A slammed finger in a car door brings immediate, sharp pain and often leaves behind a dark, discolored nail. While distressing, understanding the nature of the damage and knowing the appropriate steps for care can provide reassurance. This guide offers practical advice on managing your injured nail and recognizing when professional medical attention is needed.
Understanding Your Injured Nail
The black or deep purple color under your nail after a traumatic impact indicates a condition known as a subungual hematoma. This occurs when tiny blood vessels beneath the nail plate rupture, causing blood to collect in the confined space between the nail and the nail bed. The pressure from this trapped blood is often the source of throbbing pain. As the blood pools, it can appear red, blue, brown, or black, depending on its age and oxygenation.
Immediate Steps for Home Care
Promptly elevate your hand above your heart to reduce swelling and throbbing pain. This elevation helps to limit blood flow to the injured area, thereby minimizing further blood accumulation under the nail. Applying a cold compress or ice pack, wrapped in a cloth, to the affected finger can also help manage pain and swelling. Apply ice for about 20 minutes every two hours on the first day.
Over-the-counter pain relievers, such as ibuprofen or acetaminophen, can be taken to alleviate discomfort and reduce inflammation. It is important to protect the injured finger from further trauma by avoiding activities that might worsen the injury. While home care can be effective for minor injuries, never attempt to drain the blood from under the nail yourself, as this can introduce infection or cause further damage.
When to See a Doctor
Seek immediate medical attention if you suspect a bone fracture, which may be indicated by severe pain, an inability to move or straighten the finger, or visible deformity. An X-ray might be necessary to confirm a fracture. Signs of infection, such as increasing redness, warmth, swelling, pus, or red streaks extending from the wound, also warrant a doctor’s visit.
If the pain is unbearable despite home care, if blood covers more than 25% to 50% of the nail, or if there is significant damage to the nail bed itself, professional assessment is advisable. A doctor may perform a procedure called trephination, which involves making a small hole in the nail to drain the trapped blood and relieve pressure. This procedure is most effective within the first 48 hours of injury.
The Healing Process
The recovery from a subungual hematoma involves the gradual growth of a new nail, which will eventually push out the discolored, old nail. The dark area under the nail will slowly move towards the tip as the nail grows. Fingernails typically take about four to six months to fully regrow, while toenails can take longer, often 12 to 18 months.
In some instances, the old nail may detach and fall off entirely as the new nail grows underneath it. If the nail bed was severely damaged, the new nail might grow back with some ridges or an altered appearance. During this healing period, it is important to keep the area clean and protected to prevent infection.