A subungual hematoma is the medical term for blood trapped beneath a fingernail or toenail. This condition typically results from direct trauma, such as a crush injury or a blow to the tip of the digit. Because the blood is trapped between the rigid nail plate and the sensitive nail bed, the pressure buildup causes intense, throbbing pain. Prompt management is often needed to relieve this pressure and prevent complications. This guide outlines the safest course of action for managing this painful injury.
Assessing the Severity of the Injury
Determining the extent of the damage dictates the proper treatment path. A simple hematoma involves blood under the nail without other underlying complications. Indicators of a more serious injury include blood accumulation covering more than fifty percent of the nail plate.
Look closely for signs of injury to the surrounding tissue, such as a laceration or tear in the nail fold (the skin surrounding the base and sides of the nail). Severe crush injuries raise the possibility of an associated fracture of the distal phalanx, the bone at the fingertip. Signs like significant deformity or an inability to move the digit normally suggest a possible bone injury. In these cases, medical imaging, such as an X-ray, is necessary to fully assess the damage.
Immediate Home Care and Why Self-Drainage is Risky
While waiting for professional evaluation, you can manage the initial pain and swelling with safe home care methods. Immediately elevate the injured hand or foot above the level of your heart to reduce blood flow and pressure. Applying an ice pack wrapped in a cloth for short intervals can also help minimize swelling and discomfort. Over-the-counter pain relievers, such as acetaminophen or ibuprofen, can manage mild to moderate pain.
Attempting to drain the blood yourself is strongly discouraged due to significant risks, even though pressure relief is tempting. This procedure, known as trephination, requires a sterile field to prevent introducing bacteria into the nail bed. Using non-sterile tools at home, such as a heated paper clip, substantially increases the risk of infection.
An unsterile procedure can also lead to permanent damage to the delicate nail bed tissue, resulting in long-term nail deformity or improper regrowth. Furthermore, at-home drainage may fail if the hole is too small or if the blood has already clotted. Professional intervention ensures the procedure is performed under sterile conditions, fully releasing the pressure safely. Seeking medical attention is the safest way to manage pain and reduce the chance of serious complications.
Professional Medical Treatment Procedures
A medical professional uses controlled and sterile techniques to perform trephination for uncomplicated hematomas. After cleaning the area, they may apply a digital nerve block to numb the digit, though anesthesia is not always necessary. The standard procedure involves creating a small hole in the nail plate using an electrocautery device or a sterile, large-bore needle. This controlled perforation allows the trapped blood to escape, immediately relieving the pressure.
If the hematoma is large or if there is evidence of a severe nail bed laceration or a displaced fracture, treatment may require complete nail plate removal. Nail removal allows the doctor to inspect and surgically repair the underlying nail bed with fine sutures, protecting the matrix where the new nail grows. The primary goal is to relieve pressure, assess for deeper injury, and preserve the nail bed’s function for normal regrowth.
Recovery and Long-Term Outlook
Following successful drainage, pain relief is often immediate as the pressure is released. The site will typically drain a small amount of blood for one to two days and should be kept clean and dry to prevent infection. The dark discoloration caused by the blood will remain, but it will slowly grow out with the nail over the following months.
If the nail was removed or lost due to the injury, a new fingernail may take four to six months to fully regrow, while a toenail can take six to nine months. It is important to monitor the injury for signs of complications. These include increased redness, persistent or worsening pain, or the presence of pus. Damage to the nail-forming matrix from the initial trauma may result in a misshapen or permanently deformed nail, even with proper treatment.