What’s a subungual hematoma?

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A subungual hematoma is a pool of blood that collects under a finger or nail. It is a common result of a traumatic nail bed injury, which can occur if a toe is shattered in a doorway, stepped on, or otherwise crushed under pressure. Blood vessels under the nail rupture and leak blood into the nail bed, causing a buildup of pressure and often severe pain. In most cases, a small subungual hematoma goes away on its own in about two weeks without special treatment. A very large or painful bruise can be relieved in a doctor’s office by draining the blood or removing the damaged nail.

Trauma to a nail that compresses it into the nail bed causes delicate blood vessels to rupture. The leaking blood collects under the nail and forms a dark red or purple spot. The buildup of pressure can make a finger or toe throb and feel very tender to the touch. Depending on the severity of the injury, a person may experience constant pain, weakness, and swelling as well as a subungual hematoma.

Home remedies are usually sufficient to relieve symptoms while a minor bruise heals. A person can reduce the pulse and pain by keeping the figure high and applying an ice pack several times a day. It is important to rest your finger or toe as much as possible in the first few days to avoid further irritation. Over-the-counter anti-inflammatory medications such as aspirin and ibuprofen can also help relieve pain. As the nail heals, the dark spot gradually becomes smaller and lighter in color until it disappears completely.

A person should visit a doctor if they are in severe pain and the subungual hematoma takes up most of the space under the nail. Your doctor may carefully examine your finger to check for tears to the underlying nail bed. X-rays may be taken if a bone fracture is suspected due to the degree of swelling and pain.

A trained doctor can drain a subungual hematoma by piercing the nail with the tip of a heated needle or paper clip. Once a small hole is created, the pressure is instantly relieved as blood drains from the nail bed. You may need to remove the entire nail if your doctor thinks your nail bed may be seriously damaged. The exposed bed is treated with antibiotics and wrapped in a protective bandage to prevent infection. The digit is usually tender for several days, but eventually begins to feel better as the swelling subsides and a new nail begins to grow into place.

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