A painless and small subungual hematoma usually doesn’t need treatment. But the pressure generated by pooled blood under the nail can be extremely painful. To relieve the pain, your doctor may perform decompression, also called trephination, which allows the underlying blood to drain, relieving pressure and pain to the area.
What is subungual hematoma drainage?
Subungual Hematoma Drainage - StatPearls - NCBI Bookshelf Subungual hematomas are injuries of the nail bed in which bleeding develops under the nail. Patients usually complain of pain and discoloration of the nail. The damage is caused by a direct blow or a crush injury to the distal phalanx, for example, getting a finger pinched in a doorway.
What are the possible complications of subungual hematoma?
Subungual hematoma is associated with fractures of the distal phalanx in 10% to 25% of patients. Nail loss is possible but less likely when the evacuation of hematoma is undertaken within 24 hours of injury. If the nail is lost, there will be nail regeneration, possibly with an abnormal shape.
What is the association between occult laceration and subungual hematoma?
Subungual hematoma: association with occult laceration requiring repair. [Am J Emerg Med. 1987] Subungual hematoma: association with occult laceration requiring repair. Simon RR, Wolgin M. Am J Emerg Med. 1987 Jul; 5(4):302-4. Fingertip-nail bed injuries in children: current concepts and controversies of treatment.
Is cephalexin (Keflex) effective in the treatment of subungual hematoma?
Even when opening a subungual hematoma with an underlying fracture of the distal phalanx, antibiotics have not been shown to be of any value in preventing infection. A brief course of cephalexin (Keflex) may be justified when treating patients with diabetes and peripheral vascular disease or who are immunocompromised.
Does draining blood from toenail hurt?
The nail may feel sore or tender to the touch. As the blood pools under the nail the pressure from the blood can cause severe pain. The pressure caused by blood underneath the nail may result in the affected nail lifting off the finger or toe.
Does getting your nail drained hurt?
You may be able to relieve severe, throbbing pain by draining blood from under your nail. This procedure is not necessary and is not recommended if you are not having pain. This procedure is safe if done properly.
What to do after draining a subungual hematoma?
It is necessary to keep the splint and the wound dry. The nail may fall off during the week after the hematoma drainage but will regrow in 8 weeks (fingernail) to 6 months (toenail). It may take longer if the nail bed has been severely damaged.
When will subungual hematoma stop hurting?
With a subungual hematoma, the pain typically goes away in a few days. The nail itself will take longer to recover. The discolored nail will eventually grow out — or in some cases, it may fall off or need to be removed — and be replaced by a new, healthy one.
What happens if you don't drain a subungual hematoma?
If left untreated, a simple subungual hematoma typically grows out along with the lengthening nail plate and resolves on its own. Until the nail grows out, however, you can expect weeks to months of blue-black discoloration.
What causes throbbing pain under fingernail?
Your doctor may call it a “subungual hematoma” if you have bleeding under a fingernail or toenail. It usually happens if the nail gets crushed in an injury. It can cause symptoms such as intense pain and throbbing as blood collects under the nail.
When is it too late to drain a hematoma?
The key is to ensure that the hematoma is not older than 48 hours. In most cases, the hematoma can be drained with a large needle without any complications. Follow up of patients is recommended to ensure that there is no infection and the hematoma has resolved.
Should I go to the ER for subungual hematoma?
If you have a simple subungual hematoma — meaning a hematoma but no other bleeding or digit injury — your primary care provider or an urgent care center may be able to perform a drainage. But if you have additional injuries, you should go to the emergency room.
What is subungual hematoma?
A subungual hematoma is a collection of blood underneath the nail (in the nail bed) caused by nail injuries. The injuries rupture the capillaries and cause leakage of the blood under the nail bed. These injuries can be due to. Fall of a heavy object on the finger or toe. The finger or toe getting hit by an object, such as a hammer.
How long does it take for a subungual hematoma to heal?
A subungual hematoma usually resolves on its own without any treatment. The discoloration disappears as the nail grows. Over several months , a new nail eventually grows to replace the damaged nail.
How to stop a toe nail from bleeding?
Keep the affected hand or foot elevated (reduces the swelling). Apply ice wrapped in a cloth over the affected finger/toe. Compress the nail by wrapping a tight bandage around it ( reduces the bleeding). Take over-the-counter analgesics to relieve the pain.
How long does it take for a nail to regrow after a hematoma?
It is necessary to keep the splint and the wound dry. The nail may fall off during the week after the hematoma drainage but will regrow in 8 weeks ( fingernail) to 6 months (toenail). It may take longer if the nail bed has been severely damaged.
What is the procedure to drain a nail?
The drainage can be done by any of the techniques mentioned below. Needle: A medical needle is used to make a hole in the nail. Electrocautery: A heated wire is pressed on the nail to penetrate the nail. Paper clip: The sharp end of the paper clip is heated and pressed on the nail to pierce it.
Is subungual hematoma drainage required?
If blood is spontane ously draining from the hematoma, drainage of subungual hematoma is generally not required.
Can a doctor drain a subungual hematoma?
A subungual hematoma is sometimes drained by a doctor. A subungual hematoma is bleeding under the nail. A doctor will drain your subungual hematoma only if. It is causing discomfort or pain. It occupies less than 50% of the area of the nail surface. If blood is spontaneously draining from the hematoma, drainage of subungual hematoma is generally ...
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What are the Associated injuries of subungual hematoma?
Associated injuries include phalanx fractures and soft-tissue contusion. The evaluation process for a subungual hematoma should include a thorough history, including the timing of the injury and musculoskeletal, neurologic, and vascular assessment.
How long does it take for a subungual hematoma to subside?
Given time, the tissues surrounding this collection of blood will stretch and deform until the pressure within this mass equilibrates. Within 24 to 48 hours, the pain therefore subsides; although the patient may continue to complain of pain with activity, performing trephination at this time may not improve his discomfort to any significant extent and will potentially expose him to a small risk for infection. If trephination is not performed, explain this to the patient, who may be requesting trephination too late. The patient is often the best judge whether the pain is sufficient to warrant taking on the very small risk for infection.
What is not to do with a subungual ecchymosis?
What Not To Do: Do not perform trephination on a subungual ecchymosis (see Chapter 155 ). Do not perform a digital block. Anesthesia should not be necessary under most circumstances. Do not perform trephination on a patient who is no longer experiencing any significant pain at rest.
How to trephinate subungual hematoma?
Trephination is easily done by using an electric cautery device or by boring a hole through the nail using a needle. A heated paper clip should not be used as most paper clips are made of aluminum and are difficult to heat sufficiently to penetrate the nail. Anesthesia is usually not needed prior to trephination.
How to get rid of hematoma pain without a hole?
Do not hold a hot paper clip or cautery wire on the surface of the nail without applying enough slight pressure to melt through the nail. Just holding the hot tip adjacent to the nail can heat up the hematoma and increase the pain without making a hole to relieve the pressure.
What is a 50% subungual hematoma?
A subungual hematoma involving 50% of the nail often suggests a nail bed laceration and in the past was thought to be an indication for removal of the nail and direct repair of the lacerated nail bed with absorbable suture.
How long does it take for pain to subside after trephination?
Within 24 to 48 hours, the pain therefore subsides; although the patient may continue to complain of pain with activity, performing trephination at this time may not improve his discomfort to any significant extent and will potentially expose him to a small risk for infection.
