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Subungual Hematoma (Bleeding Under Nail)

Subungual Hematoma Overview

A subungual hematoma is a collection of blood in the space between the nailbed and fingernail. Subungual hematoma results from a direct injury to the fingernail. The pressure generated by this collection of blood under the nail causes intense pain.

Subungual Hematoma Causes

Subungual hematomas most commonly form after a crush-type injury to the tip of the finger or toe.

This injury can occur in many ways:

Hitting your finger with a hammer

Dropping a heavy object on your toe

Closing your finger in a door

Subungual Hematoma Symptoms

Blood underneath the nail of either a finger or toe is a subungual hematoma.

- You will have a discoloration of red, maroon, or other dark color beneath the nail after an injury.

The most common symptom is intense pain.

- Pressure generated between the nail and the nailbed, where the blood collects, causes this pain.

- The pain may also be caused by other injuries such as a fracture (break) to the underlying bone, or bruising to the finger or toe itself.

When to Seek Medical Care

If the pain is mild and the hematoma (blood collection) is less than 25% of the area under the nail, then home care is recommended.

If the hematoma is 25% or more of the underlying nail area, then medical attention is required.

If the injury that causes the subungual hematoma is severe enough to cause intense pain and tenderness or if the blood collection beneath the nailbed occupies 25% or more of the nail area, you should seek medical attention. The mechanism of injury for this condition can cause a fracture to the bone at the end of the finger or toe or a laceration to the nailbed under the nail that may require further medical attention.

Exams and Tests

X-ray

- Often, an x-ray is taken to look for the possibility of a fracture (break) to the underlying bone.

- X-rays do not provide any information regarding the bleeding or hematoma formation underneath the nail.

Nailbed evaluation

- Depending on the type of injury and the degree of the injury and how much blood forms under the nail, the doctor may decide to remove the nail to check the nailbed for lacerations (cuts).

Subungual Hematoma Treatment Self-Care at Home

Ice, elevation (keeping your arm or leg above the level of your heart), and anti-inflammatory medications, such as ibuprofen (Advil, Motrin), are recommended for minor hematomas. Wrap ice in a towel and do not apply ice directly to skin. A bag of frozen vegetables wrapped in a towel works well.

If the hematoma involves more than 25% of the area of the nail, then medical attention is needed.

If the nail was removed by the injury or the doctor and the nailbed wasn't cut, the following home treatment is recommended until the nailbed begins to be less sensitive, usually in 7-10 days.