Subungual Hematoma: How to Fix Your Nail

Why is it that Doctors have to have fancy names for any medical condition? A Subungual Hematoma is a perfect example. The term means blood between your fingernail or toenail and the nail bed. Regardless of what you call it, ‘Nail blood’ at the least look ugly and at worst can be pretty painful.

Although a Subungual Hematoma is much less serious than other conditions our senior communities experience, it’s good to know what to do about them. Seniors can easily have an accident that injures their fingers or toes. Then the injury brings the blood.

Technically a subungual hematoma happens when something injures the blood vessels under the fingernail or toenail. I don’t think though that you will be able to injure the blood vessel without injuring the finger or toe.

When the blood vessels pop, the blood flows out and under the finger or toenail. That little space between the nail and nail bed can’t fit a whole lot. The pressure builds from the blood pooling. That pressure may cause pain for anyone who experiences this condition.

Evaluating a Subungual Hematoma

Subungual Hematomas can result from a bunch of different accidents around the home:

• Slamming your fingers in a car door
• Stubbing your toes
• Hitting your fingers with a hammer 
• Dropping something on your toes

When one of these accidents occurs, obviously you will feel a large amount of pain. The first thing to do is to make sure your finger or toe is ok. Injuries that cause a subungual hematoma can also cause a fracture in one of your digits. If the pain is intense, it’s worth having a Doctor check it out. 

They call the fracture of the bone at the end of your finger a distal phalanx fracture. I’m not sure that helps you in any way. It’s just to show you again how doctors come up with technical names for everything!

For mild subungual hematoma pain, a good rule of thumb is to look at how much of your fingernail has blood under it. The blood could be red, maroon, or a bluish-black pigment. If the blood covers ¼ or less of the nail bed, you can just take care of the injury at home. For nail beds that are over half-full of blood, you may want to seek medical attention regardless of the pain level.

Subungual Hematoma Home Remedies

Taking care of the problem at home boils mostly down to taking care of the pain. You probably won’t be able to remove the blood at home until the fingernail grows out.

Maybe you already know about pain remedies. Most people have racked up a bunch of accidents by the time they become seniors. The same rules still apply:

• Ice (wrapped in a towel or cloth)
• Elevating the finger or toe that is bleeding
• Tylenol, Advil or other non-prescription pain remedies

Or any other pain remedies you know about. 

I was once moving furniture with my wife. My wife slid the couch towards me. It caught the nail on my big toe. It felt painful. What really shocked me though was seeing the nail sticking straight up 90 degrees from the toe!

The pain wasn’t enough to go to the Doctor. We didn’t have the internet back then. Looking back, I should have treated it better. From what I’ve researched since being in the assisted living business, it would be good to prevent infection if you lose your nail. 

If you lose your nail, try soaking the nail-less toe or finger in water with anti-bacterial soap for about 15 minutes once or twice a day for a couple of days. After you finish soaking the digit apply some non-prescription antibiotic ointment to the affected area.

What Can Medical People Do?

Let’s say you decide to go to the Doctor for your Subungual Hematoma. Here are some of the things a Doctor can do.

First of all, the Doctor will want to know if you fractured the finger or toe. They may order X-rays for you to let her know. Obviously the X-rays won’t say much about the blood vessels, but it will help them rule out treating the bone.

The Doctor will then ask you what you did to injure the finger or toe (she might ask you that before the X-ray). Depending on the nature of the injury and the amount of blood under the nail, the Doctor may decide to remove the nail to check how bad the injury is underneath.

The Next Step – Nail Trephination

That’s not to say the Doctor will remove the nail every time. Hopefully they will just do it if you have a lot of pain, or there is a high risk of cuts (or lacerations in Doctor-speak). The Doctor may also be able to drain the blood from your nail using a procedure called nail trephination. Here is a video of how nail trephination works:

Doctors might also numb your finger or toe with a ‘digital block’. They like to call your fingers or toes ‘digits’, as opposed to ‘fingers’ or ‘toes’. The block means they will inject medication that numbs the area at the base of the finger or toe. The injection might hurt more than the problem. You may want to decline this procedure if the pain it too bad.

Once your finger is numb, a Doctor has several options to drain the blood from underneath your nail:

1. The simplest way is to use a needle to put a hole in the nail and drain the blood
2. Burning through the nail. It’s called electrocautery (what did I say about big names?). Doctors can use a device that burns a hole in the nail to drain the blood.
3. The old paper clip. Most Doctors don’t practice this method much anymore. If people do use it, they unfold a paper clip so the pointed end is sticking out. Then they heat up the pointed end and use it in a combination of pushing and burning through the nail.

 WARNING: Anyone using fake nails should be aware that fake nails are flammable. You may not want to use any of the heat methods if you have fake nails. Or at least remove them.

Subungual Hematoma Follow Up

Depending on how extensive your injury is, there is usually not a lot of follow up involved with a subungual hematoma. Infections are pretty rare, so don’t try to solicit your Doctor for antibiotics. Of course, you should listen to your Doctor if he prescribes the antibiotics.

For more extensive treatment, such as deep cuts in your nail bed that required stitches, your Doctor will probably want a follow up visit to make sure everything is ok. 

Worst case, you may have a fracture in addition to the subungual hematoma. In that case, you may have a splint. Try to keep the splint and the area under it clean and dry to prevent infection. I’m pretty sure the Doctor will also want to see the progress and decide when to remove the splint.

Our assisted living homes work with Doctors all the time, even on (mostly) minor occurrences like this.  The staff at A Paradise for Parents also have basic medical training to administer medications, perform routine first aid, and are trained in CPR if required. You can read about our manager’s credentials for each of our homes, on these pages:

• 15922 N. 164thLane, Surprise, AZ 85388
• 18175 W. Banff Lane, Surprise, AZ 85388
• 15257 N. 135thDrive, Surprise, AZ 85379
• 15292 W. Campbell Ave. Surprise AZ 85395

If you have any questions, please don’t hesitate to call us at 623-295-9890, check out our website, or email us at Cam@aparadiseforparents.com.