What is subungual hematoma?
A subungual hematoma is a transient condition where blood and fluid collect underneath the fingernail or toenail. This is usually the result of some kind of injury to the blood vessels under the nail bed.
How common is subungual hematoma?
Subungual hematoma is quite common. Please discuss with your doctor for further information.
What are the symptoms of subungual hematoma?
The common symptoms of subungual hematoma are:
- Severe, throbbing pain
- A dark-colored discoloration (red, maroon, or purple-black) under all or part of the affected nail
- Tenderness and swelling of the tip of the affected finger or toe
There may be some symptoms not listed above. If you have any concerns about a symptom, please consult your doctor.
When should I see my doctor?
If you have any signs or symptoms listed above or have any questions, please consult with your doctor. Everyone’s body acts differently. It is always best to discuss with your doctor what is best for your situation.
What causes subungual hematoma?
These injuries can happen easily. You might:
- Slam your finger in a car door or house door
- Hit your finger with a heavy object such as a hammer
- Drop a heavy object such as a dumbbell on your toe
- Stub your toe on a hard surface
If you have a darkened area under a nail and haven’t had an injury, see your doctor to rule out other possible causes.
What increases my risk for subungual hematoma?
Please discuss with your doctor for further information.
Diagnosis & treatment
The information provided is not a substitute for any medical advice. ALWAYS consult with your doctor for more information.
How is subungual hematoma diagnosed?
If you had a severe blow to a finger or toe, either seek immediate medical attention from your doctor or go to an emergency room. You should do this in case you have broken bones or serious damage to the nail bed and/or surrounding tissues.
Your doctor will examine your nail. You’ll probably also have an X-ray taken to see if you have a bone fracture or other injury.
How is subungual hematoma treated?
A painless and small subungual hematoma usually doesn’t need treatment. But the pressure generated by pooled blood under the nail can be extremely painful.
To relieve the pain, your doctor may perform decompression, also called trephination, which allows the underlying blood to drain, relieving pressure and pain to the area.
Your doctor may numb the affected finger or toe with a nerve block and use one of the following decompression methods:
- Cautery. The doctor uses a heated wire (electrocautery device) or carbon laser to burn a hole or holes. The heated tip of the wire is cooled by contact with the hematoma, which prevents injury to the nail bed. This is a quick and painless procedure.
- Needle. The doctor uses a needle to make a hole in the nail.
After the procedure, your doctor will bandage your nail. You will need to keep the finger or toe bandaged and elevated — and may also need to use cold compresses — during the first 12 hours after decompression. In some cases, your doctor may recommend you use a splint for as long as 3 days until the tenderness subsides.
The main complication associated with decompression is a small risk of infection in the residual hematoma.
If you have bleeding under a large area of the nail surface, the nail bed may be injured. In this case, your doctor may need to remove the entire nail and use stitches to repair the nail bed.
Lifestyle changes & home remedies
What are some lifestyle changes or home remedies that can help me manage subungual hematoma?
The following lifestyles and home remedies might help you cope with subungual hematoma:
- Ice and elevate your affected finger or toe. Place ice wrapped in a towel over the painful area for as long as directed. Elevate your hand or foot on pillows above the level of your heart to help decrease swelling and pain.
- Keep your injured finger or toe dry for as long as directed.
- Gently trim your nail if it begins to fall off in pieces. This may decrease your risk for catching the nail on an object or ripping it off.
- Wear shoes that are comfortable and fit correctly to prevent more injury to your toe.
If you have any questions, please consult with your doctor to better understand the best solution for you.
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