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Bleeding under the nail: Subungual hematoma

A subungual hematoma is the medical term for transient bleeding that occurs under a fingernail or toenail. This common injury is usually the result of a crush injury. Severe pain and a throbbing sensation are associated with this because the blood collects under the nail. The treatment consists of removing the pressure of the collected blood under the nail. Minor bleeding does not even require medical treatment. Normally the prospects for a subungual hematoma are very good, unless other symptoms are accompanied by the bleeding.

  • Causes of bleeding under the nail
  • Symptoms: Pain due to collected blood
  • Diagnosis and examinations
  • Treatment: Remove pressure and drain blood
  • Prognosis for subungual hematoma is excellent


Causes of bleeding under the nail

Most often, a subungual hematoma is a direct result of trauma or crushing of the tip of the finger or toe. This happens, among other things, in the following circumstances:

  • The patient is wearing shoes that are too tight.
  • The patient drops a hammer or other heavy object on the toes.
  • The patient hits the fingers with a hammer or other heavy object.
  • The patient stubs his toes on a hard surface.
  • The patient has his fingers trapped between a car door or house door.


Symptoms: Pain due to collected blood

The most common symptom of a subungual hematoma is severe, throbbing pain due to the pressure of the blood and fluid that collects between the nail and the nail bed. Furthermore, the patient has a dark discoloration under all nails or part of the affected nail. This is initially red to purple and later dark brown and black when the blood clots. The nail of the affected finger or toe is sensitive and also swollen. The bleeding spot grows together with the nail. The pain usually disappears a few days after the trauma. The nail often looks worse than it feels, although this is not the case with every patient.

Diagnosis and examinations

Contact the doctor

The patient always has bleeding under the nail diagnosed in the event of trauma, because this may be accompanied by a bone fracture and/or serious damage to the nail bed and/or surrounding tissues. If the patient suddenly notices bleeding under the nail without the presence of trauma, a visit to the doctor is also indicated, as this may indicate a tumor. In addition, contact with the doctor is necessary when the bleeding does not stop, the pain becomes intense or when the patient shows significant damage to the base of the nail.

Physical and diagnostic examination

The doctor examines the nail thoroughly. The doctor then takes an X-ray of the nail to rule out a broken bone, a tumor or other injury.

Differential diagnosis

Sometimes the doctor diagnoses the patient with a subungual hematoma, while the patient has a tumor under the nail. A visit to the doctor is certainly recommended if there is a dark spot under the nail that is not the result of trauma to the nail. With a tumor, the spot remains under the nail and, unlike a subungual hematoma, does not grow with the nail.

Treatment: Remove pressure and drain blood

Uncomplicated subungual hematoma

A painless and small subungual hematoma usually requires no treatment. However, the pressure of the collected blood may be very painful. To relieve the pain, the doctor performs a so-called decompression (decompression = removing pressure). He then makes a small hole in the nail through which the underlying nail leaks out, relieving pressure and reducing pain. This treatment method is known as trepanation. After such a procedure, the patient is given a bandage on the nail. The patient then holds the finger or toe in an elevated position. He may also use cold compresses or ice if necessary for the first twelve hours after this treatment. The patient should not immediately place the ice on the affected nail as this may cause even greater damage (frostbite). However, he does use ice wrapped in a towel. In some cases, the doctor recommends using a splint for up to three days after treatment until the sensitivity decreases. Over-the-counter painkillers are also allowed. The main complication of decompression is a small risk of inflammation.

Complicated subungual hematoma

If a subungual hematoma affects a large portion of the nail surface, the nail bed is significantly damaged. In these cases it is sometimes necessary to remove the nail along with the sutures on the nail bed.

Prognosis for subungual hematoma is excellent

The affected nail usually falls out spontaneously after a few weeks. After about eight weeks, the patient receives a new fingernail. Regrowth of a new toenail takes a longer time, namely approximately six to nine months. If there is damage to the nail bed and/or surrounding tissues, this will take a little longer. Sometimes the new nail takes on a different appearance.

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