Most people are not familiar with the term subungual hematoma. It is simply bleeding under the nail, whether fingernail or toenail. Subungual hematomas are usually due to crush injuries, causing severe pain and pounding as blood accumulates beneath the nail. On its own, subungual hematomas are no cause for alarm and do not require medical emergency. But sometimes, bleeding underneath the nails is a symptom of broken bones or damage to the nail bed and/ or neighboring tissues.
Causes of Subungual Hematoma
As previously mentioned, subungual hematoma is usually a result of a crush-type injury concerning or comprising the finger or toe. Some traumatic injuries which involve the fingers or toes are the following:
- Hitting the finger with a heavy object
- Slamming the finger in a house or car door
- Toes getting stepped on multiple times
- Dropping a weighty object on the toe, such as a bowling ball
- Bumping the toe on a hard surface
It is usually quite obvious when there is bleeding under the nails. Some of the accompanying signs and symptoms include:
- A dark-colored discoloration under part or all of the affected nail/s (usually purple-black, red or maroon)
- Intense, pounding pain from the pressure of blood accumulating between the nail and its nail bed
- Tenderness and swollen tip of the affected finger/s or toe/s
- Spot will grow out with the nail
*If there is a darkened area under the nail with no history of injury and dark spot is in the same spot, it may be a tumor.
When to Seek Medical Help
- Hematoma is present in 50% or more of the underlying nail area
- Nail falls off and bleeding is continuous
- Very intense pain
- Whole finger become red and starts swelling
- Deformed finger or toe
- Injured joint proximate to the area
Treatment for Subungual Hematoma
First aid can be administered to subungual hematoma to relieve of symptoms.
- To minimize swelling, ice the injured finger/ toe. Never apply ice directly on the injured area. Wrap in a washcloth. Elevate the injured area above heart level.
- To reduce pain, over-the-counter pain medications may be taken, such as acetaminophen and ibuprofen. Aspirin may be also be taken but do not give to children younger than 18 years of age.
- If the nail was removed with no injury to the nail bed, follow the method until nail becomes less sensitive.
- Soak the injured area in water and antibacterial soap for 10 to 15 minutes. Do this twice a day.
- After soaking, apply a topical antibiotic ointment and place a dry sterile bandage.
Prevention of Subungual Hematoma
Subungual hematoma can be easily prevented by applying safety premeasures and common sense.
- Watch children’s hands as the doors are closed.
- When using the hand in tasks, even in seemingly menial chores, give full attention. Subungual hematoma is commonly due to distractions.
- If one works in high-risk jobs, use appropriate attire and wear necessary safety equipment.
- Do not lift weighty objects by self if it will be an extremely hard task. Ask for help.
It is necessary to apply first aid, when it is possible, to alleviate symptoms and give comfort to the casualty. To learn how to treat subungual hematoma and other bleeding injuries, register in the nearest First Aid Courses.