Overview

A subungual hematoma is a collection of blood, essentially a bruise, that forms under your fingernail or toenail. It happens when tiny blood vessels break and bleed in the space between the nail and the nail bed below.

This condition is almost always caused by a direct injury or trauma to the nail, such as stubbing your toe hard, hitting your finger with a hammer, or dropping something heavy on your foot. Anyone can get a subungual hematoma, from active children at play to adults who've had an accidental knock. It's especially common in people who play sports or have jobs where their hands and feet are at risk of injury. The good news is that a subungual hematoma is not contagious at all, as it's purely the result of an injury. While it can be quite painful, especially right after the injury, and the appearance might be a bit alarming, it usually resolves on its own as your nail grows out.

Symptoms

You might experience several signs if you have a subungual hematoma. Here are some of the most common:

• Dark discoloration: - This is often the first thing you'll notice. The area under your nail may look red, purple, dark brown, or even black.
• Throbbing pain or intense pressure: - This is very common shortly after the injury, caused by the blood collecting and putting pressure on the sensitive nail bed.
• Swelling: - The tip of your finger or toe around the affected nail might look swollen.
• Tenderness: - The nail and the area around it will likely be very tender to touch.
• Feeling of pressure: - Even if not intensely painful, you might feel a constant pressure under the nail.
• Nail lifting: - In some cases, the nail may feel loose or start to lift away from the nail bed as blood accumulates.
• Potential nail loss: - If the hematoma is large or the injury severe, the nail might eventually fall off. This isn't always the case, but it can happen as a new nail grows underneath.

The pain often starts to lessen after a day or two, especially if the pressure is relieved or as your body begins to reabsorb the blood.

Diagnosis

Diagnosing a subungual hematoma is usually straightforward for a healthcare professional.

• How is it diagnosed? - A doctor can typically diagnose it by simply looking at your injured nail and talking with you about how the injury occurred. Your description of the pain and the immediate appearance of the dark color under the nail are key clues.
• Common tests or procedures: - Most of the time, no special tests are needed. However, if the injury was particularly forceful, or if your doctor suspects you might have broken a bone in your finger or toe, they may recommend an X-ray to check for fractures.

Management & Treatment

Dealing with the sight of blood under a nail can be unsettling, and the throbbing pain can be quite intense. We understand that you want to find relief quickly and safely. The good news is that treatment is often straightforward.

How a subungual hematoma is treated depends on its size and how much pain it’s causing. For very small, minimally painful spots, your body may simply reabsorb the blood over time without any specific treatment.

Home Care for Minor Injuries

If the hematoma is small and your pain is manageable, you can likely care for it at home. The goal is to reduce swelling and ease discomfort.

• Rest, Ice, and Elevate: Gently apply a cold compress wrapped in a towel to the injured finger or toe for about 20 minutes at a time, several times a day. Keeping your hand or foot elevated above the level of your heart can also help minimize throbbing and swelling.
• Over-the-Counter (OTC) Pain Relievers: Medications like ibuprofen (Advil, Motrin) or acetaminophen (Tylenol) can help manage the pain.

When to Seek Medical Care

If the pressure and pain are severe, or if the hematoma covers more than a quarter of your nail, it's time to see a healthcare provider. The intense pain is caused by the pressure of the blood trapped between the nail and the nail bed.

To provide relief, your doctor may perform a simple in-office procedure called nail trephination. This involves creating one or more tiny holes in the nail to allow the blood to drain out, which instantly relieves the pressure. This procedure is quick and generally painless, as the nail itself doesn't have nerves. Your doctor may numb the area first just in case.

In cases where the injury is more significant or the nail bed itself is cut, your doctor might need to remove the entire nail to repair the tissue underneath with stitches.

Important Safety Warning: Please do not try to drain the hematoma yourself. Using unsterilized tools like a hot pin or needle at home can cause further injury and lead to a serious infection. This should only be done by a medical professional.

What to Expect After Treatment

If you had a drainage procedure, the relief from pain is often immediate. Your doctor will bandage your finger or toe, and you'll need to keep it clean.

It’s very common for the damaged nail to fall off completely within a few weeks, whether you had it drained or not. A new, healthy nail will grow in to replace it, but this takes time. A new fingernail may take up to 6 months to fully regrow, while a toenail can take 12 to 18 months.

Duration & Outlook

Understanding how long a subungual hematoma lasts and what to expect can be reassuring.

• Typical timeline for condition: - The sharp pain often improves significantly within a few days. The discolored area, however, will remain visible until the damaged part of the nail grows out completely. For fingernails, this can take about 6 months. For toenails, which grow more slowly, it can take 12 to 18 months.
• Is it chronic or acute? - A subungual hematoma is an acute condition, meaning it happens suddenly as a result of an injury and is not a long-term, recurring problem on its own.
• What outcomes to expect: - In most cases, the bruised area will simply grow out with the nail, and a new, healthy nail will replace it. Sometimes, especially with larger hematomas, the old nail may fall off. If this happens, a new nail will typically grow in its place, though this process takes time.
• Warning signs for complications: - It's important to watch for signs of infection. These include increasing pain, redness, warmth, or swelling around the nail, pus draining from the area, or a fever. If the nail bed itself was badly damaged, there's a small chance the new nail might grow back with a different shape or texture.

Prevention

While accidents happen, there are steps you can take to reduce your risk of getting a subungual hematoma.

• How can it be prevented? - The best prevention is to protect your fingers and toes from direct injury.
• Common triggers and how to avoid them:
  • Be extra careful when using tools like hammers or knives.
  • Watch out for slamming fingers in doors, drawers, or car doors.
  • Wear sturdy, closed-toe shoes, especially when working with heavy objects or in environments where foot injuries are possible. Consider steel-toed boots if your job requires it.
  • If you're an athlete, especially a runner, ensure your shoes fit properly to prevent your toes from repeatedly hitting the end of the shoe.
  • Keep play areas safe for children, minimizing risks of heavy objects falling on small hands or feet.

Causes & Triggers

Understanding what causes a subungual hematoma can help you avoid it.

• What causes it? - A subungual hematoma is caused by a direct, often forceful, blow or crushing injury to your fingernail or toenail. This trauma causes the small blood vessels under the nail to break and bleed into the confined space between the nail plate and the nail bed.
• Common triggers and how to avoid them:
  • Crushing injuries: - Slamming a finger in a door, dropping a heavy object on a toe. Avoid by being mindful of hand/foot placement and using safety gear.
  • Direct blows: - Hitting a finger with a hammer, stubbing a toe forcefully against a hard object. Avoid by using caution with tools and being aware of your surroundings.
  • Repetitive trauma: - Less common, but can occur in athletes, like runners whose toes constantly hit the inside of their shoes. Avoid by ensuring proper-fitting footwear.
• Who is most likely to develop it? - Anyone can get a subungual hematoma if they experience an injury to their nail. However, they are more common in:
  • Children, due to their active play and occasional lack of coordination.
  • Athletes, particularly in sports involving running, kicking, or potential impacts.
  • Individuals in manual labor jobs where hands and feet are at risk.
• Risk factors: - The primary risk factor is engaging in activities or being in environments where there's a higher chance of direct trauma to your fingers or toes.

When to see a doctor

While many minor subungual hematomas can be cared for at home, there are times when it's really important to see a doctor or a dermatologist.

• What signs should you look for? - Pay attention to the severity of your symptoms and any changes.
• How to know when to see a dermatologist or doctor:
  • If the pain is severe, throbbing, and unbearable, even after taking over-the-counter pain relievers.
  • If the hematoma (the dark area) covers more than 25% to 50% of your nail surface. A doctor might need to relieve the pressure.
  • If you notice any signs of infection, such as increasing redness spreading around the nail, warmth in the area, pus draining from under or around the nail, or if you develop a fever.
  • If there was a deep cut (laceration) associated with the injury to the nail or surrounding skin.
  • If you suspect a broken bone in your finger or toe (e.g., inability to move it, significant swelling, or deformity).
  • If you are unsure about the diagnosis or how to properly care for the injury.
  • If the nail is very loose, looks like it might fall off completely, and you're concerned about it.
  • If you have diabetes or a condition that affects your circulation or healing, it's always a good idea to have any foot or hand injury checked by a doctor.

Remember, it's always better to be cautious. A healthcare professional can provide an accurate diagnosis and guide you on the best course of action.

Frequently Asked Questions (FAQs):

• Will my nail definitely fall off if I have a subungual hematoma?
  Not necessarily. If the hematoma is small, the nail might stay intact and the bruised area will simply grow out. However, if the hematoma is large or the injury was quite severe, the pressure of the blood can separate the nail from the nail bed, and it may eventually fall off. A new nail will usually grow in its place, but this can take many months.
• Is a subungual hematoma just a blood blister under the nail?
  In a way, yes. It's similar in that it's a collection of blood caused by injury. However, because it's trapped under the hard nail plate, the pressure can be much more intense and painful than a typical blood blister on the skin.
• How long will it take for my nail to look normal again?
  The discoloration itself doesn't fade; it has to grow out with the nail. Fingernails grow about 3 millimeters per month, so it can take around 6 months for a fingernail to fully replace itself. Toenails grow slower, about 1 millimeter per month, so it can take 12 to 18 months, or even longer, for a toenail to grow out completely.
• Should I try to pop or drain the blood from under my nail myself?
  No, it is strongly advised not to try and drain a subungual hematoma yourself. Poking holes in your nail or trying to lift it can introduce bacteria and lead to a serious infection, or cause further damage to the nail bed. If the pressure is severe, a doctor can perform a sterile procedure called nail trephination to relieve it safely.
• Is it normal for the area to still be a bit tender after a few days?
  Yes, it's quite normal for the area to remain tender to touch for several days, or even a week or two, especially if the initial injury was significant. The intense, throbbing pain usually subsides earlier. However, if the pain starts to get worse instead of better, or if you see signs of infection (like redness, swelling, or pus), you should see a doctor.