Subungual Hematoma

A subungual hematoma is a painful condition where blood collects under a fingernail or toenail. This makes the nail look dark or discolored, like a bruise. It usually happens when you hit your finger or toe hard, like slamming it in a door.

Nail trauma is the main reason for subungual hematomas. When you hit your nail hard, it can break small blood vessels. This lets blood leak under the nail, causing pain and swelling. Activities like running or wearing tight shoes can also cause this problem over time.

It’s important to know the signs of a subungual hematoma to treat it right. You might see your nail turn dark, feel throbbing pain, or notice swelling. If not treated, it could get infected or damage your nail forever. Knowing how to deal with it can help you recover quickly and keep your nails healthy.

What is a Subungual Hematoma?

A subungual hematoma, also known as a bruised nail or nail bleeding, is a painful condition. It happens when blood collects under the nail plate. This is due to damage to the tiny blood vessels under the nail, causing discoloration and pressure buildup.

While subungual hematomas can affect both fingernails and toenails, they are more common in toenail hematomas. This is because the feet are more likely to experience trauma.

Understanding the Anatomy of the Nail

To understand how subungual hematomas form, it’s important to know the nail’s anatomy. The nail has several parts:

How Subungual Hematomas Form

When the nail experiences trauma or repetitive stress, the blood vessels in the nail bed can rupture. This leads to bleeding beneath the nail plate. As the blood accumulates, it creates a visible discoloration and pressure that can cause significant pain.

The affected nail may appear dark red, purple, or black, depending on the amount of blood trapped underneath.

Subungual hematomas are more likely to occur in toenails due to several factors. First, the toes are frequently exposed to impact and pressure from activities like walking, running, or wearing tight shoes. Second, the larger size of the toenails provides a greater surface area for injury. Lastly, conditions like fungal infections or psoriasis, which are more common in toenails, can weaken the nail and make it more susceptible to toenail hematomas.

Common Causes of Subungual Hematomas

Subungual hematomas can happen for many reasons. This includes both sudden injuries and ongoing health issues. Knowing what causes them can help prevent and spot them early.

Trauma and Injury

Most often, subungual hematomas come from sudden injuries. These injuries can cause nail damage and bleeding under the nail. Here are some examples:

Repetitive Stress

Doing the same thing over and over can also cause subungual hematomas. This is because it puts constant pressure on the nails. Here are some examples:

• Ill-fitting shoes that constantly rub against toes
• Long-distance running or hiking
• Occupations requiring extensive manual labor or tool use

Underlying Health Conditions

Sometimes, subungual hematomas can point to a bigger health problem. Conditions like fungal infections, psoriasis, or blood disorders can make nails more likely to bleed or detach. If you get subungual hematomas often without any injury, see a doctor to check for health issues.

Symptoms of a Subungual Hematoma

If you’ve got a bruised nail or subungual hematoma, you might wonder what symptoms to watch for. Common signs include pain, tenderness, and nail discoloration. You might feel a throbbing or painful sensation in the nail, which can vary in intensity.

As blood builds up under the nail, you’ll see a change in its look. The nail discoloration usually shows as a dark red, maroon, or purple color. This can look like a bruise, which is why it’s called a “bruised nail.” The area might also feel tender or sensitive to touch.

As the subungual hematoma heals, the nail discoloration might change. The dark color may fade or move away from the cuticle as the nail grows. Sometimes, the trapped blood can push the nail away from the nail bed, causing more pain.

Diagnosing a Subungual Hematoma

If you think you have a subungual hematoma after a nail injury, getting a proper diagnosis is key. It helps figure out how bad it is and what treatment you need. Doctors usually do a physical check and might use imaging tests.

Physical Examination

Your doctor will first do a detailed check of the nail and the area around it. They’ll look at the size, color, and where the discoloration is. They might press gently on the nail to see if it hurts, which could mean there’s a hematoma.

They’ll also ask about how the nail injury happened and any pain you’re feeling.

Imaging Tests

At times, imaging tests are needed to see how bad the nail injury is and to check for other problems. X-rays can spot bone fractures that might happen with a subungual hematoma. If there’s a chance of something stuck under the nail or an infection, an ultrasound or MRI might be used.

Your doctor will look at what they find from the physical exam and imaging tests. Then, they’ll suggest the best treatment for your nail injury and what you need.

At-Home Treatment Options for Subungual Hematomas

If you have a mild subungual hematoma and the pain is manageable, you can try some at-home treatments. These simple remedies can be effective for minor cases. But, it’s important to watch your symptoms and see a doctor if they get worse or don’t go away.

Ice and Elevation

Applying ice to the affected area can help reduce pain and swelling. Wrap an ice pack or bag of frozen vegetables in a thin towel. Then, apply it to the injured nail for 10-15 minutes at a time, several times a day. Also, elevating the affected hand or foot above your heart can help minimize swelling and promote blood flow for better nail repair.

Pain Relief Medications

Over-the-counter pain medications like acetaminophen or ibuprofen can help manage pain and discomfort. These medications can also help reduce inflammation, which may aid in the nail repair process. Always follow the dosage instructions on the packaging and consult with your healthcare provider if you have any concerns or underlying health conditions.

It’s important to remember that at-home treatments may not be suitable for all cases of subungual hematomas. If you experience severe pain, significant swelling, or signs of infection, such as redness, warmth, or discharge around the affected nail, seek prompt medical attention. This is for proper evaluation and treatment.

When to Seek Medical Attention

Minor subungual hematomas can usually be treated at home. But, there are times when you need to see a doctor. If the pain is severe, you see signs of infection, or if home care doesn’t work, get medical help fast.

Fingernail trauma can cause problems if not treated. It’s key to know when you need a doctor. Look out for these signs:

Your doctor will check how bad your subungual hematoma is. They will tell you the best way to treat it. Sometimes, they might need to do a procedure called nail trephination to drain the blood. If the nail is badly damaged or infected, they might need to remove part or all of it.

Getting medical help quickly for serious fingernail trauma is important. It helps avoid more problems and helps your nail heal right. Don’t wait to see a doctor when you need to for your nail health.

Professional Treatment for Subungual Hematomas

If a subungual hematoma hurts a lot or covers a big part of the nail, you might need a doctor’s help. A healthcare provider can check how bad the nail damage is. They will tell you the best way to fix it and help it heal.

Nail Trephination

Nail trephination is a method to make a small hole in the nail to let the blood out. This helps with the pain and pressure from the hematoma. A doctor can do this in their office using a clean needle or drill.

This method works best if done within 48 hours after the injury. Here’s a table showing the good and bad sides of nail trephination:

Nail Removal

Sometimes, taking out the whole nail is needed for it to heal right. This is for really bad cases or when trephination doesn’t work. Removing the nail is done under local anesthesia and might need a second visit to make sure it heals well.

When the nail is gone, the nail bed will heal. A new nail will grow back in a few months. It’s key to keep the area clean and safe to avoid infection and help the new nail grow well.

Preventing Subungual Hematomas

Accidents can happen, but there are ways to lower your risk of getting a painful subungual hematoma. Protecting your nails from injury and fixing health issues can keep them healthy and safe.

Protecting Your Nails

One key way to avoid subungual hematomas is to protect your nails from harm. Wear protective gear when doing activities that might hurt your nails, like:

• Properly fitting, sturdy closed-toe shoes
• Steel-toed boots for construction or heavy labor
• Gloves when working with tools or playing certain sports

Trimming long fingernails can also help. Shorter nails are less likely to snag or break, which can cause nail injury. Keeping nails short can reduce the chance of painful accidents.

Addressing Underlying Health Issues

Health problems like diabetes, peripheral arterial disease, and fungal infections can increase your risk. If you have one of these, work with your doctor to manage it. This can help protect your nail health.

Check your nails often for damage, color changes, or texture issues. If you see something odd, see a dermatologist or podiatrist. They can help prevent and treat nail injuries.

Complications of Untreated Subungual Hematomas

Not treating a subungual hematoma can cause serious problems. The blood under the nail can put pressure, leading to nail detachment and a lot of pain.

Untreated hematomas can also get infected. This is more likely if the injury broke the skin or nail. Look out for signs like more pain, redness, swelling, and discharge. If you see these, get medical help fast to stop the infection from spreading.

Another issue is nail deformities. The nail might grow in a weird shape or color because of the trapped blood. In bad cases, the nail could fall off, leading to nail loss. The bigger the hematoma and the longer it’s untreated, the higher the risk of these problems.

It’s important to watch the subungual hematoma closely. If the pain gets worse or you see signs of infection, see a doctor. Early treatment can help avoid more damage and help the nail heal right.

Recovery and Nail Regrowth After a Subungual Hematoma

After treating a subungual hematoma, the nail starts to heal. The time it takes for the nail to fully recover depends on the injury’s severity and the treatment. In most cases, the damaged nail part will grow out and be replaced by healthy tissue.

Nail regrowth takes several months. Fingernails and toenails grow slowly, about 3.5 mm and 1.6 mm per month, respectively. It’s key to practice good nail care during this time to aid healing and prevent damage or infection.

Nail Care During the Healing Process

To care for your nail as it heals, keep it clean and dry. Avoid picking at or manipulating the damaged area. If your doctor treated the injury with nail trephination or removal, follow their instructions for wound care and watch for infection signs. Applying moisturizer to the skin around the nail can prevent dryness and cracking, helping the healing process.

Even after the nail fully regrows, it might look different, like ridges or discoloration. These changes are usually harmless and will improve over time. But, if you notice persistent or worsening symptoms like pain, swelling, or discharge, see your healthcare provider to check for complications.