Summary about Disease
A subungual hematoma is a collection of blood under the fingernail or toenail. It typically results from trauma to the nail, such as stubbing a toe or hitting a finger. The pressure from the blood accumulation causes pain and may eventually lead to nail detachment.
Symptoms
Throbbing pain under the nail
Reddish-purple or blackish discoloration under the nail
Pressure sensation under the nail
Possible nail bed injury visible through the nail
Possible nail detachment (in severe cases)
Causes
Direct trauma to the nail (e.g., hitting with a hammer, stubbing a toe)
Repetitive microtrauma (e.g., from ill-fitting shoes during running)
Heavy objects falling on the nail
Crushing injuries to the finger or toe
Medicine Used
Pain relievers: Over-the-counter pain medications such as ibuprofen or acetaminophen can help manage the pain.
Antibiotics: if an open wound occurs in the region of the hematoma, antibiotic medication (topical or oral) can be used to prevent secondary infection.
Trephination: In some cases, a doctor may perform trephination (drilling a small hole in the nail) to relieve pressure and drain the blood. No medication is used in trephination itself, but antiseptic is used before and after.
Is Communicable
No, a subungual hematoma is not communicable. It is caused by physical trauma and is not infectious.
Precautions
Protect the injured nail from further trauma.
Wear comfortable shoes with adequate toe space.
Use caution when handling heavy objects.
Consider protective footwear in hazardous environments.
After trephination, keep the area clean and bandaged to prevent infection.
How long does an outbreak last?
A subungual hematoma is not an outbreak. The duration of symptoms depends on the size of the hematoma and whether the nail detaches. Pain may subside within a few days after pressure relief (if trephination is performed). Nail regrowth, if detachment occurs, can take several weeks to months (fingernails faster than toenails).
How is it diagnosed?
Physical examination of the nail and surrounding tissue.
Review of the patient's history of trauma.
X-rays may be performed to rule out underlying fractures, especially in severe injuries.
Timeline of Symptoms
Immediately after injury: Sharp, throbbing pain. Reddish discoloration appears under the nail.
Within hours: Pain intensifies as blood accumulates. Discoloration darkens to purple or black.
Within days: Pain may start to subside, especially if pressure is relieved. The hematoma may dry out.
Weeks to months: If the nail detaches, a new nail will grow, a process that can take several months (longer for toenails).
Important Considerations
Large hematomas or those associated with significant pain should be evaluated by a healthcare professional.
Consider trephination for pain relief, especially if the hematoma covers a large portion of the nail.
Rule out underlying fractures, especially in cases of severe trauma.
Be aware of signs of infection (increased pain, redness, swelling, pus) and seek prompt medical attention.
Individuals with diabetes or peripheral vascular disease should be especially cautious and seek medical advice promptly.