a dermatologist can help address this habit to allow for healthy nail growth.
Nail Lifting
When a nail starts to lift or detach from the nail bed, it is known as onycholysis. This condition can be caused by various factors, including injury from cleaning under the nails with a sharp object. Nail lifting often results in white discolouration and can lead to rapid nail damage and debris collection under the nail.
While this covers some of the common fingernail shape changes, it is important to consult a board-certified dermatologist if you notice any unusual or persistent changes in your nails. They can help determine whether these changes are harmless or indicative of a more serious underlying condition.
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Fingernail infections
Fingernails can reveal a lot about a person's health. Pressing on the fingernail and checking its colour can indicate whether there is good blood flow to the nail bed. This is called the capillary nail refill test. If there is good blood flow, the nail bed will turn white when pressed and regain its pink colour within 2 seconds after the pressure is released. A nail bed that takes longer to regain its colour may indicate poor blood flow.
Nail infections, or paronychia, occur when bacteria or fungi get under the skin around the nail. Paronychia can be acute or chronic. Acute paronychia symptoms appear over a few hours or days, while chronic paronychia symptoms develop more slowly and can last for six weeks or longer.
The most common cause of infectious paronychia is a staph infection, caused by the Staphylococcus aureus bacteria. Other bacteria, such as Streptococcus pyogenes, can also cause the infection. Bacteria enter the skin through cuts, broken skin, hangnails, ingrown nails, or irritation from water, chemicals, or trauma to the nail bed or cuticle area.
People who work with chemicals and don't wear protective gloves, those who bite their nails or cuticles, and those with certain underlying skin conditions are at a higher risk of developing nail infections. Jobs that require constant hand-wetting, such as bartenders and dishwashers, also increase the risk of paronychia.
Symptoms of paronychia include redness, swelling, and pain around the nail. A pus-filled blister (abscess) may also form. In some cases, the nail may lift up and show white discolouration. Without treatment, nail infections can worsen and lead to a deeper infection. However, when diagnosed early, paronychia can often be treated with soaks and antibiotics. For fungal paronychia, antifungal creams, lotions, or oral medications may be prescribed.
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Frequently asked questions
Pressing on a fingernail can be used to check for a number of health issues, including:
- Dehydration and blood flow to tissue (capillary nail refill test).
- Nail infections such as paronychia, which can cause redness, swelling and pain.
- Hematoma, which occurs when blood or fluid builds up under the nail after an injury, causing pain.
- Tumours under the nail, which can be extremely painful.
Curved fingernails can be a harmless trait that runs in the family. However, it could also be a sign of a disease, so it is recommended to see a dermatologist if you notice your fingernails starting to curve.
Pain under the fingernail when pressed can be caused by a number of issues, including injury, infection, a tumour, or conditions such as nail fungus, ingrown nails, or hematoma. If you are in extreme pain or suspect a serious cause, it is important to see a doctor.
A change in the colour of your fingernail could be caused by a number of issues. For example, a dark streak could be a sign of melanoma, the most serious type of skin cancer. Discolouration can also be caused by conditions such as nail fungus, or a hematoma, which can cause a purple, brown or black appearance. If you notice any changes in colour, it is important to see a dermatologist.
