A subungual hematoma is a common injury where blood becomes trapped between the nail plate and the nail bed, typically caused by direct trauma like crushing a finger or stubbing a toe. This pooling of blood quickly creates intense, throbbing pressure beneath the rigid nail, leading to significant pain. To relieve this pressure, a procedure called trephination involves creating a small hole in the nail plate to allow the accumulated blood to drain, offering rapid relief.
When to Seek Medical Attention Immediately
Before considering any at-home remedies, recognize signs that require immediate professional medical attention. Any injury involving visible deformity or the inability to comfortably move the joint suggests a possible underlying fracture requiring an X-ray. A medical professional should examine the injury if the hematoma covers more than 50% of the nail surface, or if there is a severe laceration or open wound near the cuticle or nail fold. Seeking care is also advisable if the injury is more than 48 hours old, as clotted blood makes drainage difficult or ineffective.
Signs of a developing infection also warrant an immediate visit. Symptoms include spreading redness or warmth around the injury site, increasing pain that does not subside, or pus draining from the area. People with pre-existing conditions, such as diabetes or immune system disorders, should always consult a doctor before attempting self-treatment due to an increased risk of complications. Healthcare providers can ensure a sterile environment and address any deeper injuries to the nail bed or surrounding bone.
Performing At-Home Nail Drainage Safely
The procedure for draining a subungual hematoma at home, known as trephination, should only be attempted when pain is severe and after ruling out the need for professional care. The goal is to create a small opening in the nail plate without causing further injury to the sensitive tissue underneath. This method is often performed using a small metal object, such as a paper clip, heated until it is incandescent.
Straighten a standard metal paper clip and hold one end with a cloth or pliers to protect your fingers from the heat. Hold the tip over a flame until it glows red-hot, which sterilizes the tip and prepares it to melt the nail material. Once the tip is glowing, gently touch it to the center of the hematoma, which is the darkest point under the nail.
Allow the heat of the metal to melt through the nail material rather than trying to push or drill through it. The nail plate has no nerves, so this melting action should not be painful. Applying pressure could cause the hot metal to contact the sensitive nail bed beneath. If the paper clip cools before penetrating the nail, reheat it and repeat the gentle touching motion in the same spot. As soon as the hole is complete, the trapped blood will flow out, resulting in immediate relief of pressure and pain.
Recovery and Expected Healing Time
Once drainage is complete, proper aftercare is necessary to prevent infection and promote healing. For the next two to three days, soak the injured digit in warm, soapy water for about ten minutes, three times daily. Following each soak, gently pat the area dry and cover the puncture site with a sterile, non-stick bandage. Over-the-counter pain relievers may be used to manage any residual discomfort.
It is normal for clear or slightly bloody fluid to continue draining for up to 72 hours following the procedure. If pain returns or worsens, a warm soak can help clear the hole of any clotted blood blocking the drainage. The injured nail will often loosen and fall off as a new, healthy nail grows underneath.
The time frame for full recovery depends on the injury location; a fingernail generally takes about four to six months to completely regrow. Toenails grow much slower, taking between six and eighteen months to fully replace themselves. Monitor the area for delayed signs of infection, such as fever or pus, and consult a doctor if the new nail grows in with significant deformities, which can indicate damage to the nail matrix.