Treatment for Blood Under Your Nail

Your fingers and toes serve as the first contact with the world. Thus, your fingernails and toenails are especially prone to injury whether it be a stubbed toe or power-tool injury.

Sometimes such injury results in a bleed under the nail, a condition called subungual hematoma. These bleeds can result in darkened discoloration (i.e., black nail), pressure, and pain. In addition to being painful, nail discoloration can also be unsightly, which is another reason to seek medical help for this condition.

Subungual Hematoma Explained

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With subungual hematoma, injury to the nail results in bleeding (hematoma) at the level of the nail bed (under the nail plate) or nail matrix. The nail matrix is a rapidly dividing layer of cells at the base of the nail lying toward the cuticle. Rapidly dividing cells of the nail matrix fill with keratin and thus become a hardened nail.

More extensive damage to the nail can not only result in bleeding under the nail (i.e., simple subungual hematoma) but also more extensive damage to the nail fold or digit itself.

If left untreated, a simple subungual hematoma typically grows out with the lengthening nail plate and resolves on its own, although sometimes subungual hematomas can result in your nail falling off (onycholysis).

Until the nail grows out, however, you can expect weeks to months of blue-black discoloration. Interestingly, fingernails grow faster than toenails so it takes longer for your toenails to grow out. 

In addition to discoloration, blood under the nail can result in pressure and pain, which can be relieved by a primary care physician or podiatrist (i.e., “foot doctor”). Delayed treatment can result in nail deformity or infection.

When to See Your Doctor

If you experience a bleed under your nail, your doctor or urgent care physician can drain the excess fluid to and relieve the pressure. The procedure, called a nail trephination, is useful when performed within the first 48 hours.

If your subungual hematoma happened due to a severe injury, you should also see a healthcare provider because there may be a toe or finger fracture. 

Diagnosis

Based on the history and physical exam, most cases of subungual hematoma can be readily diagnosed (and treated) by your healthcare provider. When a fracture is expected, an X-ray is needed.

Rarely, what appears to be a subungual hematoma can be something else such as:

• Nail bed nevus (a mole or birthmark that grows slowly or not at all)
• Splinter hemorrhage (indicative of psoriasis or endocarditis)
• Longitudinal melanonychia (pigmented bands)
• Melanoma

All these listed conditions are painless, and, unlike subungual hematomas, these lesions don’t change or change slowly.

Some differential diagnoses are serious, like endocarditis (i.e., heart infection) or melanoma (i. e, skin cancer), so it’s a good idea to have your nails checked out by your physician if you can’t pinpoint the cause.

Treatment

It takes about 48 hours for blood at the level of the nail bed to clot. During this time, this blood can be drained by a physician, a process called nail trephination. If you wait to have the blood drained, nail trephination may not be able to be performed.

Nail trephination uses hot metal wire, electrocautery device, or spinning, large-bore needle to pierce the nail bed. Fortunately, the nail bed lacks innervation so nail trephination doesn’t hurt.

The hole created by piercing should be large enough to let the blood drain which takes about a day or two. During this time, the hole through which the blood oozes should be covered with sterile gauze. 

After nail trephination, you won’t need antibiotics although a pain reliever like ibuprofen may help with residual pain. Your physician will advise you on effective pain relief. Make sure to follow all your physician’s instructions (including instructions to soak the affected area and apply clean dressing) and follow up with your physician as prescribed. 

If the affected area reaccumulates blood or appears infected, contact your physician.

When the hematoma covers more than half the nail, your physician may choose to remove the nail completely. Moreover, if the nail injury is deep, the nail may also be removed. Before removing the nail, your physician will perform a digital block in order to anesthetize the area.

Finally, keep in mind that it can take several months for a nail to grow back.

Subungual hematoma: Symptoms, causes, and treatment

A finger slammed in a door, a thumb hit with a hammer, a brick dropped on a toe — these nail injuries are common and extremely painful. They can cause blood to pool visibly under a nail, which is called a subungual hematoma.

A subungual hematoma occurs when an injury breaks open blood vessels under the nail, causing blood to collect and become trapped in one spot.

Poorly fitting shoes can also cause subungal hematomas, especially if the person is very active. Shoes that are too tight or narrow can put pressure on the toenail, breaking blood vessels and leading to a pool of blood under the nail.

Running or hiking down steep hills or stopping and starting suddenly, such as while playing soccer or basketball, can also cause a type of subungual hematoma. This is often called runner’s toe.

If a subungual hematoma is small and the pain is mild, it will usually resolve without treatment or complications.

However, if there is severe damage to the nail bed, or if the pain is unmanageable, a person should seek medical treatment.

Share on PinterestAn injury may cause blood to collect under the damaged nail of a finger or toe.

A person may have a subungual hematoma if they have injured their finger or toe and:

• there appears to be blood under the nail
• the nail feels sore or tender
• it feels like there is pressure under the nail
• the nail is discolored

People with artificial nails may not be able to see a subungual hematoma. If a person feels intense pain and pressure, they should remove the artificial nail and examine the nail bed.

Share on PinterestA doctor may perform nail trephination to drain the blood and help alleviate pain and pressure.

A minor subungual hematoma does not cause serious health problems. Home remedies can help to manage pain while the injury heals.

Over-the-counter pain relievers can reduce discomfort and swelling. In addition, the RICE method can be useful for minor subungual hematomas. RICE stands for:

• Rest: Limit use of the affected finger or toe.
• Ice: Use an ice pack, to reduce swelling and pain.
• Compression: Apply pressure such as a wrap to the area immediately, to reduce the amount of blood that can pool.
• Elevation: Keep the affected hand or foot elevated, to reduce swelling.

For more serious injuries, this may not be enough. Any significant injury to the nail can damage or break the bone underneath. A person should seek medical attention if:

• the pain is unbearable
• the injury happened to a baby or child
• the bleeding is uncontrollable
• there is a cut or laceration
• the base of the nail is damaged
• without injury, any nail turns dark or discolored

A doctor may need to remove a severely injured nail or use stitches for deep cuts.

Sometimes the damaged nail is not removed but used as a cover to protect the nail bed while it heals. The damaged nail may need to be removed at a later date.

When the damaged nail bed heals, the bleeding will stop and a new nail will grow.

If a doctor suspects that the bone is broken, they may order an X-ray. Broken fingertips may be covered with a hard splint for several weeks to promote healing and to protect the area from further injury.

A doctor may perform a procedure called nail trephination to drain the blood from under the nail. This can help to relieve pain and pressure.

The doctor will make a small hole in the nail with a laser or needle. Afterward, the area may be wrapped with a bandage and may continue to drain for up to 3 days.

This procedure should not be attempted at home, as it can cause infections or further injury to the nail bed.

Possible signs of an infection include:

• fluid or pus draining from under the nail
• increased swelling or pain
• red streaks in the skin
• a fever
• a feeling of heat or throbbing in the finger or toe
• excessive redness around the area of injury

If any of these symptoms appear, see a doctor right away.

Although it is rare, melanoma can occur under a fingernail or toenail. Melanoma is the deadliest form of skin cancer.

A tumor may look like a subungual hematoma. Melanoma can cause a dark mark to form under the nail. However, it does not usually cause pain and is not linked to an injury.

Speak to a doctor about any unusual marks or colors on the nail that appear without an injury.

Share on PinterestIt can take up to 9 months for a minor subungual hematoma to heal under a toenail.

A minor subungual hematoma usually heals over time without treatment. The trapped blood will eventually be reabsorbed, and the dark mark will disappear.

This can take 2–3 months for a fingernail, and up to 9 months for a toenail.

If there is severe damage to the nail bed, the nail may be malformed or cracked when it grows back. Or, it may fail to regrow. This is uncommon, however, and may be prevented by seeing a doctor for treatment when an injury occurs.

Subungual hematoma: Symptoms, causes, and treatment

A finger slammed in a door, a thumb hit with a hammer, a brick dropped on a toe — these nail injuries are common and extremely painful. They can cause blood to pool visibly under a nail, which is called a subungual hematoma.

A subungual hematoma occurs when an injury breaks open blood vessels under the nail, causing blood to collect and become trapped in one spot.

Poorly fitting shoes can also cause subungal hematomas, especially if the person is very active. Shoes that are too tight or narrow can put pressure on the toenail, breaking blood vessels and leading to a pool of blood under the nail.

Running or hiking down steep hills or stopping and starting suddenly, such as while playing soccer or basketball, can also cause a type of subungual hematoma. This is often called runner’s toe.

If a subungual hematoma is small and the pain is mild, it will usually resolve without treatment or complications.

However, if there is severe damage to the nail bed, or if the pain is unmanageable, a person should seek medical treatment.

Share on PinterestAn injury may cause blood to collect under the damaged nail of a finger or toe.

A person may have a subungual hematoma if they have injured their finger or toe and:

• there appears to be blood under the nail
• the nail feels sore or tender
• it feels like there is pressure under the nail
• the nail is discolored

People with artificial nails may not be able to see a subungual hematoma. If a person feels intense pain and pressure, they should remove the artificial nail and examine the nail bed.

Share on PinterestA doctor may perform nail trephination to drain the blood and help alleviate pain and pressure.

A minor subungual hematoma does not cause serious health problems. Home remedies can help to manage pain while the injury heals.

Over-the-counter pain relievers can reduce discomfort and swelling. In addition, the RICE method can be useful for minor subungual hematomas. RICE stands for:

• Rest: Limit use of the affected finger or toe.
• Ice: Use an ice pack, to reduce swelling and pain.
• Compression: Apply pressure such as a wrap to the area immediately, to reduce the amount of blood that can pool.
• Elevation: Keep the affected hand or foot elevated, to reduce swelling.

For more serious injuries, this may not be enough. Any significant injury to the nail can damage or break the bone underneath. A person should seek medical attention if:

• the pain is unbearable
• the injury happened to a baby or child
• the bleeding is uncontrollable
• there is a cut or laceration
• the base of the nail is damaged
• without injury, any nail turns dark or discolored

A doctor may need to remove a severely injured nail or use stitches for deep cuts.

Sometimes the damaged nail is not removed but used as a cover to protect the nail bed while it heals. The damaged nail may need to be removed at a later date.

When the damaged nail bed heals, the bleeding will stop and a new nail will grow.

If a doctor suspects that the bone is broken, they may order an X-ray. Broken fingertips may be covered with a hard splint for several weeks to promote healing and to protect the area from further injury.

A doctor may perform a procedure called nail trephination to drain the blood from under the nail. This can help to relieve pain and pressure.

The doctor will make a small hole in the nail with a laser or needle. Afterward, the area may be wrapped with a bandage and may continue to drain for up to 3 days.

This procedure should not be attempted at home, as it can cause infections or further injury to the nail bed.

Possible signs of an infection include:

• fluid or pus draining from under the nail
• increased swelling or pain
• red streaks in the skin
• a fever
• a feeling of heat or throbbing in the finger or toe
• excessive redness around the area of injury

If any of these symptoms appear, see a doctor right away.

Although it is rare, melanoma can occur under a fingernail or toenail. Melanoma is the deadliest form of skin cancer.

A tumor may look like a subungual hematoma. Melanoma can cause a dark mark to form under the nail. However, it does not usually cause pain and is not linked to an injury.

Speak to a doctor about any unusual marks or colors on the nail that appear without an injury.

Share on PinterestIt can take up to 9 months for a minor subungual hematoma to heal under a toenail.

A minor subungual hematoma usually heals over time without treatment. The trapped blood will eventually be reabsorbed, and the dark mark will disappear.

This can take 2–3 months for a fingernail, and up to 9 months for a toenail.

If there is severe damage to the nail bed, the nail may be malformed or cracked when it grows back. Or, it may fail to regrow. This is uncommon, however, and may be prevented by seeing a doctor for treatment when an injury occurs.

Subungual hematoma: Symptoms, causes, and treatment

A finger slammed in a door, a thumb hit with a hammer, a brick dropped on a toe — these nail injuries are common and extremely painful. They can cause blood to pool visibly under a nail, which is called a subungual hematoma.

A subungual hematoma occurs when an injury breaks open blood vessels under the nail, causing blood to collect and become trapped in one spot.

Poorly fitting shoes can also cause subungal hematomas, especially if the person is very active. Shoes that are too tight or narrow can put pressure on the toenail, breaking blood vessels and leading to a pool of blood under the nail.

Running or hiking down steep hills or stopping and starting suddenly, such as while playing soccer or basketball, can also cause a type of subungual hematoma. This is often called runner’s toe.

If a subungual hematoma is small and the pain is mild, it will usually resolve without treatment or complications.

However, if there is severe damage to the nail bed, or if the pain is unmanageable, a person should seek medical treatment.

Share on PinterestAn injury may cause blood to collect under the damaged nail of a finger or toe.

A person may have a subungual hematoma if they have injured their finger or toe and:

• there appears to be blood under the nail
• the nail feels sore or tender
• it feels like there is pressure under the nail
• the nail is discolored

People with artificial nails may not be able to see a subungual hematoma. If a person feels intense pain and pressure, they should remove the artificial nail and examine the nail bed.

Share on PinterestA doctor may perform nail trephination to drain the blood and help alleviate pain and pressure.

A minor subungual hematoma does not cause serious health problems. Home remedies can help to manage pain while the injury heals.

Over-the-counter pain relievers can reduce discomfort and swelling. In addition, the RICE method can be useful for minor subungual hematomas. RICE stands for:

• Rest: Limit use of the affected finger or toe.
• Ice: Use an ice pack, to reduce swelling and pain.
• Compression: Apply pressure such as a wrap to the area immediately, to reduce the amount of blood that can pool.
• Elevation: Keep the affected hand or foot elevated, to reduce swelling.

For more serious injuries, this may not be enough. Any significant injury to the nail can damage or break the bone underneath. A person should seek medical attention if:

• the pain is unbearable
• the injury happened to a baby or child
• the bleeding is uncontrollable
• there is a cut or laceration
• the base of the nail is damaged
• without injury, any nail turns dark or discolored

A doctor may need to remove a severely injured nail or use stitches for deep cuts.

Sometimes the damaged nail is not removed but used as a cover to protect the nail bed while it heals. The damaged nail may need to be removed at a later date.

When the damaged nail bed heals, the bleeding will stop and a new nail will grow.

If a doctor suspects that the bone is broken, they may order an X-ray. Broken fingertips may be covered with a hard splint for several weeks to promote healing and to protect the area from further injury.

A doctor may perform a procedure called nail trephination to drain the blood from under the nail. This can help to relieve pain and pressure.

The doctor will make a small hole in the nail with a laser or needle. Afterward, the area may be wrapped with a bandage and may continue to drain for up to 3 days.

This procedure should not be attempted at home, as it can cause infections or further injury to the nail bed.

Possible signs of an infection include:

• fluid or pus draining from under the nail
• increased swelling or pain
• red streaks in the skin
• a fever
• a feeling of heat or throbbing in the finger or toe
• excessive redness around the area of injury

If any of these symptoms appear, see a doctor right away.

Although it is rare, melanoma can occur under a fingernail or toenail. Melanoma is the deadliest form of skin cancer.

A tumor may look like a subungual hematoma. Melanoma can cause a dark mark to form under the nail. However, it does not usually cause pain and is not linked to an injury.

Speak to a doctor about any unusual marks or colors on the nail that appear without an injury.

Share on PinterestIt can take up to 9 months for a minor subungual hematoma to heal under a toenail.

A minor subungual hematoma usually heals over time without treatment. The trapped blood will eventually be reabsorbed, and the dark mark will disappear.

This can take 2–3 months for a fingernail, and up to 9 months for a toenail.

If there is severe damage to the nail bed, the nail may be malformed or cracked when it grows back. Or, it may fail to regrow. This is uncommon, however, and may be prevented by seeing a doctor for treatment when an injury occurs.

Subungual Hematoma – American Osteopathic College of Dermatology (AOCD)

A subungual hematoma is a transient condition where blood and fluid collect underneath the fingernail or toenail. This is usually caused by a traumatic injury as in hitting your thumb with a hammer or stubbing a toe. It can also occur from wearing tight-fitting shoes which trap blood in the toes leading to an increased pressure within the blood vessels of the toes. In either case, the injury leads to the breakage of small blood vessels underneath the nail which leak blood into a potential space below the nail that causes discoloration of the nail and intense pressure.

Initially the injury may only hurt. The nail may feel sore or tender to the touch. As the blood pools under the nail the pressure from the blood can cause severe pain. The pressure caused by blood underneath the nail may result in the affected nail lifting off the finger or toe. The color under the nail will change over time initially red to purple and later to dark brown and black as the blood clots. The pain usually resolves days after the injury and the nail looks worse than it feels.

Usually the treatment is minimal and consists of rest, ice, elevation, and compression of the finger or toe. Over the counter pain medication can be given if needed. Elevation and the use of ice help to reduce the swelling and further pain. Placing ice directly on the affected nail could cause further injury, so wrapping ice in a cloth towel and applying it to the affected area works best. Compression can further reduce the bleeding underneath the nail. Regardless of treatment the hematoma will eventually be resorbed by the body and a new nail will grow out. On average the nail takes 6 to 9 months to grow completely out. A complication to be aware of is damaging the cells that re-grows the nail (the nail matrix). If the nail matrix is damaged the nail will grow incorrectly or may not re-grow a nail.

There are a few reasons to seek medical attention: if bleeding does not stop, if the pain becomes too intense, or if there is significant injury to the base of the nail. Depending on the manner of injury issues to be aware of would be; a deep cut or laceration to the skin of the finger or toe underneath the nail that may require stitches as well as taking an x-ray to determine if the bone of the finger or toe involved is broken. If necessary the pressure caused by the hematoma can be resolved by a medical professional using a technique called trephination. This is done by using a sharp instrument to pierce the nail and drain the blood which relieves the pain. Drainage or removing the nail is discouraged from being attempted by the public because this could lead to further complications of infection, additional trauma, slowing of the healing process, or leaving the finger or toe vulnerable.

Over the course of several months a new nail replaces the damaged, discolored nail. There usually is no need for further treatment or follow up.

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The medical information provided in this site is for educational purposes only and is the property of the American Osteopathic College of Dermatology. It is not intended nor implied to be a substitute for professional medical advice and shall not create a physician – patient relationship. If you have a specific question or concern about a skin lesion or disease, please consult a dermatologist. Any use, re-creation, dissemination, forwarding or copying of this information is strictly prohibited unless expressed written permission is given by the American Osteopathic College of Dermatology.  

Finger Injury

Is this your child’s symptom?

Types of Finger Injuries

• Cuts, Scrapes (skinned knuckles) and Bruises. These are the most common injuries.
• Jammed Finger. The end of a straightened finger or thumb receives a blow. Most often, this is from a ball. The energy is absorbed by the joint surface and the injury occurs there. This is called traumatic arthritis. For jammed fingers, always check that the fingertip can be fully straightened.
• Crushed or Smashed Fingertip. Most often, this is from a car door or a screen door. The end of the finger may get a few cuts or a blood blister. Sometimes, the nail can be damaged. Broken bones are not common with this kind of injury. If they do occur, they are at risk for a bone infection (osteomyelitis).
• Fingernail Injury. If the nailbed is cut, it needs sutures to prevent a deformed fingernail.
• Subungual Hematoma (Blood Clot under the Nail). Most often caused by a crush injury. This can be from a door crushing the finger. It can also be from a heavy object falling on the nailbed. Many are only mildly painful. Some are severely painful and throbbing. These need the pressure under the nail released. A doctor can put a small hole through the nail. This can relieve the pain and prevent loss of the fingernail.
• Dislocations. The finger has been pushed out of its joint.
• Fractures. Finger has a broken bone.

Pain Scale

• Mild: your child feels pain and tells you about it. But, the pain does not keep your child from any normal activities. School, play and sleep are not changed.
• Moderate: the pain keeps your child from doing some normal activities. It may wake him or her up from sleep.
• Severe: the pain is very bad. It keeps your child from doing all normal activities.

When to Call for Finger Injury

Call Doctor or Seek Care Now

• Skin is split open or gaping and may need stitches
• Large swelling is present
• Blood under a nail is causing more than mild pain
• Fingernail is torn off
• Base of nail has popped out from under the skin fold
• Cut over knuckle of hand
• Dirt in the wound is not gone after 15 minutes of scrubbing
• Can’t open and close the hand or use the fingers normally
• Severe pain and not better 2 hours after taking pain medicine
• Age less than 1 year old
• You think your child has a serious injury
• You think your child needs to be seen, and the problem is urgent

Contact Doctor Within 24 Hours

• You think your child needs to be seen, but the problem is not urgent

Contact Doctor During Office Hours

• Dirty cut and no tetanus shot in more than 5 years
• Clean cut and no tetanus shot in more than 10 years
• Pain not better after 3 days
• Not using the finger normally after 2 weeks
• You have other questions or concerns

Self Care at Home

Seattle Children’s Urgent Care Locations

If your child’s illness or injury is life-threatening, call 911.

Care Advice for Minor Finger Injuries

1. What You Should Know About Finger Injuries:
   • There are many ways that children can hurt their fingers.
   • There are also many types of finger injuries.
   • You can treat minor finger injuries at home.
   • Here is some care advice that should help.
2. Pain Medicine:
   • To help with the pain, give an acetaminophen product (such as Tylenol).
   • Another choice is an ibuprofen product (such as Advil).
   • Use as needed.
3. Bruised/Swollen Finger:
   • Soak in cold water for 20 minutes.
   • Repeat as needed.
4. Small Cuts or Scratches:
   • For any bleeding, put direct pressure on the wound. Use a gauze pad or clean cloth. Press down firmly on the place that is bleeding for 10 minutes. This is the best way to stop bleeding. Keep using pressure until the bleeding stops.
   • Wash the wound with soap and water for 5 minutes.
   • For any dirt in the wound, scrub gently.
   • For any cuts, use an antibiotic ointment (such as Polysporin). No prescription is needed.
   • Cover it with a bandage (such as Band-Aid). Change daily.
5. Jammed Finger:
   • Caution: Be certain range of motion is normal. Your child should be able to bend and straighten each finger. If movement is limited, your doctor must check for a broken bone.
   • Soak the hand in cold water for 20 minutes.
   • If the pain is more than mild, “buddy-tape” it to the next finger.
6. Smashed or Crushed Fingertip:
   • Wash the finger with soap and water for 5 minutes.
   • For any cuts, use an antibiotic ointment (such as Polysporin). No prescription is needed.
   • Cover it with a bandage (such as Band-Aid). Change daily.
7. Torn Nail (from catching it on something):
   • For a cracked nail without rough edges, leave it alone.
   • For a large flap of nail that’s almost torn through, cut it off. Use a pair of scissors that have been cleaned. Cut along the line of the tear. Reason: Pieces of nail taped in place will catch on objects.
   • Soak the finger for 20 minutes in cold water for pain relief.
   • Use an antibiotic ointment (such as Polysporin). No prescription is needed. Then cover with a bandage (such as Band-Aid). Change daily.
   • After about 7 days, the nailbed should be covered by new skin. It should no longer hurt. A new nail will grow in over 6 to 8 weeks.
8. Remove Ring:
   • Remove any ring that is on an injured finger.
   • Reason: swelling may occur.
9. Call Your Doctor If:
   • Pain becomes severe
   • Pain not better after 3 days
   • Finger not normal after 2 weeks
   • You think your child needs to be seen
   • Your child becomes worse

And remember, contact your doctor if your child develops any of the ‘Call Your Doctor’ symptoms.

Disclaimer: this health information is for educational purposes only. You, the reader, assume full responsibility for how you choose to use it.

Last Reviewed: 04/29/2021

Last Revised: 03/11/2021

Copyright 2000-2021. Schmitt Pediatric Guidelines LLC.

Subungual Hematoma

A subungual hematoma is blood under the nail. It can occur when your finger or toe is hit or crushed. It causes the nail to look red, black, or blue. In some cases, you may fracture the bone under the nail. 

If the bruise is small and not too painful, it will heal without treatment. If the bruise is large and painful, you may need to have the blood drained.

If a large area of the nail is damaged, your doctor may want to remove it. If he or she doesn’t remove the nail, it may become loose or fall off in the next 2 weeks. In almost all cases, the nail will grow back from the area under the cuticle called the matrix. This takes a few weeks to start and is complete in about 4 to 6 months for a fingernail and 12 months for a toenail. If the nail bed or matrix was damaged, the nail may grow back with a rough or irregular shape. Sometimes the nail may not regrow at all.

Home care

The following guidelines will help you care for your wound at home:

• Apply an ice pack (ice cubes in a plastic bag, wrapped in a thin towel) for no more than 20 minutes every 3 to 6 hours for the first 1 to 2 days. Continue this, as needed, 3 to 4 times a day until the pain and swelling goes away.

• If the nail was drained:

  • Keep the nail covered with a clean adhesive bandage for the next 2 days. There may be some oozing of blood during that time, so change the bandage as needed.

  • Rinse the finger or toe once a day under warm running water. Clean any crust away with a cotton-tipped applicator soaked in soapy water.

• If the nail was removed:

  • The nail bed (tissue under the nail) is moist, soft and sensitive. This needs to be protected from injury for the first 7 to 10 days until it dries out and becomes hard. Keep it covered with a dressing or adhesive bandage until that time.

• Bandages tend to stick to a newly exposed nail bed and can be hard to remove if left in place more than 24 hours. Therefore, unless you were told otherwise, change dressings every 24 hours. Apply petroleum jelly and then a non-stick dressing. This will keep the bandage from sticking and make it easier to remove.  If necessary, soak the dressing off while holding your finger or toe under warm running water.

• If an X-ray showed a fracture, protect the finger or toe for 3 to 4 weeks while it’s healing.

Here is some information regarding medicine and your wound:

• You can take over-the-counter pain medicine such as acetaminophen for pain, unless you were given a different pain medicine to use. Talk with your healthcare provider before using this medicine if you have chronic liver or kidney disease. Also talk with your provider if you have had a stomach ulcer or digestive tract bleeding, or you are taking blood-thinner medicine.

• If you were given antibiotics, take them until they are used up. It’s important to finish the antibiotics even if the wound looks better. This will ensure the infection has cleared.

Follow-up care

Follow up with your doctor, or as advised. Any time there is an injury that causes bleeding, or if the nail was drained, there is a risk for infection. Watch carefully for the signs listed below.

When to seek medical advice

Call your doctor right away if any of these occur:

• Increasing redness around the nail

• Increasing local pain or swelling

• Pus draining from the nail

• Fever of 100.4ºF (38ºC) or higher, or as directed by your healthcare provider

90,000 Subungual hematoma – causes, symptoms, diagnosis and treatment

Subungual hematoma is a consequence of mechanical trauma to the nail phalanx of the upper or lower extremity, in which hemorrhage occurs in the soft tissues of the nail bed. The damage is characterized by pain of varying degrees of intensity, a local increase in temperature, edema, the appearance of red, and then bluish and black staining of the nail plate. Diagnosis is based on history and clinical presentation.In most cases, no treatment is required. Detachment of the nail plate, laceration of soft tissues is an indication for surgical treatment of the damaged area, suturing and dressing.

General information

Synonymous names are used to denote pathology: bruise under the nail, “blue nail”. Throughout life, each person suffers such bodily harm, sometimes more than once. More often, injuries are recorded in males of working age.The peak of injuries occurs during the warm season and the vacation period, when the majority are engaged in construction and repair, work on personal plots, and actively rest in nature. The overwhelming majority of cases of subungual hemorrhage remain outside the field of vision of doctors, since patients often consider the damage to be insignificant and simply ignore it.

Subungual hematoma

Causes

In the development of subungual hematomas, physical impact and a number of predisposing factors play a role.Thus, the risk of bleeding in response to minor trauma increases in patients taking anticoagulants. Patients with diabetes mellitus and other diseases in which polyneuropathy develops, tactile and pain sensitivity are impaired late, notice damage. The main reasons for the appearance of subungual hematomas are:

• Sharp directional impact. A contusion of the terminal phalanx, depending on the strength of the impact, can lead to damage to the vessels of the skin, crushing of tissues, the appearance of a laceration, and bone fracture.Each of these injuries is characterized by an accumulation of blood under the nail. Therefore, any injury requires medical attention.
• Prolonged mechanical stress. Wearing shoes of the wrong size and fullness leads to injury to the nail plates and the skin beneath them. In fact, a callus develops, which fills with serous fluid or blood. In this case, the nail plate may peel off completely or partially.

Pathogenesis

The development of a subungual hematoma is based on a violation of the integrity of the vessels. The spilled blood soaks the tissues, including the nail plate. If the volume of blood is small, the structure of the soft tissues is preserved. If the volume and rate of bleeding are significant, then under the pressure of the blood, the soft tissues exfoliate with the formation of a cavity. A hematoma that has formed under the skin at the hole or in the area of ​​the nail bed, as the nail grows, moves in the distal direction.Blood pressure in the area of ​​the hematoma irritates the nerve endings, which provokes pain. A sharp increase in hematoma volume leads to the formation of a subungual space or a breakthrough of blood near the nail folds.

The blood soaked in soft tissues is gradually absorbed. The staining of the nail plate is irreversible. Over time, the blood clot loses moisture, becomes first dark blue, then blackens. In both cases, a spot is formed, which moves to the free edge of the nail plate.

Classification

Often the terms “hematoma” and “bruising” are used interchangeably, but this is not entirely true. The differences between these two conditions relate to the mechanisms of injury, the clinical picture of the disease, the duration of forced temporary disability due to limb injury, and medical approaches to treatment.

• Subungual bruise. Develops as a result of the impregnation of the skin and subcutaneous tissue with blood from damaged vessels.As a rule, it is formed with a slight effect on the strength and is characterized by unexpressed symptoms. The patient’s condition is quickly normalized, the functioning of the limb is restored.
• Subungual hematoma. Differs from bruising by dissection of tissues with the formation of a cavity filled with blood. Hemorrhagic impregnation also takes place, however, the volume of blood poured out is much greater than with bruising, which increases the likelihood of nail detachment and the development of other complications.

Symptoms of the subungual hematoma

The characteristic signs of hemorrhage in the subungual region that developed after trauma are local hyperemia, fever, edema, pulsating or bursting pain. The peak of the local temperature rise occurs 2-3 hours after the injury. On the 2-3rd day, the pain subsides, the swelling begins to subside.

Immediately after injury, the nail acquires a deep red or cherry-purple color. On the second or third day, the affected area turns blue, after another week or two it acquires an intense black color.The blood-soaked portion of the nail is gradually moved towards the nail edge and cut off. Thus, the black spot can persist for 2-3 months.

In cases where uncomfortable shoes are the cause of injury, slight soreness or discomfort may occur. But more often a change in the color of the nail plate becomes an accidental find during the implementation of foot care. Simultaneously with the color change, exfoliated fragments of the plate, calluses on the skin of the fingers in the area of ​​the nail ridges are often revealed.

Complications

Damage to the skin and base of the nail leads to its deformation. The severity and duration of the deformation is determined by whether the growth zone was affected. Normally, the deformed areas are cut off with scissors during the manicure. Trauma to the base of the nail plate leads to persistent deformity that does not disappear over time. The appearance of a crack or chipped nail as a result of mechanical action creates conditions for the penetration of infection and the development of purulent inflammation of damaged tissues.Microorganisms multiply especially actively in the hematoma cavity. Insufficient care of the bruised phalanx can cause the development of felon.

Diagnostics

In appearance, subungual hematomas have similar features to onychopathies in psoriasis, melanoma. The extent of the damage to the finger on impact is not always obvious. In this regard, it is better to consult a surgeon, even if the injury seems frivolous. Comprehensive examination of a patient with phalanx injury includes:

• General examination .A hematoma is indicated by the presence of a previous mechanical effect, an acute course with a rapid increase in symptoms. Palpation of the damaged area is painful. Drainage, which can be performed directly during the outpatient appointment, has a quick effect.
• X-ray examination . An X-ray of a finger is performed to detect a violation of the integrity of the bones and joints of the limb. According to the X-ray data, it is possible to judge the presence of a fracture, but it is impossible to draw unambiguous conclusions about the degree of damage to soft tissues (skin, tendons, muscles), the volume of the hematoma.

Treatment of subungual hematoma

Medical tactics are determined by the severity of the injury. Indications for seeking medical help are intense, unbearable pain in the area of ​​the injured phalanx and the size of the hematoma over ¼ of the nail area. The scope of medical care is determined by the surgeon on the basis of examination and X-ray data:

• First aid. Proper care of the damaged phalanx allows you to quickly relieve pain, stop or slow down bleeding, and prevent detachment of the nail plate.Immediately after the injury, you must immerse your finger in a container of cold water for 15-20 minutes. Then, if there is an open wound, treat the damaged area with an antiseptic solution and apply a bandage.
• Drainage of hematoma. The nail plate over the hematoma is punctured with a needle or burned through with a thermocoupler. The outflow of blood through a small hole leads to a decrease in pressure on the tissues, a decrease in the intensity of pain. A drained subungual hematoma dissolves faster, which is important for patients who need not have cosmetic defects on their hands.
• Removal of the nail plate. The nail plate is removed partially or completely when it is detached from the nail bed. Attempts to save the nail can lead to unfavorable consequences: detached fragments disrupt the normal functioning of the finger, and can cause additional injury in case of accidental separation.
• Surgical debridement. Crushing injury of tissues, laceration, bone fracture require PST, which includes removal of non-viable fragments, suturing, drainage.The purpose of medical manipulations is to create optimal conditions for healing, prevention of dysfunction of the foot or hand, and purulent-septic complications.
• Whitening damaged nail. The blood-soaked nail plate grows back within a few months. To eliminate a cosmetic defect in one procedure, the injection subungual injection of special bleaches allows. In this case, the black spot is completely discolored. Topically applied whitening drugs do not give a noticeable effect.

Forecast and prevention

In the overwhelming majority of cases, the subungual hematoma goes away on its own without treatment. Within a month or two, only a cosmetic defect in the form of a dark spot on the nail reminds of the injury. As a preventive measure, it is recommended to observe safety precautions and accuracy when performing work, closing doors, moving goods. Properly selected sports and casual shoes allow you to maintain the health of your feet. To protect the fingers, it is recommended to use special work gloves and various devices that reduce the likelihood of damage to the upper limbs (grips, clamps, manipulators).

90,000 Subungual hematoma – causes, symptoms, diagnosis and treatment

Subungual hematoma is a consequence of mechanical trauma to the nail phalanx of the upper or lower extremity, in which hemorrhage occurs in the soft tissues of the nail bed. The damage is characterized by pain of varying degrees of intensity, a local increase in temperature, edema, the appearance of red, and then bluish and black staining of the nail plate.Diagnosis is based on history and clinical presentation. In most cases, no treatment is required. Detachment of the nail plate, laceration of soft tissues is an indication for surgical treatment of the damaged area, suturing and dressing.

General information

Synonymous names are used to denote pathology: bruise under the nail, “blue nail”. Throughout life, each person suffers such bodily harm, sometimes more than once.More often, injuries are recorded in males of working age. The peak of injuries occurs during the warm season and the vacation period, when the majority are engaged in construction and repair, work on personal plots, and actively rest in nature. The overwhelming majority of cases of subungual hemorrhage remain outside the field of vision of doctors, since patients often consider the damage to be insignificant and simply ignore it.

Subungual hematoma

Causes

In the development of subungual hematomas, physical impact and a number of predisposing factors play a role.Thus, the risk of bleeding in response to minor trauma increases in patients taking anticoagulants. Patients with diabetes mellitus and other diseases in which polyneuropathy develops, tactile and pain sensitivity are impaired late, notice damage. The main reasons for the appearance of subungual hematomas are:

• Sharp directional impact. A contusion of the terminal phalanx, depending on the strength of the impact, can lead to damage to the vessels of the skin, crushing of tissues, the appearance of a laceration, and bone fracture.Each of these injuries is characterized by an accumulation of blood under the nail. Therefore, any injury requires medical attention.
• Prolonged mechanical stress. Wearing shoes of the wrong size and fullness leads to injury to the nail plates and the skin beneath them. In fact, a callus develops, which fills with serous fluid or blood. In this case, the nail plate may peel off completely or partially.

Pathogenesis

The development of a subungual hematoma is based on a violation of the integrity of the vessels. The spilled blood soaks the tissues, including the nail plate. If the volume of blood is small, the structure of the soft tissues is preserved. If the volume and rate of bleeding are significant, then under the pressure of the blood, the soft tissues exfoliate with the formation of a cavity. A hematoma that has formed under the skin at the hole or in the area of ​​the nail bed, as the nail grows, moves in the distal direction.Blood pressure in the area of ​​the hematoma irritates the nerve endings, which provokes pain. A sharp increase in hematoma volume leads to the formation of a subungual space or a breakthrough of blood near the nail folds.

The blood soaked in soft tissues is gradually absorbed. The staining of the nail plate is irreversible. Over time, the blood clot loses moisture, becomes first dark blue, then blackens. In both cases, a spot is formed, which moves to the free edge of the nail plate.

Classification

Often the terms “hematoma” and “bruising” are used interchangeably, but this is not entirely true. The differences between these two conditions relate to the mechanisms of injury, the clinical picture of the disease, the duration of forced temporary disability due to limb injury, and medical approaches to treatment.

• Subungual bruise. Develops as a result of the impregnation of the skin and subcutaneous tissue with blood from damaged vessels.As a rule, it is formed with a slight effect on the strength and is characterized by unexpressed symptoms. The patient’s condition is quickly normalized, the functioning of the limb is restored.
• Subungual hematoma. Differs from bruising by dissection of tissues with the formation of a cavity filled with blood. Hemorrhagic impregnation also takes place, however, the volume of blood poured out is much greater than with bruising, which increases the likelihood of nail detachment and the development of other complications.

Symptoms of the subungual hematoma

The characteristic signs of hemorrhage in the subungual region that developed after trauma are local hyperemia, fever, edema, pulsating or bursting pain. The peak of the local temperature rise occurs 2-3 hours after the injury. On the 2-3rd day, the pain subsides, the swelling begins to subside.

Immediately after injury, the nail acquires a deep red or cherry-purple color. On the second or third day, the affected area turns blue, after another week or two it acquires an intense black color.The blood-soaked portion of the nail is gradually moved towards the nail edge and cut off. Thus, the black spot can persist for 2-3 months.

In cases where uncomfortable shoes are the cause of injury, slight soreness or discomfort may occur. But more often a change in the color of the nail plate becomes an accidental find during the implementation of foot care. Simultaneously with the color change, exfoliated fragments of the plate, calluses on the skin of the fingers in the area of ​​the nail ridges are often revealed.

Complications

Damage to the skin and base of the nail leads to its deformation. The severity and duration of the deformation is determined by whether the growth zone was affected. Normally, the deformed areas are cut off with scissors during the manicure. Trauma to the base of the nail plate leads to persistent deformity that does not disappear over time. The appearance of a crack or chipped nail as a result of mechanical action creates conditions for the penetration of infection and the development of purulent inflammation of damaged tissues.Microorganisms multiply especially actively in the hematoma cavity. Insufficient care of the bruised phalanx can cause the development of felon.

Diagnostics

In appearance, subungual hematomas have similar features to onychopathies in psoriasis, melanoma. The extent of the damage to the finger on impact is not always obvious. In this regard, it is better to consult a surgeon, even if the injury seems frivolous. Comprehensive examination of a patient with phalanx injury includes:

• General examination .A hematoma is indicated by the presence of a previous mechanical effect, an acute course with a rapid increase in symptoms. Palpation of the damaged area is painful. Drainage, which can be performed directly during the outpatient appointment, has a quick effect.
• X-ray examination . An X-ray of a finger is performed to detect a violation of the integrity of the bones and joints of the limb. According to the X-ray data, it is possible to judge the presence of a fracture, but it is impossible to draw unambiguous conclusions about the degree of damage to soft tissues (skin, tendons, muscles), the volume of the hematoma.

Treatment of subungual hematoma

Medical tactics are determined by the severity of the injury. Indications for seeking medical help are intense, unbearable pain in the area of ​​the injured phalanx and the size of the hematoma over ¼ of the nail area. The scope of medical care is determined by the surgeon on the basis of examination and X-ray data:

• First aid. Proper care of the damaged phalanx allows you to quickly relieve pain, stop or slow down bleeding, and prevent detachment of the nail plate.Immediately after the injury, you must immerse your finger in a container of cold water for 15-20 minutes. Then, if there is an open wound, treat the damaged area with an antiseptic solution and apply a bandage.
• Drainage of hematoma. The nail plate over the hematoma is punctured with a needle or burned through with a thermocoupler. The outflow of blood through a small hole leads to a decrease in pressure on the tissues, a decrease in the intensity of pain. A drained subungual hematoma dissolves faster, which is important for patients who need not have cosmetic defects on their hands.
• Removal of the nail plate. The nail plate is removed partially or completely when it is detached from the nail bed. Attempts to save the nail can lead to unfavorable consequences: detached fragments disrupt the normal functioning of the finger, and can cause additional injury in case of accidental separation.
• Surgical debridement. Crushing injury of tissues, laceration, bone fracture require PST, which includes removal of non-viable fragments, suturing, drainage.The purpose of medical manipulations is to create optimal conditions for healing, prevention of dysfunction of the foot or hand, and purulent-septic complications.
• Whitening damaged nail. The blood-soaked nail plate grows back within a few months. To eliminate a cosmetic defect in one procedure, the injection subungual injection of special bleaches allows. In this case, the black spot is completely discolored. Topically applied whitening drugs do not give a noticeable effect.

Forecast and prevention

In the overwhelming majority of cases, the subungual hematoma goes away on its own without treatment. Within a month or two, only a cosmetic defect in the form of a dark spot on the nail reminds of the injury. As a preventive measure, it is recommended to observe safety precautions and accuracy when performing work, closing doors, moving goods. Properly selected sports and casual shoes allow you to maintain the health of your feet. To protect the fingers, it is recommended to use special work gloves and various devices that reduce the likelihood of damage to the upper limbs (grips, clamps, manipulators).

90,000 Subungual hematoma – causes, symptoms, diagnosis and treatment

Subungual hematoma is a consequence of mechanical trauma to the nail phalanx of the upper or lower extremity, in which hemorrhage occurs in the soft tissues of the nail bed. The damage is characterized by pain of varying degrees of intensity, a local increase in temperature, edema, the appearance of red, and then bluish and black staining of the nail plate.Diagnosis is based on history and clinical presentation. In most cases, no treatment is required. Detachment of the nail plate, laceration of soft tissues is an indication for surgical treatment of the damaged area, suturing and dressing.

General information

Synonymous names are used to denote pathology: bruise under the nail, “blue nail”. Throughout life, each person suffers such bodily harm, sometimes more than once.More often, injuries are recorded in males of working age. The peak of injuries occurs during the warm season and the vacation period, when the majority are engaged in construction and repair, work on personal plots, and actively rest in nature. The overwhelming majority of cases of subungual hemorrhage remain outside the field of vision of doctors, since patients often consider the damage to be insignificant and simply ignore it.

Subungual hematoma

Causes

In the development of subungual hematomas, physical impact and a number of predisposing factors play a role.Thus, the risk of bleeding in response to minor trauma increases in patients taking anticoagulants. Patients with diabetes mellitus and other diseases in which polyneuropathy develops, tactile and pain sensitivity are impaired late, notice damage. The main reasons for the appearance of subungual hematomas are:

• Sharp directional impact. A contusion of the terminal phalanx, depending on the strength of the impact, can lead to damage to the vessels of the skin, crushing of tissues, the appearance of a laceration, and bone fracture.Each of these injuries is characterized by an accumulation of blood under the nail. Therefore, any injury requires medical attention.
• Prolonged mechanical stress. Wearing shoes of the wrong size and fullness leads to injury to the nail plates and the skin beneath them. In fact, a callus develops, which fills with serous fluid or blood. In this case, the nail plate may peel off completely or partially.

Pathogenesis

The development of a subungual hematoma is based on a violation of the integrity of the vessels. The spilled blood soaks the tissues, including the nail plate. If the volume of blood is small, the structure of the soft tissues is preserved. If the volume and rate of bleeding are significant, then under the pressure of the blood, the soft tissues exfoliate with the formation of a cavity. A hematoma that has formed under the skin at the hole or in the area of ​​the nail bed, as the nail grows, moves in the distal direction.Blood pressure in the area of ​​the hematoma irritates the nerve endings, which provokes pain. A sharp increase in hematoma volume leads to the formation of a subungual space or a breakthrough of blood near the nail folds.

The blood soaked in soft tissues is gradually absorbed. The staining of the nail plate is irreversible. Over time, the blood clot loses moisture, becomes first dark blue, then blackens. In both cases, a spot is formed, which moves to the free edge of the nail plate.

Classification

Often the terms “hematoma” and “bruising” are used interchangeably, but this is not entirely true. The differences between these two conditions relate to the mechanisms of injury, the clinical picture of the disease, the duration of forced temporary disability due to limb injury, and medical approaches to treatment.

• Subungual bruise. Develops as a result of the impregnation of the skin and subcutaneous tissue with blood from damaged vessels.As a rule, it is formed with a slight effect on the strength and is characterized by unexpressed symptoms. The patient’s condition is quickly normalized, the functioning of the limb is restored.
• Subungual hematoma. Differs from bruising by dissection of tissues with the formation of a cavity filled with blood. Hemorrhagic impregnation also takes place, however, the volume of blood poured out is much greater than with bruising, which increases the likelihood of nail detachment and the development of other complications.

Symptoms of the subungual hematoma

The characteristic signs of hemorrhage in the subungual region that developed after trauma are local hyperemia, fever, edema, pulsating or bursting pain. The peak of the local temperature rise occurs 2-3 hours after the injury. On the 2-3rd day, the pain subsides, the swelling begins to subside.

Immediately after injury, the nail acquires a deep red or cherry-purple color. On the second or third day, the affected area turns blue, after another week or two it acquires an intense black color.The blood-soaked portion of the nail is gradually moved towards the nail edge and cut off. Thus, the black spot can persist for 2-3 months.

In cases where uncomfortable shoes are the cause of injury, slight soreness or discomfort may occur. But more often a change in the color of the nail plate becomes an accidental find during the implementation of foot care. Simultaneously with the color change, exfoliated fragments of the plate, calluses on the skin of the fingers in the area of ​​the nail ridges are often revealed.

Complications

Damage to the skin and base of the nail leads to its deformation. The severity and duration of the deformation is determined by whether the growth zone was affected. Normally, the deformed areas are cut off with scissors during the manicure. Trauma to the base of the nail plate leads to persistent deformity that does not disappear over time. The appearance of a crack or chipped nail as a result of mechanical action creates conditions for the penetration of infection and the development of purulent inflammation of damaged tissues.Microorganisms multiply especially actively in the hematoma cavity. Insufficient care of the bruised phalanx can cause the development of felon.

Diagnostics

In appearance, subungual hematomas have similar features to onychopathies in psoriasis, melanoma. The extent of the damage to the finger on impact is not always obvious. In this regard, it is better to consult a surgeon, even if the injury seems frivolous. Comprehensive examination of a patient with phalanx injury includes:

• General examination .A hematoma is indicated by the presence of a previous mechanical effect, an acute course with a rapid increase in symptoms. Palpation of the damaged area is painful. Drainage, which can be performed directly during the outpatient appointment, has a quick effect.
• X-ray examination . An X-ray of a finger is performed to detect a violation of the integrity of the bones and joints of the limb. According to the X-ray data, it is possible to judge the presence of a fracture, but it is impossible to draw unambiguous conclusions about the degree of damage to soft tissues (skin, tendons, muscles), the volume of the hematoma.

Treatment of subungual hematoma

Medical tactics are determined by the severity of the injury. Indications for seeking medical help are intense, unbearable pain in the area of ​​the injured phalanx and the size of the hematoma over ¼ of the nail area. The scope of medical care is determined by the surgeon on the basis of examination and X-ray data:

• First aid. Proper care of the damaged phalanx allows you to quickly relieve pain, stop or slow down bleeding, and prevent detachment of the nail plate.Immediately after the injury, you must immerse your finger in a container of cold water for 15-20 minutes. Then, if there is an open wound, treat the damaged area with an antiseptic solution and apply a bandage.
• Drainage of hematoma. The nail plate over the hematoma is punctured with a needle or burned through with a thermocoupler. The outflow of blood through a small hole leads to a decrease in pressure on the tissues, a decrease in the intensity of pain. A drained subungual hematoma dissolves faster, which is important for patients who need not have cosmetic defects on their hands.
• Removal of the nail plate. The nail plate is removed partially or completely when it is detached from the nail bed. Attempts to save the nail can lead to unfavorable consequences: detached fragments disrupt the normal functioning of the finger, and can cause additional injury in case of accidental separation.
• Surgical debridement. Crushing injury of tissues, laceration, bone fracture require PST, which includes removal of non-viable fragments, suturing, drainage.The purpose of medical manipulations is to create optimal conditions for healing, prevention of dysfunction of the foot or hand, and purulent-septic complications.
• Whitening damaged nail. The blood-soaked nail plate grows back within a few months. To eliminate a cosmetic defect in one procedure, the injection subungual injection of special bleaches allows. In this case, the black spot is completely discolored. Topically applied whitening drugs do not give a noticeable effect.

Forecast and prevention

In the overwhelming majority of cases, the subungual hematoma goes away on its own without treatment. Within a month or two, only a cosmetic defect in the form of a dark spot on the nail reminds of the injury. As a preventive measure, it is recommended to observe safety precautions and accuracy when performing work, closing doors, moving goods. Properly selected sports and casual shoes allow you to maintain the health of your feet. To protect the fingers, it is recommended to use special work gloves and various devices that reduce the likelihood of damage to the upper limbs (grips, clamps, manipulators).

90,000 Subungual hematoma – causes, symptoms, diagnosis and treatment

Subungual hematoma is a consequence of mechanical trauma to the nail phalanx of the upper or lower extremity, in which hemorrhage occurs in the soft tissues of the nail bed. The damage is characterized by pain of varying degrees of intensity, a local increase in temperature, edema, the appearance of red, and then bluish and black staining of the nail plate.Diagnosis is based on history and clinical presentation. In most cases, no treatment is required. Detachment of the nail plate, laceration of soft tissues is an indication for surgical treatment of the damaged area, suturing and dressing.

General information

Synonymous names are used to denote pathology: bruise under the nail, “blue nail”. Throughout life, each person suffers such bodily harm, sometimes more than once.More often, injuries are recorded in males of working age. The peak of injuries occurs during the warm season and the vacation period, when the majority are engaged in construction and repair, work on personal plots, and actively rest in nature. The overwhelming majority of cases of subungual hemorrhage remain outside the field of vision of doctors, since patients often consider the damage to be insignificant and simply ignore it.

Subungual hematoma

Causes

In the development of subungual hematomas, physical impact and a number of predisposing factors play a role.Thus, the risk of bleeding in response to minor trauma increases in patients taking anticoagulants. Patients with diabetes mellitus and other diseases in which polyneuropathy develops, tactile and pain sensitivity are impaired late, notice damage. The main reasons for the appearance of subungual hematomas are:

• Sharp directional impact. A contusion of the terminal phalanx, depending on the strength of the impact, can lead to damage to the vessels of the skin, crushing of tissues, the appearance of a laceration, and bone fracture.Each of these injuries is characterized by an accumulation of blood under the nail. Therefore, any injury requires medical attention.
• Prolonged mechanical stress. Wearing shoes of the wrong size and fullness leads to injury to the nail plates and the skin beneath them. In fact, a callus develops, which fills with serous fluid or blood. In this case, the nail plate may peel off completely or partially.

Pathogenesis

The development of a subungual hematoma is based on a violation of the integrity of the vessels. The spilled blood soaks the tissues, including the nail plate. If the volume of blood is small, the structure of the soft tissues is preserved. If the volume and rate of bleeding are significant, then under the pressure of the blood, the soft tissues exfoliate with the formation of a cavity. A hematoma that has formed under the skin at the hole or in the area of ​​the nail bed, as the nail grows, moves in the distal direction.Blood pressure in the area of ​​the hematoma irritates the nerve endings, which provokes pain. A sharp increase in hematoma volume leads to the formation of a subungual space or a breakthrough of blood near the nail folds.

The blood soaked in soft tissues is gradually absorbed. The staining of the nail plate is irreversible. Over time, the blood clot loses moisture, becomes first dark blue, then blackens. In both cases, a spot is formed, which moves to the free edge of the nail plate.

Classification

Often the terms “hematoma” and “bruising” are used interchangeably, but this is not entirely true. The differences between these two conditions relate to the mechanisms of injury, the clinical picture of the disease, the duration of forced temporary disability due to limb injury, and medical approaches to treatment.

• Subungual bruise. Develops as a result of the impregnation of the skin and subcutaneous tissue with blood from damaged vessels.As a rule, it is formed with a slight effect on the strength and is characterized by unexpressed symptoms. The patient’s condition is quickly normalized, the functioning of the limb is restored.
• Subungual hematoma. Differs from bruising by dissection of tissues with the formation of a cavity filled with blood. Hemorrhagic impregnation also takes place, however, the volume of blood poured out is much greater than with bruising, which increases the likelihood of nail detachment and the development of other complications.

Symptoms of the subungual hematoma

The characteristic signs of hemorrhage in the subungual region that developed after trauma are local hyperemia, fever, edema, pulsating or bursting pain. The peak of the local temperature rise occurs 2-3 hours after the injury. On the 2-3rd day, the pain subsides, the swelling begins to subside.

Immediately after injury, the nail acquires a deep red or cherry-purple color. On the second or third day, the affected area turns blue, after another week or two it acquires an intense black color.The blood-soaked portion of the nail is gradually moved towards the nail edge and cut off. Thus, the black spot can persist for 2-3 months.

In cases where uncomfortable shoes are the cause of injury, slight soreness or discomfort may occur. But more often a change in the color of the nail plate becomes an accidental find during the implementation of foot care. Simultaneously with the color change, exfoliated fragments of the plate, calluses on the skin of the fingers in the area of ​​the nail ridges are often revealed.

Complications

Damage to the skin and base of the nail leads to its deformation. The severity and duration of the deformation is determined by whether the growth zone was affected. Normally, the deformed areas are cut off with scissors during the manicure. Trauma to the base of the nail plate leads to persistent deformity that does not disappear over time. The appearance of a crack or chipped nail as a result of mechanical action creates conditions for the penetration of infection and the development of purulent inflammation of damaged tissues.Microorganisms multiply especially actively in the hematoma cavity. Insufficient care of the bruised phalanx can cause the development of felon.

Diagnostics

In appearance, subungual hematomas have similar features to onychopathies in psoriasis, melanoma. The extent of the damage to the finger on impact is not always obvious. In this regard, it is better to consult a surgeon, even if the injury seems frivolous. Comprehensive examination of a patient with phalanx injury includes:

• General examination .A hematoma is indicated by the presence of a previous mechanical effect, an acute course with a rapid increase in symptoms. Palpation of the damaged area is painful. Drainage, which can be performed directly during the outpatient appointment, has a quick effect.
• X-ray examination . An X-ray of a finger is performed to detect a violation of the integrity of the bones and joints of the limb. According to the X-ray data, it is possible to judge the presence of a fracture, but it is impossible to draw unambiguous conclusions about the degree of damage to soft tissues (skin, tendons, muscles), the volume of the hematoma.

Treatment of subungual hematoma

Medical tactics are determined by the severity of the injury. Indications for seeking medical help are intense, unbearable pain in the area of ​​the injured phalanx and the size of the hematoma over ¼ of the nail area. The scope of medical care is determined by the surgeon on the basis of examination and X-ray data:

• First aid. Proper care of the damaged phalanx allows you to quickly relieve pain, stop or slow down bleeding, and prevent detachment of the nail plate.Immediately after the injury, you must immerse your finger in a container of cold water for 15-20 minutes. Then, if there is an open wound, treat the damaged area with an antiseptic solution and apply a bandage.
• Drainage of hematoma. The nail plate over the hematoma is punctured with a needle or burned through with a thermocoupler. The outflow of blood through a small hole leads to a decrease in pressure on the tissues, a decrease in the intensity of pain. A drained subungual hematoma dissolves faster, which is important for patients who need not have cosmetic defects on their hands.
• Removal of the nail plate. The nail plate is removed partially or completely when it is detached from the nail bed. Attempts to save the nail can lead to unfavorable consequences: detached fragments disrupt the normal functioning of the finger, and can cause additional injury in case of accidental separation.
• Surgical debridement. Crushing injury of tissues, laceration, bone fracture require PST, which includes removal of non-viable fragments, suturing, drainage.The purpose of medical manipulations is to create optimal conditions for healing, prevention of dysfunction of the foot or hand, and purulent-septic complications.
• Whitening damaged nail. The blood-soaked nail plate grows back within a few months. To eliminate a cosmetic defect in one procedure, the injection subungual injection of special bleaches allows. In this case, the black spot is completely discolored. Topically applied whitening drugs do not give a noticeable effect.

Forecast and prevention

In the overwhelming majority of cases, the subungual hematoma goes away on its own without treatment. Within a month or two, only a cosmetic defect in the form of a dark spot on the nail reminds of the injury. As a preventive measure, it is recommended to observe safety precautions and accuracy when performing work, closing doors, moving goods. Properly selected sports and casual shoes allow you to maintain the health of your feet. To protect the fingers, it is recommended to use special work gloves and various devices that reduce the likelihood of damage to the upper limbs (grips, clamps, manipulators).

SUBLUGUARY HEMATOMA | NOTES ONE PODOLOG

Good day to all!

My name is Svetlana and I am a podiatrist!

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Most often with deformed, ingrown, thickened and not quite healthy-looking nails! And more often than not, it’s toenails!

On this channel you will learn a lot of interesting information about how to take care of your feet and toenails! And what to do if nail problems have already appeared!

Ask questions and I will definitely answer them!

People often injure the nail plate on the foot as a result of falling, hitting the foot against a hard object, wearing tight, uncomfortable shoes, or simply on a sliding surface.

Hematoma under the nail is the formation of a blood clot that appears as a result of severe injury to the nail plate.

If a severe hematoma appears, then the doctor prescribes a certain treatment.

But you can identify the causes of the injury and determine the treatment yourself at home.

Hematoma is a stoppage of blood in the vessels. It stagnates and clots form at the site of the injury. Since the nail plate is very strong, hemorrhage occurs under it.Blood does not leak out, but accumulates under the skin. Therefore, the hematoma may turn dark blue or black. The damaged area may swell slightly.

Most often, a hematoma under the thumbnail appears within a couple of hours. If a bruise appears due to a bruise or uncomfortable shoes, and it is not the cause of any ailment, then the hematoma will disappear within a week.

The rate of disappearance depends on how quickly the blue discoloration under the nail passes. After all, blue discoloration can disappear on its own, but the blood clot itself may need to be removed from under the nail plate from a specialist.

Some people do not attach importance to such injuries. However, such an irresponsible attitude towards one’s own health can be fraught with unpleasant consequences.

If there is damage to the soft tissues, infection can begin. In some cases, felon appears under the nail. This is an acute suppuration of soft tissues under the nail, accompanied by severe pain and causing its deformation.

Prevention

To protect yourself from severe hemorrhages under the nail plates, you should follow simple rules:

• You need a balanced diet, which includes vitamin C, which strengthens vascular tissues;
• Perform pedicure with high-quality instruments and cosmetics, do not use low-quality varnishes, do not apply them without a base under a colored coating;
• Wear comfortable shoes with a wide toe, in which toes would not be pressed against each other;
• Wear socks in the cold season to prevent frostbite or the influence of subzero temperatures;
• to observe the rules of personal hygiene of hands and feet;
• trim nails regularly, but not too short;
• Be careful when moving heavy objects that can cause injury to the nail plates;
• Avoid walking barefoot on the ground or grass as this increases the risk of injury;
• Keep feet and hands clean, dry, always wear clean socks and shoes to prevent the development of fungi;
• Leave the shoes to be ventilated between uses in order to exclude high humidity, which contributes to the growth of bacteria;
• Treat any problems of nails and the whole body in the early stages.

With this prophylaxis, you will be able to noticeably reduce bruising. But if the injury did occur, you need to contact a specialist and go through all the stages of getting out of this problem.

Thank you for reading the article to the end!

All health and healthy nails!

Subungual hematoma | Healthy Skin Center, Ufa

SUBLUGUARY HEMATOMA is a small blood clot that has formed under the nail plate under the influence of various factors.This type of mass can appear on the fingers and toes. The most common reason for the occurrence of a subungual hematoma is a bruise, a strong blow, and squeezing of the nail.

REASONS : a small amount of blood accumulates between the nail and the skin, as a result of which a bruise forms on the finger, a hematoma under the nail plate may appear due to:

1. Hard blow to the finger;
2. Pinching or pinching a finger;
3. Wearing small shoes;

SYMPTOMS: if a finger injury occurs, the first thing that is felt is severe pain and burning in the nail area.Blood will begin to accumulate under the nail plate. The pain will be pulsating in nature, you will feel a “twitching” of the finger, or there will be a feeling of bursting in the area of ​​the nail. The finger itself increases in size as a result of edema. A change in the color of the nail itself appears, at first the color turns red, then gradually acquires a bluish tint and finally becomes black-violet.

TREATMENT: The sooner first aid is provided, the more chances you have to save and preserve the nail plate.The first thing to do when injured toes and toes is ice or something cold. An anti-inflammatory drug will prevent the spread of the inflammatory process, it must be taken immediately after injury.

If the injury was so severe that the nail plate was removed, you need to rinse the wound with running water and lubricate it with an antiseptic, in no case we do not recommend self-medication, but we recommend that you visit a surgeon at the HEALTHY SKIN CENTER clinic.

For more information and make an appointment with a surgeon, call:

Address: Ufa, st. Revolutionary, 70

Phones: +7 (347) 294-15-94

Mobile: +7 (987) 254-15-94 (WhatsApp)

Working hours: Mon-Fri 09:00 – 21:00; Sat 10:00 – 15:00

There are contraindications, it is necessary to consult a specialist.

90,000 Blood under the nail (hematoma under the nail) – what to do, how to get rid of

Blue or dark spots under the nail can occur periodically in almost all people.There can be many reasons for them, but most often it is the presence of a hematoma under the nail. But sometimes, and much more serious diseases can manifest themselves in a similar way, and therefore it is important to correctly determine the cause of the blue nail.

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Symptoms and signs of a subungual hematoma

Blood under the nail is the main symptom of a hematoma.

After an injury, the natural color changes to a red, maroon or other dark color under the nail.

The most common symptom of a hematoma under the nail is pain.

The pressure created between the nail plate and the nail bed, where blood collects, causes quite severe pain.

The pain that accompanies a subungual hematoma can also be caused by other injuries such as contusion, sprain, limb fracture, traumatic skin injury, and nail injury.

Forecast and prevention

Primary prevention of nail hemorrhages caused by chronic dermatoses has not been developed.Secondary prevention measures aimed at preventing relapse include:

1. Nail care with the use of vitamin creams.
2. Baths with sea salt, if possible, annual spa treatment, including thalassotherapy, mud therapy.
3. Elimination of nail injuries.
4. Regular intake of vitamins.
5. A diet based on the principles of a healthy diet.

The prognosis for subungual hemorrhages depends on the course of the underlying disease.With timely treatment, long-term and stable remissions are possible.

Do I need to see a doctor?

When to seek medical attention for a subungial hematoma:

• If the pain is mild and the hematoma (blood collection) occupies less than 25% of the area under the nail, then home care may be considered.
• If a hematoma under the nail occupies 50% or more of the area of ​​the nail area, then medical attention is required.

If the injury causing bleeding under the nail is severe enough with severe pain and swelling, see a doctor. Mechanical injury can lead to fracture of the bones of the fingers or damage to the nail bed under the nail, which requires additional medical attention.

Diseases with the same symptoms

In essence, a subungual hematoma on the big toe or hand is an absolutely safe disease.In the early days, of course, it gives a certain discomfort, like any other injury, but it does not carry any real harm to health. Much more unpleasant is that some serious illnesses can have similar symptoms. It is very important, if you find a dark spot on your nail, to conduct a thorough diagnosis, as well as to analyze the past for the presence of any injuries.

In particular, localized darkening of nails can cause fungus in its later stages of development.Such spots can be of very different types, but they all resemble hematomas at one stage or another of development. Since they appear far from the onset of the disease, it is quite possible to conduct a high-quality and complete diagnosis. If you remember for sure that you have not had any injuries relatively recently, then it is very likely that the disease is caused by a fungus.

The bruising under the toenails remains very painful for almost a week after the injury. Even if your finger itself is hardly injured, the nail will still hurt when pressed, or severe throbbing pain will be present all the time.The fungus, although it can cause mild pain, is not at all so much reminiscent of itself and is characterized mainly by itching.

If, in addition to the blue discoloration of the plate, you notice at least some of the signs listed below, then you should consult a doctor for the treatment of nail fungus. All these signs directly or indirectly indicate the disease.

1. Skin itching;
2. Skin peeling;
3. Occurrence of painful cracks between the toes;
4. Brittle and brittle nails;
5. Plate delamination;
6. Unpleasant odor;
7. Yellowing or blue discoloration of the plate.

Also, a blue nail may indicate the presence of cardiovascular diseases. Usually, in this case, the nails turn blue completely and all at once, which occurs as a result of insufficient saturation of the fingertips with oxygen. In this case, all the fingertips acquire a bluish tint, and the blue discoloration of the nail is not local, but total.

However, the presence of blue spots can be explained quite simply. Perhaps you used a dark varnish without using a protective base.The nail may not be completely colored, for example, if the varnish was applied after polishing. A darker color will appear in areas where sawing was most intense.

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Diagnosis of subungial hematoma

X-ray

X-ray radiation is a simple and effective method for detecting a fracture of the bones of the fingers. However, x-rays do not provide any information about bleeding or bruising under the nail.

Physical Diagnosis

Depending on the type, severity of the injury and the amount of blood under the nail, the doctor may decide to remove the nail to check for any possible damage to the nail bed. But usually, if the nail is not damaged and there are no lacerations, it is not removed.

What is the danger of a hematoma

A hematoma appears 3-4 hours after a severe injury to the fingers or toes. Most often, it spontaneously heals and comes off the surface of the skin, but sometimes the lack of treatment can lead to complications that affect the girl’s health.

The chronic form of the defect (especially with a fungal infection) or the illiterate implementation of its treatment can lead to suppuration, which is accompanied by tearing. An open wound can get an infection that penetrates the bloodstream and affects the entire body, triggering severe inflammatory processes.

Accompanied by the consequence of severe discomfort while walking, and especially when pressing on the damaged area. To fix the problem, surgery is routinely used.The operation is not dangerous for the girl, however, severe deformation of the natural manicure / pedicure can become its side effect.

How to remove a hematoma under the nail at home

Ice, elevation (hold an arm or leg above the level of the heart) and pain relievers – this is a simple list of recommendations on how to treat small hematomas under the finger at home.

Folk remedies

And they are also worth listing. Here are some popular folk remedies to help get rid of the bruise under the fingernail:

• Baths.You need to take 3 liters of water heated to 40 ° C, a tablespoon of sea salt and 10 drops of any essential oil. Add 100 ml of fresh aloe juice. Hold your feet (hands) in this bath for 15 minutes. Then dry and grease with a non-greasy cream.

• Bodyagi mask. You need to take 10-20 grams of dry powder and dilute with warm water. You need to pour in a little, stirring the composition – you should get a thick consistency. It will take no more than 50 ml. The gruel should be applied to the bruise and held for 20 minutes.Then remove and wipe with a cotton pad dipped in chamomile broth. The procedure should be repeated 2-3 times a day.
• Homemade ointment. You need to take laundry soap (35 g), rub it, mix with ammonia (30 ml), camphor laurel oil (30 ml) and lamp (50 ml), add turpentine (250 ml). Boil for 5-7 minutes. Allow to cool. The affected area should be treated every 4 hours.
• Lotions. You will need to mix apple cider vinegar (250 ml), dry wine (250 ml) and sea salt (10 g).It is necessary to moisten cotton pads or a napkin with this compound and apply it to the injured area every 2 hours.

And we must not forget about the effect on the body from the inside. The best remedy for relieving pain is considered to be a decoction of St. John’s wort. It is easy to prepare – you need to take 3-4 tbsp. l. dried herbs, pour a liter of water and cook for 15 minutes. Then strain and drink like tea.

Treatment of hematoma under the finger

Several methods are used to remove blood from under the nail.Options include removing part of the nail or trepanning the nail to drain (drain) the accumulated blood. For this purpose, the nail plate is perforated with a hot metal wire, either by screwing in a hollow needle, or the electrocautery method is used (not in the case of acrylic nails because of the risk of inflammation). All of these methods allow the blood under the nail to drain outward, which in turn reduces pain. Drainage does not occur immediately and in extreme cases can last up to one and a half days.

Don’t be alarmed if a healthcare professional decides to use a simple paper clip to remove the blood from under the nail: this technique, although older, is still used by some healthcare practitioners. The paper clip is straightened to release the pointed end, which is heated under fire. Then a quick perforation of the nail plate is performed.

After removing the hematoma under the nail, apply a moist sterile dressing.Usually this is the whole procedure for treating hematoma under the nail. In rare cases, the doctor decides to completely remove the nail and apply stitches.

None of the techniques are preferred.

When exactly the blood is drained from under the finger and the hematoma comes down depends on the experience of the doctor and the procedure.

Follow-up treatment

• Once the subungual hematoma has resolved, follow-up is usually not required.
• Antibiotics are usually not needed after the blood has been removed from under the nail.
• If a nail has been removed and the incision in your nail bed has been stitched, you need to see a doctor within 48-72 hours for a second examination.
• Self-dissolving sutures are commonly used, so removal of sutures is not required.
• If stitches are insoluble (nylon), they must be removed after about seven days.

What does it look like on your thumb?

The “blue nail” is not immediately noticeable. Immediately after injury – a bruise without a fracture – the terminal phalanx turns red and swells, the local temperature rises.Further, the color of the nail changes to cherry blue. The size and shape of the hematoma is determined by the strength of the mechanical factor and the place of its impact.

Pains appear in the bruised area – bursting, pulsating. With an increase in hematoma or the addition of an inflammatory process, they become intense, disrupt sleep and habitual activity. After a few days, the pain subsides, and the nail turns blue.

As the blood clot dries up, its color also changes.The nail turns from dark blue to black. This area gradually moves from the growth zone to the peripheral edge. “Blue nail” can exist for a long time – up to 2-3 months. After a bruise, other disorders can also form:

• Deformation of the nail.
• Crack or chip in the plate.
• Panaritium.

The last situation is due to the penetration of bacteria under the nail with the development of a purulent-inflammatory process. Then there are signs of an acute process – sharp pains, redness and swelling, fever, deterioration in general health.

Blueness of the nail is a consequence of a bruise, a symptom of hemorrhage in the tissue and the plate itself. The defect persists for quite a long time.

How to avoid a subungual hematoma?

Use common sense and practice various safety precautions – do not let your fingers get caught in doors or heavy objects from falling on your feet.

Professional footwear is an important safety feature. For example, in certain high-risk jobs such as construction.Or playing certain sports — you shouldn’t play football with rag sneakers.

Watch out for children’s hands when opening and closing car doors.

Don’t Distract – Finger injuries often occur when the person using the tool is distracted.

Do not lift what you cannot lift alone. Find people to help you carry heavy objects to avoid dropping them on your toes.

Causes of occurrence

A bruise under the nail cannot appear just like that.For a hematoma to form, it must be preceded by one of the following events:

• Strong blow to the finger.
• Pinching.
• Crush.
• Playing football without special shoes (boots).
• Development of some specific diseases (diabetes mellitus, melanoma, increased vascular fragility, heart ailments).
• Long-term wearing of tight or uncomfortable shoes.
• Taking medications that affect blood clotting.
• Fungus accompanied by itching and flaking of the plate.
• Wearing specific shoes. This is vital for skaters, skiers, etc.

Forecast

After the large hematoma under the nail drains, the pressure under the nail will decrease and the pain will decrease significantly.

The hole formed by the perforation will remain and heal at the rate at which a nail normally grows.

One of the possible risks and long-term complications of a subungual hematoma is nail loosening.

If the injury is severe and includes soft tissue disruption, healing may be difficult. This complication can lead to nail deformity or abnormal nail growth.

Deformity can be temporary and will go away after the nail grows or, despite all the efforts of doctors and proper home care, it can be permanent, and a clearly deformed nail will remain so forever.

First aid

Whatever the cause of the injury to the thumbs, after a bruise, it is immediately necessary to provide yourself or the victim who is nearby, first aid.Timely first aid is especially important if a child has a problem, which is also not considered a rarity, because children are very mobile.

First of all, it is necessary to apply cold to the damaged area. To do this, you can use ice, frozen foods, cold water. Treatment of this injury is necessary even before visiting a doctor. So that the infection does not spread to the nearest tissues, it is necessary to take a non-steroidal anti-inflammatory drug from a home medicine cabinet. Drugs such as Ketorol, Ibuprofen or Analgin will reduce pain and the development of the inflammatory process.

And what if not just a bruise formed on the nails, but the nail plate is completely or partially detached from the finger? The separation of the nail indicates that this part of it is no longer powered by the capillaries.