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Treating subungual hematoma

Subungual hematoma is the accumulation of blood under the fingernail. It is usually caused by a crush or blunt type of injury to the digit of the nails. It results to bleeding of the nail bed or the nail matrix which causes the formation of subungual hematoma. It is characterized by a severe and throbbing pain when blood accumulates under the nail. It needs immediate treatment if bones are broken or the nail bed and the surrounding tissues are damaged.


  • Injury due to slamming the finger in a door
  • Hitting the finger with a heavy object such as hammer
  • Blunt trauma or caused by a rounded object

    Pain can be felt in the nail

  • A direct blow to the distal phalanx such as a crush in a door jamb
  • Crush injuries
  • Dropping heavy objects on the hand
  • Repetitive pressure due to hiking, running and playing tennis or soccer
  • Stubbing the toes on corners of tables or chairs
  • Climbing or hiking on rugged terrain

Symptoms of subungual hematoma

  • Pain can be felt in the nail
  • A dark-colored discoloration under the affected fingernail
  • Agonizing pain under the nail
  • Sudden accumulation of blood under the nail
  • Pressure feeling under the nail
  • Tenderness and swelling of the affected nail or toe


  • Apply ice or cold therapy on the affected area for at least 10 minutes to lessen the bleeding and the swelling for 2-3 hours every day. Avoid ice directly on the skin. Wrap whatever cold therapy is used using a towel or a small cloth before placing to the area to prevent further damage and worsen the condition.
  • Elevate the affected area above the level of the heart to lessen the swelling and the bleeding. It also aids the tissue fluids to flow away from the affected area.
  • Use the suggested anti-inflammatory drugs such as ibuprofen to reduce the inflammation and discomfort.
  • Injection of prescribed local anesthetic to the affected finger to make it numb. Then a hole is drilled in the nail to drain the accumulated blood out. A hole is made using a needle, electrocautery or a paper clip that is sterilized. After the drainage the area will just heal on its own. This treatment is called trephination or decompression. Then tie the affected nail or bandaged and keep it elevated. Apply cold compress on the area especially for the first 12 hours. Use prescribed splints for at least 3 days to lessen the tenderness of the area.
  • If the injury requires the nail to be removed from the nail bed, perform the following measures to lessen the sensitivity of the nail bed especially for the next 7-10 days. Soak regularly the affected area in water and use antibacterial soap for at least 10-15 minutes. Dry the area and apply a prescribed antibiotic ointment such as Neosporin. Cover the area using a sterile dry bandage.

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