Subungual Hematoma

If you had just slammed your finger on your car door and the pain is unbearable and the nail has turned black and blue, then you are likely to have Subungual hematoma. The nail hematoma is seldom serious but always painful.
Also called Runner's Toe or Tennis Toe, Subungual Hematoma is a collection of blood under the fingernail or toenail.

This may have been caused by an injury such as slamming the nail in a door or dropping a heavy object on the nail. Subungual Hematoma can occur when blood thinning or cancer treatment medicines are consumed or you have an autoimmune condition. Subungual Hematoma can be extremely painful for an injury of its size although otherwise it is not a serious medical condition.

Signs and symptoms

• A discoloration in red or purple or maroon under the nail after an injury.
  
• Throbbing and intense pain; pressure generated between the nail and the nail bed where the blood collects causes this pain.
  
• Swelling in the affected nail or toe.
  
• Tender to the touch.
  

Causes

Subungual hematomas commonly occur after a crush type of injury at the tip of the finger or toe – hitting your finger with a hammer, dropping a heavy object on your toe or closing your finger in a door. Subungual Hematoma may be caused by ill fitting shoes and insufficient space for the toes.

The condition also results from slamming a finger in a door or from sports activities such as climbing or hiking in a rugged terrain. Due to running injuries, a foot might have lost a toenail and this is exacerbated by poorly fitting shoes.

Subungual Hematoma that occurs from repetitive thrusting of the longest toe into a shoe's toe box is called jogger's toe or runner's toe. Here bleeding occurs from the nail bed underlying the nail plate.

Runners toe is caused by downward pressure or horizontal separation of nail plate from nail bed. Repetitive traumatic injury leads to bleeding and blood gets pooled underneath the toe nail. The deformed nail plate gradually grows out and is replaced by new nail plate several months later. Sometimes the toe may become painful and require surgical drainage.

Treatment of Subungual Hematoma

A small hole is made in the nail to drain the blood. This will decrease pain and swelling. Following commonly used methods for draining hematoma include:

Cautery, a battery operated device used to burn a hole in the nail until the blood is reached and drained out of the hole. In case the patient is using artificial acrylic nails which might be flammable, this method should not be used.

A large diameter needle is used to drill or bore into the nail to create a hole to allow the blood to drain out.

Nail removal may be done if the nail is damaged. The doctor may also have to repair the tissue under the nail. Although anesthesia is generally not required, a digital nerve block is recommended to be performed if the nail is to be removed.

A splint may be placed on the finger or toe to prevent movement and protect the area while it heals. Subungual hematoma may typically heal without incident, although infection of the nail may occur.

Caring for Subungual hematoma

Keep injured finger or toe dry as long as directed.

Trim nails gently if it begins to fall off in pieces. This may decrease risk for catching the nail on an object or ripping it off.

Wear shoes that are comfortable and fit correctly to prevent injury to the toe.

Ice is used to elevate the affected finger. Place ice wrapped in a towel over the painful area for as long as directed and then elevate hand or foot on pillows above the level of the heart to help decrease swelling and pain.

If the nail was removed by the injury and the nail bed is not cut, then it is recommended to have the following home treatment done until the nail bed begins to be less sensitive, usually in a week to ten days. Twice daily soak with antibacterial soap and water for ten to fifteen minutes. After soaking, apply a topical antibiotic ointment and a dry sterile bandage.

Prevention

Exert caution when dealing with heavy objects. While on some high risk jobs, used steel toed shoes. Watch children's hands while opening and closing doors. Give full attention to the task on hand. Finger injuries often happen when the person using the hammer is distracted. In case of heavy objects, find people who can carry them – instead of dropping them on your toes.