A subungual hematoma is a collection of blood (hematoma) underneath a fingernail or toenail (usually appears like a black toenail or fingernail). It’s not a serious medical condition although it can be extremely painful with an injury of its size. The intense pain is mainly due to the pressure produced by the collection of blood.
Subungual hematoma mostly result from traumatic nail bed injury, which commonly occurs when the digit is smashed in a door, stepped on, or hit under pressure.
Trauma to the nail compresses it down to the nail bed causing delicate blood vessels to rupture, leaking blood into the nail bed resulting into the build up of pressure and the subsequent pain. The leaking blood collects underneath the nail forming a dark red or purple spot.
As much as it may not be a serious medical condition, many times it is much of a concern to some people. Below are 10 facts you can learn today about subungual hematomas.
1. What are the causes of subungual hematoma?
Subungual hematomas are common, crush-type injury of the digits. The injury can happen due to several reasons where the most common among patient complaints include:
– hitting the finger with a hammer.
– hurting the finger when closing the door.
– dropping a heavy object on the toes.
– stubbing the toes on corners of chairs and tables.
– climbing or hiking rugged terrain.
– sporting activities.
2. What are the signs and symptoms of subungual hematoma?
* Blood underneath the nail. There is a discoloration characterized as dark red, maroon, or purple spot beneath the nail after injury.
* Intense pain. When blood collects underneath the nail, it results into an intense pressure that leads to onset of pain.
* Tenderness and swelling of the affected nail or toe.
3. How is subungual hematoma diagnosed?
By analyzing the nail, the health provider will be able to confirm if you do have subungual hematoma. The following tests may be performed:
(i) An X-ray of your finger or toe may be performed to check for broken bones.
(ii) A dermascopy may be performed to check for the extent of your nail damage using a microscope.
(iii) A biopsy is a test performed by taking a part or all of the involved nail. The nail is sent to the lab for further analysis.
4. What are available subungual hematoma treatment options?
In case of a mild hematoma, home remedies can be used to relieve the pain. Available subungual hematoma home remedies include the use of:
(i) Ice and Elevate: To relieve the throbbing and pain, you can keep the digit elevated by raising the arm or leg with the affected nail. Apply a pack of ice several times a day for up to 20 minutes each. Wrapping the ice with cloth is recommended than placing it directly on the affected nail. In the first few days, it’s imperative to rest the toe or nail as much as possible to avoid further irritation.
(ii) Over-the-counter NSAIDs can help relieve the pain and swelling, for example aspirin and ibuprofen.
In case of intense pain coming from the hematoma, the following procedures can be implemented.
(i) Trephination: Also known as decompression, whereby the health provider numbs the affected digit then drains the subungual hematoma by piercing the nail using a cautery, a heated needle or paper clip. This helps relieve the pain and swelling.
(ii) Nail removal: If the nail is badly injured it will be totally removed and followed by stitches of the nail bed to help repair the tissues. This enables the nail to regrow.
(iii) A splint may be placed on the digit to protect the area and also limit movement while it heals.
5. How to prevent further injury to your subungual hematoma at home?
Keep the involved digit as dry as possible. Wear comfortable shoes that perfectly fit to prevent injury to the toe. Keep the nails well-trimmed to avoid them catching on an object that could further aggravate the condition.
6. When to contact a healthcare provider?
If confirmed to just be a mild hematoma, home remedy can be perfect. But when you notice the following, better seek medical attention.
– Increase in redness, pain, and swelling.
– Falling nail and bleeding.
– Noticeable pus and foul smell coming from the nail.
7. How can subungual hematoma be prevented?
You can easily avoid subungual hematoma by applying careful practices such as:
*Wearing steel-toed shoes when working in high-risk areas such as construction.
*Avoid lifting things you cant lift alone.
*Watching your kid’s hand, and yours as well, when slamming the door.
*Giving full attention to the tasks at hand because most hand injuries are due to distractions.
8. What are necessary follow-up care?
After draining of the hematoma, follow-up will not be always necessary but you will be prescribed with antibiotics that can be used to prevent infection. In case of a laceration, most of the stitches placed should dissolve over time but if not, you may visit the hospital for removal after around 7 days.
Close monitoring at home is also recommended.
9. What to expect of subungual hematoma prognosis?
After the draining procedure, the pain will be relieved and the nail starts to grow. However, nail bed laceration is a possible long-term complication.
Stitching is usually performed after the nail is removed where the skin beneath the cut heals with time. It is possible to result into a deformation of the nail either temporarily or permanently.
10. Why should diabetics be concerned?
Diabetes causes unhealthy changes to your extremities including hardening of veins of the hands and feet, decreased supply of blood, and vein damage to an extent that pain receptors fail to let you feel the presence of injuries.
In case of subungual hematoma in a diabetic person, when the nail bed becomes infected it may spread to deeper tissues like the bones especially if not treated properly. Diabetics are more susceptible to infection and should always be on the look out.
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