Ava Monroe
A subungual hematoma is a common injury that occurs when blood vessels under the nail bed break and bleed due to trauma, resulting in blood pooling under the nail. This can cause severe throbbing pain and nail discolouration. While small hematomas may not require drainage, larger hematomas can be very painful and may need to be drained by a healthcare professional to relieve the pressure and pain. The nail may fall off due to the hematoma, and it can take between 4 to 6 months for a fingernail and 12 to 18 months for a toenail to grow back, with possible cosmetic changes.
| Characteristics | Values |
|---|---|
| What is it? | Bleeding under a nail after an injury, causing pain and discoloration of the nail |
| Treatment | If the hematoma is small and not causing much pain, it can be treated at home with rest, ice, and pain medication. For larger hematomas, drainage and additional treatment are required. |
| Drainage | A small hole is made in the nail to allow the blood to drain out and relieve the pressure and pain. Drainage is recommended when the hematoma is painful or covers 50% or more of the nail. |
| Recovery | A new fingernail takes about 4 to 6 months to grow back, while a toenail can take 12 to 18 months. The new nail may have ridges or other abnormalities. |
| Prevention | Be aware of your hands and feet when closing doors. Keep fingernails trimmed and avoid nail biting and cuticle biting. |
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What You'll Learn
- Trephination: a procedure to drain blood and relieve pain
- Home remedies: rest, ice, pain medication, and elevation
- Medical care: drainage, stitches, antibiotics, and anaesthetic
- Nail regrowth: time varies, may have ridges or abnormalities
- Prevention: wear proper shoes, trim nails, and be aware of hand/foot placement
Trephination: a procedure to drain blood and relieve pain
A subungual hematoma is a common, painful injury that occurs when there is bleeding under the nail, usually caused by a direct blow or crush injury to the distal phalanx. This results in blood getting trapped under the nail, causing painful pressure on the nail bed. The nail appears dark red and may throb.
Trephination is a quick, safe, and effective procedure that involves creating a small hole in the nail plate to drain the hematoma and relieve the pressure and pain. It is performed by healthcare professionals in a variety of settings, including emergency rooms and urgent care clinics. The procedure can be done using a cautery device, a needle, or a heated paper clip. The patient can expect to bleed from the trephination site, and there may be drainage through the hole for up to 36 hours afterward.
It is important to note that attempting to drain a subungual hematoma at home can lead to serious infection and permanent damage to the nail or finger. Therefore, it is recommended to seek medical care for proper drainage and treatment.
After the trephination procedure, the nail will regrow, but it may be deformed if the nail bed was damaged by the original injury. In most cases, the new nail will slowly regrow, and any cosmetic changes due to injury at the base of the nail may be permanent.
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Home remedies: rest, ice, pain medication, and elevation
A subungual hematoma is a bruised fingernail or toenail that develops after sudden trauma to your nail, like dropping a heavy object on your toe or finger. It can be very painful and cause throbbing as blood collects under the nail.
If the hematoma is small and doesn't cause pain, you can treat it at home with rest, ice, pain medication, and elevation. Over-the-counter anti-inflammatories like aspirin, Advil, or Motrin can help with minor pain. You can also use a cool pack and keep your hand or foot elevated to reduce swelling.
It's important to note that most cases of subungual hematoma will heal on their own within a few months, and the new nail will grow out within around 6–9 months. However, this can differ for each person and may take years. In some cases, the nail may be malformed or cracked when it grows back, or it may fail to regrow.
If you have a large hematoma, severe pain, or any additional injuries, you should seek medical care for drainage and additional treatment. It's also important to contact a doctor if you experience severe pain, bleeding that does not stop, signs of infection, or if the hematoma does not go away on its own.
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Medical care: drainage, stitches, antibiotics, and anaesthetic
A subungual hematoma is a common injury that occurs when blood vessels under the nail break open due to trauma, causing blood to collect and become trapped under the nail. This can be very painful and cause discoloration of the nail. While small hematomas may not require any treatment, it is always best to seek medical advice. If the injury is severe, medical care may involve drainage, stitches, antibiotics, and anaesthetic.
Drainage
If a subungual hematoma is causing pain or covers a significant portion of the nail, doctors may recommend drainage. Drainage should ideally be performed within the first 48 hours after injury, as the blood begins to clot after this time, making drainage difficult. Drainage can be performed in a doctor's office or urgent care center and involves creating a small hole in the nail to allow the blood to flow out. This procedure, called trephination, can provide immediate relief from pain and pressure. It is important to note that drainage can also be done using a heated paper clip in the absence of other medical supplies. However, this should not be attempted at home as it can lead to infections or further injury to the nail bed.
Stitches
In some cases, a subungual hematoma may be associated with nail avulsion or finger-tip avulsions. While stitches are not mentioned explicitly in the sources, it is reasonable to assume that repairing these avulsions may involve stitching the affected area.
Antibiotics
There is currently no consensus on the use of post-procedure antibiotics for subungual hematoma drainage. A small observational study found no benefit from antibiotics.
Anaesthetic
While not mentioned explicitly in the sources, it is likely that anaesthetic is used during more invasive procedures, such as surgical removal of the nail and nail bed repair.
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Nail regrowth: time varies, may have ridges or abnormalities
A subungual hematoma is a bruise that forms under a nail after trauma. It is usually caused by a crushing or stubbing injury, such as getting a finger pinched in a doorway. This results in blood pooling under the nail bed's surface, causing severe throbbing pain and discoloration of the nail. The blood vessels in the nail bed are injured and start to leak blood, which builds up underneath the nail plate. As blood enters the space, it applies painful pressure to the nail bed.
If the hematoma is small and not causing much pain, you can often let it heal at home with rest, ice, and pain medication. However, if you have a large hematoma, severe pain, or any additional injuries, you should seek medical care for drainage and additional treatment. One such treatment is trephination, a procedure that involves making a small hole in the nail to allow the blood to drain out and relieve the pressure. Drainage can be performed quickly and relatively painlessly in a doctor's office or urgent care center. It is important to note that you should not attempt to drain a hematoma at home as it may lead to serious infection and permanent damage to your nail or finger.
If your fingernail falls off due to the pressure of the hematoma, it may take between 4 and 6 months for a new nail to fully grow back. Toenails typically take between 12 and 18 months to grow back. Nails that grow back may have ridges or other abnormalities, and these changes may be permanent. The new nail will probably have grooves or ridges and be somewhat misshapen.
The time it takes for a nail to regrow varies depending on the severity of the injury. If the trauma to the nail injures the nail matrix (the tissue inside the cuticle at the base of the nail where new nail is formed), a ridge or split can develop. If the matrix heals normally, this deformity will eventually disappear as the nail regrows.
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Prevention: wear proper shoes, trim nails, and be aware of hand/foot placement
Subungual hematomas are bruises that form under a nail after trauma. They can be very painful and affect both fingernails and toenails. While they usually aren't dangerous, they can sometimes lead to bacterial infections. It's important to be aware of the severity of your injury and seek medical care if you're in any doubt.
To prevent subungual hematomas, it's important to wear proper shoes that fit your feet well. This is especially important when running or engaging in other repetitive-pressure activities, as poorly fitting shoes can cause subungual hematomas over time. Wearing tight shoes can also lead to a fall that could result in a subungual hematoma. Additionally, avoiding going barefoot or wearing open-toed shoes when lifting heavy objects or walking around can help prevent injuries to your toes.
Trimming your nails regularly can also help prevent subungual hematomas. Long nails are more likely to get in the way and get injured, especially when working with your hands or doing other necessary tasks. Keeping your nails short and tidy reduces the risk of accidentally crushing or tearing them, which could lead to a subungual hematoma.
Being aware of your hand and foot placement is crucial in preventing subungual hematomas. Always know where your hands and feet are when closing doors or handling heavy objects. Avoid distractions when using tools that might slip or hurt your fingers, such as hammers or saws. When engaging in manual labor or handling hazardous materials, wear gloves, shoes, and/or boots appropriate for the task. Taking these precautions can help lower your risk of experiencing a subungual hematoma.
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Frequently asked questions
A subungual hematoma is a bruise that forms under a nail after trauma. It is caused by a direct blow or a crush injury to the distal phalanx, for example, getting a finger pinched in a doorway.
The main symptom of a subungual hematoma is severe, throbbing pain. Other symptoms include discoloration of the nail, distal phalanx fractures, nail avulsion, or finger-tip avulsions.
Small hematomas may heal on their own without any treatment. Larger hematomas may require drainage to relieve the pressure and pain. This procedure, called trephination, involves making a small hole in the nail to allow the blood to drain out.
It typically takes about 4 to 6 months for a fingernail to grow back, and 12 to 18 months for a toenail. The new nail may have ridges or other abnormalities.
No, it is not recommended to drain a subungual hematoma at home as it can lead to serious infection and permanent damage to the nail or finger. Always seek medical care for proper diagnosis and treatment.
