Hematoma Under the Nail
A Hematoma is the result of trauma to the nail plate. It can happen from simply trapping your finger or toe in the car door to friction from improperly fitting or 'too-tight' shoes, to a sports-related injury. A hammer does a pretty good job at causing a hematoma as well! The nail bed will bleed due to this trauma, and the blood is trapped between the nail bed and the nail plate. A hematoma may also indicate a fractured bone. Many people who participate in sports activities experience hematoma because of the constant friction from the shoes against the toenails. Hematoma may result in nail plate separation and infection because the blood can attract fungi and bacteria.
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.
Twice daily soaks with antibacterial soap and water for 10-15 minutes
After soaks, application of a topical antibiotic ointment (such as Neosporin) and a dry sterile bandage (Band-Aid)
Medical Treatment
Several techniques are used to drain the blood beneath the nail. This procedure is also called releasing the hematoma.
No single technique is preferred.
How your hematoma is drained depends on the experience of the doctor and where it is done.
Frequently, the finger or toe is numbed with a digital block. (Your fingers and toes are called digits.)
A numbing medication such as lidocaine is injected at the bottom of your finger or toe.
Injecting the medication here numbs the entire digit.
As soon as your finger or toe is numb, the procedure can take place.
The following are commonly used methods for draining your hematoma:
Cautery: A battery-operated device is used to burn a hole in the nail until the blood is reached and drains out the hole.
Needle: A large diameter needle is used to drill or bore into the nail to create a hole to allow the blood to drain out.
Paper clip: This technique, although an older one, is still used by some practitioners. A paper clip is opened so that the pointed end is free. Then the pointed end is heated up, usually by passing it through a flame, and used to burn through the nail. This technique uses a combination of the cautery method and the needle method.