Subungual Hematoma

What is a subungual hematoma?

A subungual hematoma is a condition where blood collects under your fingernail or toenail. Fingernails or toenails are the hard, flat covering on the ends of your fingers and toes. They protect your nail bed (area under your nail) that has many blood vessels and nerves. With subungual hematoma, blood gets trapped under your nail causing pressure and pain. Treatment of your subungual hematoma may relieve the pressure and decrease your pain.

What causes a subungual hematoma?

Your subungual hematoma may be caused by any of the following:

  • Injury: An injury may happen if your finger is slammed in a closing door. It may also happen if a heavy object is dropped on your toe. This type of injury may also cause a fracture (bone break) of the finger or toe. Certain sports may increase your risk for a subungual hematoma. This happens when your toe rubs or hits the inside of your shoe again and again.

  • Medical conditions: Certain cancers, such as melanoma (skin cancer) and Kaposi's sarcoma, and diseases of the blood. Autoimmune disorders, such as pemphigus vulgaris, where your body attacks its own cells may also cause a hematoma.

  • Medicine: Certain medicines used to stop your body from making blood clots or to treat cancer.

What are the signs and symptoms of a subungual hematoma?

A new subungual hematoma appears red, and is very painful and tender when touched. Your nail may be broken. You may have cuts, sores, and bleeding around your nail . If you have an old subungual hematoma, your nail may have a dark blue, purple or black color.

How is a subungual hematoma diagnosed?

Your caregiver may ask when you first saw the change in your nail. He may also ask about your activities and any medicines you are taking. Your caregiver will look at your nail to see how much blood has collected under it. He may take very small pieces of your nail to test for blood. He may check the sensations (how well you feel things) of your fingertips or toes. He may also check the blood flow to your nail bed by pinching it so it turns white. He will then let go to see how fast it gets pink again. You may also need any of the following:

  • Biopsy: The whole nail or a part of it may be removed and sent to a lab for tests. This may help your caregiver learn the cause of your hematoma.

  • Dermoscopy: This procedure uses a special hand-held microscope called a dermoscope. It will help your caregiver see any injury to your nail much better.

  • X-ray: You may need x-rays of your hand or foot. This allows your caregiver to see if any of your bones were broken during the injury.

How is a subungual hematoma treated?

If you have a small subungual hematoma, it may get better on its own. Keep your hand or foot raised above the level of your heart to help decrease swelling and pain. Place ice wrapped in a towel on your finger or toe for 20 minutes every hour. You may also need any of the following:

  • Medicine:

    • Digit block: A digit block is a shot of pain medicine that makes you lose feeling. You may need this if your pain continues or is getting worse. A digit block may also be used to make you lose feeling in an area before a procedure is done.

    • Antibiotics: This medicine is given to help treat or prevent an infection caused by bacteria.

    • Pain medicine: You may be given medicine to take away or decrease pain. Your caregiver will tell you how much to take and how often to take it. Take the medicine exactly as directed by your caregiver. Do not wait until the pain is too bad before taking your medicine. The medicine may not work as well if you wait too long to take it. Tell caregivers if the pain medicine does not help, or if your pain comes back too soon.

    • Td vaccine: This vaccine is a booster shot used to help prevent diphtheria and tetanus. The Td booster may be given to adolescents and adults every 10 years or for certain wounds and injuries.
  • Splint: Your caregiver may put a splint on your finger or toe. A splint will prevent movement and protect your injury so it can heal.

  • Surgery: If your hematoma is under more than half your nail, you may need to have your nail removed. Your nail bed may also need to be repaired. If you have a fracture, you may need to have the bone put back into place.

  • Trephination: Your caregiver may make very small holes in your nail to drain the blood and decrease your pain. He may use a hot paper clip, small drill, needle, laser, or surgical blade to make the holes. After draining the blood, he may put a dry, tight bandage over your finger or toe. The bandage may help pull out any more blood from under the nail and protect you from infection.

When should I call my caregiver?

Call your caregiver if:

  • Your finger becomes red and swollen.

  • Your nail falls off and there is bleeding.

  • You have questions about your condition, treatment or care.

When should I seek immediate help?

Seek care immediately or call 911 if:

  • There is pus, a bad smell, or red streaks coming out from your injury.

  • You have pain on your finger or toe that is getting worse, even after taking medicine.

Care Agreement

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment. The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

© 2014 Truven Health Analytics Inc. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. All illustrations and images included in CareNotes® are the copyrighted property of A.D.A.M., Inc. or Truven Health Analytics.

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