Isla Bennett
Fingernail pain can be caused by various factors, including injuries, infections, and irritation. One common cause is paronychia, a bacterial or fungal nail infection that results in swelling, redness, and pain around the nail. Ingrown nails, nail biting, and hangnails can also lead to fingernail pain. Additionally, certain manicure practices, such as gel manicures or aggressive cuticle cutting, can contribute to nail pain and increase the risk of infection. In some cases, fingernail pain may be indicative of more serious conditions, such as tumours or psoriasis, which require medical attention.
| Characteristics | Values |
|---|---|
| Type of pain | throbbing, burning, shooting, stinging, dull ache, mild, moderate, severe |
| Cause | traumatic, infectious, inflammatory, neoplastic (bone and non-bone), iatrogenic, syndromic, fungal infection, bacterial infection, hangnail, bruise, subungual hematoma, paronychia, onychalgia |
| Treatment | antibiotics, steroids, antifungals, drainage, nail removal, ice, warm water, antibiotic ointment, bandage, antifungal drugs, oral antibiotic, topical antibiotic, trephination |
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What You'll Learn
Subungual hematoma
The most common symptom of subungual hematoma is severe, throbbing pain. There may also be discoloration of the nail as blood pools under it. If the injury is severe, there may be broken bones or damage to the nail bed and surrounding tissues. In such cases, immediate medical attention is required.
Small subungual hematomas may not need medical treatment. To reduce swelling and minor pain, one can ice and elevate the affected area and take over-the-counter anti-inflammatory medications. However, if the pain is severe, a doctor may perform a procedure called decompression or trephination to relieve the pressure and pain. This involves draining the blood that has collected under the nail by creating a small hole in the nail using a heated wire, laser, or needle.
While decompression is effective in relieving pain, there is a small risk of infection in the residual hematoma. In some cases, if there is bleeding under a large area of the nail surface, the entire nail may need to be removed, and the nail bed may require stitches. Even with proper repair, the new nail may take longer to grow back and may not look normal. Therefore, it is important to seek medical advice if you suspect you have a subungual hematoma, especially if there is no apparent cause for the darkened area under the nail.
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Paronychia
Acute paronychia is usually due to bacterial infection with Staphylococcus aureus (which may be multiresistant), Streptococcus pyogenes, Pseudomonas, or other bacterial pathogens. It can also be caused by the cold sore virus, Herpes simplex (herpetic whitlow), and the yeast, Candida albicans. Acute paronychia develops rapidly over a few hours, and usually affects a single nail fold. Symptoms include pain, redness, and swelling. If herpes simplex is the cause, multiple tender vesicles may be observed. Sometimes yellow pus appears under the cuticle and can evolve into an abscess. The nail plate may lift up (onycholysis).
Chronic paronychia is a gradual process that may start in one nail fold, particularly the proximal nail fold, but often spreads to several other fingers. Each affected nail fold is swollen and lifted off the nail plate. This allows the entry of organisms and irritants. The affected skin may be red and tender, and sometimes a little pus (white, yellow, or green) can be expressed from under the cuticle. The nail plate thickens and is distorted, often with transverse ridges. The main complication of chronic paronychia is nail dystrophy.
To prevent paronychia, it is recommended to keep the hands dry and warm, avoid wet work or use waterproof gloves, and keep fingernails clean.
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Ingrown nails
- Cutting your toenails incorrectly, i.e., cutting them too short or rounding the corners.
- Wearing shoes that are too tight or place too much pressure on your toes, which may cause the nail to grow into the surrounding tissue.
- Participating in certain sports and activities like dancing, soccer, or skiing.
- Poor foot hygiene, such as not keeping your feet clean and dry.
- Toe trauma, such as banging your toe or getting stepped on.
- The shape of your toe, such as having a larger nail compared to the size of your toe.
Ingrown toenails can often be treated at home using simple steps. Soaking your foot in warm water mixed with Epsom salt or soapy water twice a day can help manage the infection and prevent further pain. Keeping your foot dry when you're not soaking it is also important. You can carefully lift the edge of the nail and place a small piece of cotton or dental floss between the nail and your skin to help the nail grow above the edge of the skin. Using an antibiotic cream and a bandage can also help, as can taking pain relievers such as ibuprofen or acetaminophen.
However, if you have an infection or a severe ingrown toenail, it's important not to cut the nail yourself, as this may worsen the condition. If symptoms don't improve with home remedies, it's recommended to see a healthcare provider. In severe cases, a procedure called nail avulsion may be necessary to remove part of the nail surgically.
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Bone injury
Pain under the fingernail can be indicative of a bone injury. A subungual hematoma, or a bruised nail, is a common nail injury that involves bleeding below the hard part of the nail, leading to swelling, nail discolouration, and pain. This is usually caused by blunt force trauma, such as hitting your finger with a hammer or slamming it in a door. In the case of a severe injury, a broken bone or deep cut may require the removal of the nail plate to facilitate the repair of the underlying tissue.
Bone injuries under the fingernail can also be caused by bacterial infections such as paronychia, which occurs when bacteria enter the skin through cuts in the cuticle and nail fold. While paronychia usually resolves with antibiotics, it can progress to involve the underlying bone in rare cases. In such instances, more extensive treatment may be required to prevent the infection from spreading to the rest of the body.
Onychalgia, or nail pain, can also be caused by bone injuries. This condition has four stages of pain, with the first stage involving the activation and sensitization of mechanosensitive sensory and sympathetic nerve fibres. The acidic environment created by the release of acid during bone resorption is sensed by ion channels, further contributing to the pain.
It is important to seek medical attention for any serious nail injuries, including those that may involve a broken bone. A healthcare provider can assess the extent of the injury and determine the appropriate course of treatment. In some cases, this may involve creating a small hole in the nail to drain blood and fluid, relieving pressure and pain. If the bone is broken, more invasive procedures, such as placing a wire in the finger to stabilise the bone, may be necessary.
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Fungal infection
Fingernail pain can be caused by a fungal nail infection, also known as onychomycosis or tinea unguium. This occurs when fungi enter through small cracks in the nail or the surrounding skin, causing infection. Fungi are normally present in and on the body, but when they begin to overgrow, they can lead to an infection.
Fungal nail infections can affect both the fingernails and toenails, with toenails being more commonly affected due to the warm and moist environment created by shoes. The most common type of fungal nail infection is distal subungual infection, which causes the outer edge of the nail to have a jagged appearance with white and/or yellow streaks. The infection invades the nail bed and the underside of the nail, and the nail becomes rough, soft, and prone to crumbling.
Candida yeasts are a common cause of fungal nail infections, particularly in fingernails. Candida infections often occur in individuals who frequently soak their hands in water, such as through dishwashing or swimming. These infections usually start around the cuticle, causing it to become swollen, red, and tender. The nail may partially lift off the nail bed or even fall off completely.
Fungal nail infections can be treated with antifungal medication, which comes in the form of tablets or a special paint applied directly to the nail. The two most commonly prescribed antifungal medications for nail infections are terbinafine and itraconazole, which typically need to be taken for several months. In severe cases, surgical removal of the affected nail may be recommended if other treatments have been ineffective. Laser treatment is another option for stubborn infections, but it is not commonly available as a routine treatment.
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Frequently asked questions
There could be several reasons for this. Pain in the entire fingernail could be due to a condition called paronychia, which is a bacterial or fungal infection. It could also be due to an injury, such as a bruised nail or a broken bone. Other possible causes include ingrown nails, hangnails, or a subungal tumor. If the pain is severe or persistent, it is recommended to consult a doctor or healthcare provider for proper diagnosis and treatment.
Paronychia is a bacterial or fungal infection that causes swelling, redness, and pain around the fingernail or toenail. It usually results from bacteria entering the skin through cuts or injuries near the nail. Most cases of paronychia can be treated with antibiotics and proper wound care.
The symptoms of paronychia include pain, swelling, and tenderness around the nail. The skin may appear red and warm to the touch. In some cases, pus may build up under the skin, forming a white to yellow abscess. Acute paronychia develops rapidly over hours or a few days, while chronic paronychia develops more slowly and usually lasts six weeks or longer.
The treatment for paronychia depends on the severity and type of infection. For mild cases, soaking the affected area in warm water and keeping the hands dry and warm may be sufficient. For more severe cases, oral or topical antibiotics may be prescribed. In some instances, drainage of pus or nail removal may be necessary to prevent the infection from spreading.
There are several other possible causes of entire fingernail pain. One common cause is a bruised nail or subungual hematoma, which occurs due to blunt force trauma or crush injuries. Ingrown nails, hangnails, and subungal tumors are also potential causes of pain under the fingernail. In some cases, the pain may be related to bone injuries or syndromic conditions. If the pain persists or worsens, it is always best to consult a healthcare professional.
