What is a Subungual Hemorrhage?

Subungual hemorrhage, commonly referred to as a subungual hematoma, occurs between the nail plate and the nail bed. It is a collection of blood resulting from injury to the nail. Symptoms of a subungual hemorrhage include pain, pressure, and discoloration of the nail.

A wide variety of injuries can cause a subungual hemorrhage. Common injuries include dropping an object on the nail bed or closing a finger in a door. Construction workers, athletes, those working with tools, and those working with their hands may be more susceptible to these types of injuries.

When a subungual hemorrhage occurs, bleeding causes pressure under the nail plate. This pressure results in severe pain. In addition, a red discoloration will appear below the surface of the nail. Further injury to the bone of the toe or finger is a concern with a subungual hemorrhage. Additional injuries, like a fracture, can add to the pain experienced by those suffering from a subungual hematoma.

To relieve the pain and diagnose any further injury, treatment may be necessary. Mild pain and a collection of blood on less than a quarter of the nail’s area can be treated at home. For larger areas of blood collection, a doctor’s input should be sought.

Several tests can be done by a physician when assessing the severity of a subungual hemorrhage. An x-ray will show any fractures that may have occurred to the bone. Beyond that, doctors will perform a visual exam of the nail bed. This will help them decide the appropriate treatment option.

Some subungual hematomas may need to be drained. This is done by first numbing the affected finger or toe. The doctor then uses one of a variety of methods to drain the hematoma. This can include using a needle or cautery, a medical device used to burn through the nail to reach the hematoma. Removal of the nail may be necessary.

Treatment at home varies depending on the severity of the injury. For hematomas that do not require a physician visit or removal of the nail, rest, ice, and anti-inflammatory medications will heal the area. If removal of the nail occurred, twice daily soaks in a foot bath with antibacterial soap will keep the area clean and limit the chance of infection. In addition, antibiotic ointment and a bandage should be applied.

The outlook is good for a subungual hemorrhage. Unless a fracture or laceration large enough to need stitches occurred, a return doctor visit will not be necessary. Nail deformity and the nail falling off can result as the hematoma heals and the nail grows out.