Isla Bennett
Bruising your fingernail is usually the result of an accident—stubbing your toe, or slamming your finger in a door—and can be extremely painful. In some cases, your nail may fall off. The pain is caused by blood being trapped under your nail, which puts pressure on your finger or toe nerves. This is called a subungual hematoma. If you see blood or a bruise under your nail after an injury, you should seek medical care within two days.
| Characteristics | Values |
|---|---|
| Medical term | Subungual hematoma |
| Cause | An injury that breaks open blood vessels under the nail |
| Symptoms | Severe throbbing pain, intense pressure, bleeding, bruising, swelling, deformity of the finger or toe |
| Treatment | Home remedies (RICE method, basic wound care), medical treatments (trephination, nail avulsion, decompression, cautery, stitches, removal of the nail, antibiotics) |
| Healing time | A few weeks to a few months |
| Complications | Infection, long-term pain, nerve damage, incorrect healing of bones, deformed nail |
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What You'll Learn
Subungual hematoma
A subungual hematoma is a painful injury that occurs when there is bleeding under a fingernail or toenail. It is usually the result of a crush injury, such as getting a finger pinched in a doorway or stubbing a toe, which causes blood to collect under the nail. This can lead to intense pain and throbbing due to the pressure of the blood collecting between the nail and the nail bed. In some cases, the nail may fall off as a result of the injury.
While a subungual hematoma can be a minor injury, it is important to seek medical attention if the injury is accompanied by broken bones or damage to the nail bed or surrounding tissues. Additionally, if there is a large bruise under the nail, it could indicate a broken bone. X-rays can be used to determine if there is a fracture or other injury. If left untreated, fractures can heal incorrectly, causing long-term pain and interfering with the natural function of the finger or toe.
In most cases, a subungual hematoma can be treated with simple trephination, which involves draining the blood to relieve the pressure and pain. This procedure should be performed within 48 hours of the injury to prevent blood clotting, which can prolong pain. During the procedure, the doctor will numb the affected finger or toe and use a heated wire, carbon laser, or needle to make a small hole in the nail. After the procedure, it is important to keep the nail clean and dry, and avoid soaking it in water until it has healed.
While rare, there is a small risk of infection associated with the decompression procedure. If there is bleeding under a large area of the nail surface, the nail bed may be injured, and the entire nail may need to be removed and repaired with stitches. In most cases, a new fingernail can regrow in as little as 8 weeks, while a new toenail may take up to 6 months to fully regrow.
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Nerve pain
A bruised fingernail, or subungual haematoma, is usually the result of a sudden accident or trauma, like stubbing your toe or accidentally hammering your finger. The pain from a bruised nail is not just from the accident; it is the result of blood being trapped under the nail, which puts pressure on the nerves in your fingers or toes. This pressure can be excruciating, making it difficult to work or perform daily activities.
The nerve pain from trapped blood can take weeks to get better unless a healthcare provider treats it. A simple, painless procedure called trephination can be performed to drain the blood and relieve the pressure and pain. However, if the blood is not drained within the first 48 hours, it will clot, causing a bulk under the nail that could lead to unnecessary pain for weeks. Therefore, it is essential to seek medical care within two days of noticing blood or a bruise under your nail after an injury.
Minor nerve damage from a bruised nail may only require rest and a splint for the finger or toe. However, untreated fractures can heal incorrectly, leading to long-term pain and interference with the natural function of the finger or toe. In addition, if the nail comes off due to the injury, there is a risk of infection, which may require antibiotics.
Other potential causes of nerve pain under the fingernail include ingrown nails, fungal infections, torn or cracked nails, and paronychia, which is swelling around the fingernail or toenail that can be caused by bacteria, fungi, or dermatitis. Subungual tumours, which appear as nodules under the nail, can also cause extreme pain under the fingernail and require medical attention.
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Infection
A bruised fingernail, or subungual haematoma, is usually the result of a sudden accident or trauma, like slamming your finger in a door or dropping a brick on your toe. The injury causes blood to pool under the nail, leading to symptoms such as intense pain, throbbing, and discoloration. While this injury is typically minor, it can be extremely painful due to the pressure of the pooled blood, and it can take weeks or even months for the nail to look normal again. In some cases, the nail may fall off.
A nail injury can lead to infection if germs enter your body through a break in your nail or skin. If your nail comes off, there is an increased risk of infection as it leaves an opening on your finger or toe. Signs of infection to look out for include fever or feeling unwell, redness or red streaks in the skin, skin or nail feeling warm to the touch, swelling, and significant pain. If you notice any of these symptoms, seek medical attention promptly. Antibiotics may be required to treat the infection, but only a healthcare provider can determine if they are necessary.
To reduce the risk of infection, it is important to seek medical care within 48 hours of the injury. During this time, the blood under the nail can be drained through a simple procedure called trephination, which relieves the pressure and pain. After this procedure, it is crucial to keep the nail clean and dry, avoiding activities like soaking the nail in water or swimming until advised otherwise by a healthcare provider.
In rare cases, a subungual haematoma may be a sign of a more serious underlying condition. If you notice nail discoloration without any apparent injury, it is important to consult a healthcare provider. While it could be harmless, it could also indicate a health condition that requires treatment, such as skin cancer.
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Treatment
A bruised nail is usually the result of an accident or injury. While the nail may look bruised, it is actually the tissue under the nail that is bruised. This is known as a subungual hematoma, or blood under the nail. This can be extremely painful as the blood puts pressure on the nerves in the finger or toe.
If you have a large bruise under your nail, there is a chance you may also have a broken bone. X-rays are important to rule out this possibility. Other signs that you may have a broken bone include a deformed finger or toe, intense pain, or continuing pain. In this case, or if you notice any signs of infection, it is important to seek medical attention.
If you have a minor nail injury, you can treat it at home. To reduce swelling, ice the area and keep it elevated. You can also take over-the-counter anti-inflammatories like aspirin, Advil, or Motrin for minor pain. Keep the injured nail clean and dry. Avoid soaking the nail in a bath or hot tub, and don't go swimming until your healthcare provider advises it is ok to do so.
If you have a large bruise under your nail, your healthcare provider may recommend draining the blood through a procedure called trephination or decompression. This is a simple, painless procedure that relieves the pressure and pain quickly. It is important to have this procedure done within 48 hours of the injury, before the blood clots and causes a bulk under the nail. After the procedure, your doctor will bandage your nail. You will need to keep the finger or toe bandaged and elevated, and you may need to use cold compresses during the first 12 hours after decompression. In some cases, your doctor may recommend you use a splint for a few days until the tenderness subsides.
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Healing
A bruised nail is usually the result of an accident or injury. The tissue under the nail, not the nail itself, is bruised, which is known as a subungual haematoma. This can be extremely painful as the blood trapped under the nail puts pressure on the nerves in your finger or toe.
If you have a large bruise under your nail, it could be a sign of a broken bone, so it's important to get it checked out by a healthcare professional. They may recommend an X-ray to check for any fractures or other injuries. In some cases, the doctor may perform a procedure called trephination or decompression to drain the blood and relieve the pressure and pain. This is usually done within the first 48 hours to prevent blood clots from forming, which can cause weeks of unnecessary pain.
After the procedure, your doctor will bandage your nail and may recommend keeping your finger or toe elevated and using cold compresses for the first 12 hours. In some cases, a splint may be needed for a few days until the tenderness subsides. It's important to keep the area clean and dry to prevent infection.
While your finger or toe is healing, it's best to avoid any activities that increase pain or strain on the affected area. Most minor injuries will start to heal on their own after a few days of at-home care, but more severe cases may take a few weeks or longer to fully recover. Over-the-counter anti-inflammatory medications and pain relievers can help reduce inflammation and manage pain during the healing process.
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Frequently asked questions
A bruised fingernail is called a subungual hematoma.
A subungual hematoma occurs when an injury breaks open blood vessels under the nail, causing blood to collect and become trapped under the nail.
Symptoms include intense pain and throbbing as blood collects under the nail.
If the injury is minor, you may be able to treat it at home with the RICE method: Rest, Ice, Compression, and Elevation. For more serious injuries, you should seek medical treatment.
A subungual hematoma can take several months to heal completely.
