A subungual hematoma refers to a collection of blood beneath a fingernail or toenail. This common injury typically results from direct trauma, such as a finger being slammed in a door or a heavy object dropped on a toe. While the appearance of a dark, discolored nail can be alarming, many cases of subungual hematoma are minor and resolve without significant intervention. The discoloration occurs as blood pools in the confined space between the nail plate and the underlying nail bed.
Immediate Care for Minor Cases
For minor subungual hematomas not causing severe pain, home care can help. Applying a cold compress to the injured finger or toe can reduce swelling and pain by limiting further bleeding. Elevating the affected hand or foot also helps reduce swelling due to gravity.
Over-the-counter pain medications, such as acetaminophen or ibuprofen, can alleviate discomfort. Protect the injured nail from further trauma while it heals. The trapped blood will gradually dry and discolor, changing from red or purple to darker shades as it clots. This discoloration slowly grows out with the nail over several months as the nail plate naturally replaces itself.
When to Seek Professional Help
While many subungual hematomas are minor, certain signs indicate the need for professional medical evaluation. Seek medical attention if you experience severe pain not relieved by over-the-counter medication, or if the pain worsens. Signs of infection, such as increased redness, warmth, swelling, pus draining from under the nail, or a fever, warrant medical consultation. Medical attention is also recommended if the hematoma covers a large portion of the nail, generally more than 25-50% of the nail area, or if you have throbbing pain, an open wound near the nail, a suspected fracture of the underlying bone, or if the nail appears detached. Any crush injury to the digit or significant trauma also necessitates a medical assessment.
Medical Treatment Options
When a subungual hematoma causes significant pain due to pressure, a healthcare professional may perform a procedure called trephination. This involves creating a small hole in the nail plate to drain accumulated blood and relieve pressure. The procedure is quick and often provides immediate pain relief.
A medical professional uses sterile tools, such as a needle or heated device, to create the hole under sterile conditions, minimizing infection risk. If a fracture of the underlying bone is suspected, an X-ray may be ordered to assess the extent of the injury. If an infection is present, antibiotics might be prescribed.
Prevention
Common causes of this injury include dropping heavy objects on the nail, stubbing a toe, or slamming a finger in a door. Repetitive micro-trauma, like that from ill-fitting shoes during activities such as running, can also cause subungual hematomas. To prevent these injuries, wearing appropriate protective footwear, especially when handling heavy objects or engaging in activities with impact risk, is advised. Being mindful of surroundings and exercising caution when using tools can also help reduce the likelihood of trauma.