Sophia Delgado
Blood under the fingernail, or a subungual haematoma, is usually caused by a crushing or stubbing injury. This can cause severe pain and throbbing as blood collects under the nail, and can also lead to discolouration. If you have a large amount of blood under your nail, you may need to see a doctor to have it drained.
| Characteristics | Values |
|---|---|
| Medical Term | Subungual Hematoma |
| Cause | An injury that breaks open blood vessels under the nail, causing blood to collect and become trapped |
| Symptoms | Severe throbbing pain, darkened area under the nail |
| Treatment | Rest, ice, compression, elevation, decompression (trephination), stitches, splint |
| Healing Time | 6-9 months for the new nail to grow out, but can take years for the mark to disappear |
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What You'll Learn
See a doctor or healthcare provider
Blood under the fingernail or toenail is called a subungual hematoma. It usually occurs when the nail gets crushed in an injury, causing blood vessels under the nail to break open and collect blood in one spot. While small hematomas will usually heal without treatment, you should see a doctor or healthcare provider in the following cases:
- If you have not had any injury but notice a darkened area under your nail, see a doctor to rule out other possible causes.
- If you experience severe pain or throbbing due to the pressure of blood collecting under the nail, your doctor may perform decompression or trephination to drain the underlying blood and relieve pressure and pain.
- If you have a severe injury to your finger or toe, such as a deformed finger or toe, broken bones, or deep cuts, seek immediate medical attention. Your doctor may need to remove the nail, use stitches, or apply a splint to protect the area and promote healing.
- If there is severe damage to the nail bed, the nail may grow back malformed or cracked, or it may fail to regrow. Contacting a doctor when the injury occurs can help prevent this.
- If the hematoma does not heal, or you are concerned about the appearance of blood under your nails, consult a doctor to rule out more serious conditions, such as melanoma, a type of skin cancer that can occur under the nail.
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Drainage methods
Blood under the fingernail or toenail is called a subungual haematoma. This occurs when an injury breaks open blood vessels under the nail, causing blood to collect and become trapped. A subungual haematoma can cause severe throbbing pain due to the pressure of the pooling blood.
If you have a subungual haematoma, there are several drainage methods you can use to relieve the pressure and pain:
Cautery
A doctor may use a technique called cautery, which involves burning a hole or holes in the nail using a heated wire (electrocautery device) or a carbon laser. This allows the blood to drain out from under the nail. The procedure is quick and painless, and the heated wire is cooled by contact with the haematoma to prevent injury to the nail bed.
Needle
A doctor can also use a needle to make a hole in the nail and release the built-up blood. After this procedure, your doctor will bandage your nail. You will need to keep the finger or toe bandaged and elevated and may need to use cold compresses during the first 12 hours after the procedure.
Rest
Resting the affected finger or toe can help reduce swelling and pain. It is important to avoid using the injured digit as much as possible to promote healing.
Ice
Applying an ice pack to the affected area can help reduce swelling and pain.
Compression
Applying pressure with a wrap or bandage can help reduce the amount of blood that pools under the nail.
Elevation
Keeping the affected hand or foot elevated can help reduce swelling and promote drainage.
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Signs of a fracture
Blood under the fingernail, or subungual haematoma, is usually caused by a traumatic injury such as slamming your finger in a door or hitting it with a hammer. This can result in darkened discolouration, such as black spots, and pressure and pain.
A fracture of the bone under the nail is called a distal tuft fracture. This can be caused by a crushing injury, such as smashing your finger in a door or hitting it with a hammer. If there is an obvious bend or deformity at the end of the finger, this is a sign of a distal tuft fracture. Other signs of a fracture include:
- Intense pain and throbbing as blood collects under the nail
- Broken bones or damage to the nail bed and/or surrounding tissues
- Deformity of the finger or toe
- Infection, redness, or drainage at the site of the injury
- Poor circulation or other problems that may decrease the ability to fight infection
If you suspect you have a fracture, it is important to seek medical attention from your doctor or go to an emergency room. An x-ray will be needed to diagnose a distal tuft fracture. Treatment for a fracture may include a splint or cast to keep the bone from moving so it can heal.
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Home care
Blood under the fingernail or toenail is called a subungual haematoma. This usually happens when the nail gets crushed in an injury, causing blood vessels under the nail to break open and collect blood in one spot.
If you have a subungual haematoma, you can try the following home care methods:
- Rest the affected finger or toe and avoid using it as much as possible.
- Use an ice pack to reduce swelling and pain.
- Apply pressure to the area with a wrap to reduce the amount of blood that can pool under the nail.
- Keep the affected hand or foot elevated to reduce swelling.
- Use a cool pack to encourage healing.
The trapped blood will eventually be reabsorbed, and the dark mark will disappear. This can take a number of months or years. Subungual haematomas on the fingernail heal more quickly, while those on the toenail heal more slowly.
If you have not injured yourself but notice a dark area under your nail, see your doctor to rule out other possible causes.
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Nail re-growth
If you have blood under your fingernail or toenail, you may have what's called a "subungual haematoma". This usually happens due to a crush injury to the nail. The blood collects under the nail, causing intense pain and throbbing.
If the blood under your nail occupies more than half the nail area, or if you haven't injured yourself but notice a darkened area under your nail, you should see a doctor. They may recommend a procedure called decompression or trephination to relieve the pressure and pain. This involves creating a small hole in the nail to drain the blood.
If your nail has completely lifted off the nail bed, you can try to replace it and hold it in place with a bandage. However, nails will not reattach to the nail bed once they have separated. Fortunately, new nail growth usually occurs within 3-6 months for fingernails and 4 months for toenails. Nails are produced by the nail matrix cells at the base of the nail, and as long as there is no permanent damage to the nail matrix or nail bed, your nail should regrow normally.
To support nail re-growth, maintain a well-rounded diet and good general health. Keep your fingernails trimmed and avoid biting them or the surrounding cuticles, as this can also cause trauma to the nails.
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Frequently asked questions
A subungual hematoma is a medical term for dried blood under the fingernail. It is usually caused by a crushing or stubbing injury.
Symptoms include darkened discolouration, such as black spots, and pressure and pain.
If the injury is small, you may not need to seek medical care. You can treat it by icing and elevating the area to reduce swelling, and taking over-the-counter anti-inflammatories for minor pain. If you are experiencing extreme pain, or the injury is at the base of the nail, it's best to see a healthcare provider.
You can drain the hematoma, which involves making a small hole in the nail to allow the blood to flow out. This procedure can be performed quickly and relatively painlessly by a doctor.
It may take between 4 and 6 months for a fingernail to fully grow back after being removed due to a subungual hematoma.
