Sophia Delgado
A subungual hematoma is a bruised fingernail or toenail that results from blunt or crush trauma. Blood collects under the nail, causing pressure and pain. Treatment options include draining the blood, which can be performed by a doctor or at home, and taking over-the-counter pain medication. In some cases, the nail may need to be removed, and it can take several months for a new nail to grow back.
| Characteristics | Values |
|---|---|
| Medical Term | Subungual hematoma |
| Cause | Bleeding and bruising under the nail due to blunt or crush trauma |
| Symptoms | Pain, discoloration, darkened discoloration (black spots), throbbing, pressure |
| Treatment | Drainage, antibiotics, over-the-counter pain medications, elevation, cold compress, compression, removal of nail, stitches, special glue, wire placement |
| Recovery Time | 4-6 months for fingernails, 12-18 months for toenails |
| Prevention | N/A |
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What You'll Learn
Subungual hematoma: a bruised nail due to blunt force trauma
A subungual hematoma is a bruised fingernail or toenail resulting from blunt or crush trauma. Blood collects under the nail, causing pressure and often severe, throbbing pain. The injury occurs when blood vessels in the nail bed are damaged and begin to leak blood, which has nowhere to go but under the nail plate, where it pools and puts pressure on the nail plate, causing pain and discoloration.
Subungual hematomas are usually diagnosed by a doctor examining the nail and discussing any recent trauma with the patient. Treatment depends on the severity of the injury. Small hematomas may heal on their own without much issue, and can be managed at home by elevating the hand or foot, using a cold compress for pain and swelling, and applying compression to slow the bleeding.
For larger hematomas, doctors recommend draining the hematoma to relieve pressure and pain. This procedure, called trephination, involves making a small hole in the nail to allow the blood to flow out. Drainage can be performed quickly and relatively painlessly in a doctor's office or urgent care center, but must be done within the first 48 hours after injury, before the blood begins to clot. Antibiotics may be prescribed to prevent infection.
After treatment, the nail may still look discolored for many weeks, but this is normal, and the bruise will gradually disappear as the nail grows back. Fingernails may take 4 to 6 months to grow out, while toenails may take 12 to 18 months.
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Drainage: a procedure to relieve pain and pressure
A subungual hematoma is a bruised fingernail or toenail resulting from blunt or crush trauma. Blood collects under the nail, causing pressure and pain. Drainage, also called trephination, is a procedure to relieve this pain and pressure. It involves creating a small hole in the nail to allow the blood to flow out. This can be done with a sterile needle, a sterilized paper clip, or a laser. The procedure is typically painless and can be performed quickly in a doctor's office or urgent care center. It is most effective when performed within the first 48 hours after the injury, as the blood begins to clot after this amount of time, making drainage difficult.
If the hematoma is small, it may not require drainage at all and may heal on its own without much issue. In this case, the pain and pressure can be managed with home measures such as elevating the hand or foot, using a cold compress, and applying compression to slow the bleeding. However, if home measures do not provide relief, drainage may be necessary to relieve the symptoms. Doctors recommend draining subungual hematomas when they cause pain or make up 50% or more of the nail. If there is also a fractured finger, drainage is recommended if the hematoma makes up 25% or more of the nail.
During the drainage procedure, the area around the nail is numbed to prevent pain. The hole created by piercing should be large enough to let the blood drain, which takes about a day or two. The hole should be covered with sterile gauze during this time. After the procedure, it is important to follow the healthcare provider's instructions for caring for the injured nail. This may include removing the bandage after two days, gently washing around the wound, and covering it with vaseline and a non-stick bandage. Antibiotics may be prescribed to prevent infection.
Whether the nail is drained or not, it may take several months for the nail to grow back, and the new nail may have ridges or other abnormalities. In some cases, the nail may fall off or need to be removed and replaced by a new, healthy one.
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Healing time: a new nail will grow in 4-6 months
A fingernail takes about 4 to 6 months to grow back and replace a lost nail. Toenails take longer, between 12 and 18 months. The new nail will likely have grooves, ridges, and bumps, and may be misshapen. This may be permanent.
If you lose your nail, it will take about 7 to 10 days for the nail bed to heal. During this time, you can care for your wound by keeping the area clean and dry. You may also be given a splint or special shoe to protect your nail and toe or finger as they heal.
If you have a subungual hematoma, a bruised fingernail or toenail, you should see a doctor within the first 48 hours of your injury. A small hole may be made in the nail to drain the pooling blood, a procedure called trephination. This procedure is quick and relatively painless. However, if the nail is damaged, this method will not be used. In this case, the doctor may remove the nail and repair the nail bed.
Minor nail bed injuries often heal on their own, especially when no other injuries are present.
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Self-care: keep the wound clean and dry
If you have a bloody nail, it is important to keep the wound clean and dry to prevent infection and promote healing. Here are some detailed instructions to do so:
Cleaning the wound
- Clean your hands using soap and water or hand sanitizer before touching the wound.
- Use a soft washcloth and mild soap to clean the area around the wound. Avoid placing soap directly into the wound, as it can cause irritation.
- If there is dirt or debris remaining after washing, use tweezers cleaned with isopropyl alcohol to remove it.
- If the wound is bleeding, gently apply pressure with a clean cloth, tissue, or gauze until the bleeding stops.
Keeping the wound dry
- If the wound is in an area that will not get dirty or be irritated by clothing, it is recommended to leave it uncovered, as this helps it stay dry and promotes healing.
- If the wound is in an area that may get dirty or be rubbed by clothing, cover it with a bandage or sterile gauze and adhesive tape to keep it clean and dry.
- Change the bandage or gauze daily to maintain dryness and cleanliness.
Additional considerations
- If you have an artificial nail, keep it in place until the nail bed heals.
- Apply ice wrapped in a cloth for 20 minutes every 2 hours on the first day, then reduce to 3-4 times a day afterward.
- Keep your hand or foot elevated above the level of your heart to reduce throbbing and slow bleeding.
- For larger bruises, your healthcare provider may recommend draining the blood by creating a small hole in the nail. This will relieve pressure and pain.
- If the wound is severe or you are unsure how to care for it, always seek advice from a healthcare professional.
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Complications: a bacterial infection may develop
A subungual hematoma is a bruised fingernail or toenail resulting from blunt or crush trauma. Blood collects under the nail, causing pressure and pain. While subungual hematomas rarely lead to complications, it is possible to develop a bacterial infection in the injured area. Complications are more likely if the injury is more severe, especially if it damages your bone.
If you develop a bacterial infection, your provider may prescribe antibiotics to prevent its spread. Antibiotics are medications that can help stop the growth of, or kill, bacteria that cause infections in the body. They work by targeting the bacteria that are causing the infection and interfering with their ability to multiply. This helps your body to fight off the infection and prevents it from getting worse.
Your provider may also recommend or prescribe additional treatments to help manage the infection and relieve your symptoms. These treatments can include:
- Over-the-counter (OTC) pain medications: These can help relieve discomfort and reduce inflammation.
- Elevation of the affected area: Keeping your hand or foot elevated above the level of your heart can help reduce throbbing and discomfort.
- Cold compress: Applying ice wrapped in a cloth for 20 minutes every 2 hours on the first day, then 3 to 4 times a day after that can help reduce pain and swelling.
- Compression: Applying compression to the area can help slow the bleeding under the nail and reduce swelling.
It is important to follow your provider's instructions and recommendations for treating the bacterial infection. This may include taking the full course of prescribed antibiotics and following proper wound care and hygiene practices to ensure the infection clears and does not recur.
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Frequently asked questions
A subungual hematoma is a bruised fingernail or toenail that results from blunt or crush trauma. Blood collects under the nail, causing pressure and pain.
If the hematoma is small, you may not need to seek medical care. You can treat it by using a cold compress to reduce pain and swelling, and applying compression to slow the bleeding. If the affected area continues to collect blood, you experience extreme pain, or the injury is at the base of the nail, it's best to see a healthcare provider.
Doctors can drain the blood from under the nail by creating a small hole in the nail. This procedure is called trephination. If the bone is broken or the bruise is very large, the nail may need to be removed and the nail bed repaired.
It can take anywhere from 4 to 6 months for a fingernail to grow out, and 12 to 18 months for a toenail.
