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Subungual hematoma

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Subungual hematoma is the build-up of blood in the area amid the nail bed and fingernail. This usually occurs from a direct injury to the fingernail. The pressure produced by the accumulation of blood beneath the nail results to intense pain.

What are the causes?

It is important to note that a subungual hematoma typically forms after a crush-type injury to the tip of the finger or toe.

It can occur in various ways such as:

  • Striking the finger with a hammer or other tools
  • Dropping a heavy object on the toe
  • Closing the door on a finger
    Subungual hematoma
    Intense pain due to pressure between the nail and the nail bed where blood builds up.

What are the indications?

  • Blood beneath the nail of either a toe or finger. There is discoloration of maroon, red or other dark color under the nail after an injury.
  • Intense pain due to pressure between the nail and the nail bed where blood builds up. The pain can also be caused by other injuries such as a fracture to the underlying bone, tear in the nail bed or bruising.

When to seek medical care for a subungual hematoma

In case the pain is minor and the build-up of blood is less than 24% of the area beneath the nail, home care is usually enough.

If the hematoma covers 50% or more of the underlying nail, medical care is needed. In case the injury responsible for the subungual hematoma is significant enough to trigger significant pain and tenderness, you should seek medical care.

The mechanism of injury can result to a fracture to the bone at the end of the toe or finger or even a laceration to the nail bed beneath the nail that requires medical care.

Home remedies

Application of ice, elevation and pain medications are suitable for a minor case of subungual hematoma. Make sure that the ice pack is wrapped in a cloth or towel before applied on the skin.

If the hematoma covers more than 50% of the area of the nail, medical care is required.

In case the nail was taken out during the injury and the nail bed is not damaged, home treatment is recommended until the nail bed starts to become less sensitive, usually in 7-10 days. The treatment involves daily soaks with an antibacterial soap and water for 10-15 minutes and application of a dry, sterile bandage.

Quick Note / Disclaimer

The material posted on this page on subungual hematoma is for learning and educational purposes only. To learn to recognize and manage subungual hematoma, register for a first aid and CPR course with Red Deer First Aid.

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