What happens if you don't treat subungual hematoma?
A minor subungual hematoma usually heals over time without treatment. The trapped blood will eventually be reabsorbed, and the dark mark will disappear. This can take 2–3 months for a fingernail, and up to 9 months for a toenail.
When is it too late to drain a subungual 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.
How do I know if my subungual hematoma needs to be drained?
Subungual hematomas should be trephinated if they are acute (less than 24 to 48 hours old), are not spontaneously draining, are associated with intact nail folds, or are painful. After 48 hours, most subungual hematomas have clotted and trephination is typically not effective.
Can you drain a subungual hematoma after 48 hours?
Subungual hematomas can be drained up to 48 hours after the injury. (Roberts and Hedges' Clinical Procedures in Emergency Medicine, 7th Edition. Philadelphia: Elsevier; 2018, p. 744-756; UpToDate.
How long does it take for a hematoma to reabsorb?
Gradually the blood in the hematoma is absorbed back into the body. The swelling and pain of the hematoma will go away. This takes from 1 to 4 weeks, depending on the size of the hematoma. The skin over the hematoma may turn bluish then brown and yellow as the blood is dissolved and absorbed.
Can I drain my own hematoma?
The authors recommend using a disposable curette or punch biopsy tool at a tangential angle to drain the hematoma. This sharper tool creates a hole without squeezing the nail and causing pain, and the hole is also large enough to prevent clogging.
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.
When does hematoma need to be drained?
Sometimes, a hematoma may require surgical drainage. Surgery may be more likely if the blood is putting pressure on the spinal cord, brain, or other organs. In other cases, doctors may want to drain a hematoma that is at risk of infection.
How do you dissolve a hematoma?
Most hematomas resolve spontaneously over time as the blood debris is removed and the blood vessel wall is repaired by the body's repair mechanisms. Other times, surgically removing or evacuating the blood in a hematoma becomes necessary based on its symptoms or location.
What happens if you leave blood under your toenail?
Unless the area of bleeding is very small, an affected nail will usually fall off on its own after several weeks because the pooled blood has separated it from its bed. A new fingernail can regrow in as little as 8 weeks. A new toenail may not fully regrow for about 6 months.
How long can subungual hematoma last?
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.
Is it normal for a hematoma to harden?
It's important to see your doctor if your bruise swells or becomes a firm lump, because it might mean something more severe happened under the skin. A hematoma is not a bruise. Depending on the cause, it can take anywhere from 1 to 4 weeks for a hematoma to go away.
When does hematoma need to be drained?
Sometimes, a hematoma may require surgical drainage. Surgery may be more likely if the blood is putting pressure on the spinal cord, brain, or other organs. In other cases, doctors may want to drain a hematoma that is at risk of infection.
When does a hematoma need medical attention?
If the hematoma symptoms are severe or if it continues to expand over the course of a few days, you should visit your doctor right away. Emergency medicine, urgent care, primary care physicians frequently care for patients with hematomas. A primary care doctor can diagnose a soft tissue hematoma in a physical exam.
When do you evacuate a subungual hematoma?
Patients who should undergo an evacuation of a subungual hematoma are those who have blood and other fluid trapped under the nail. The blood and other fluid come from small blood vessels under the nail that has ruptured.
When should I relieve pressure under my nail?
You could accidentally touch the skin under the nail if pressure is applied to the nail. Go slowly, and reheat the clip as necessary. A thick nail may take several tries. As soon as the hole is complete, blood will escape and the pain will be relieved.
How long does it take for a subungual hematoma to heal?
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 is subungual hematoma?
Overview. Subungual hematoma is the medical term for bleeding and bruising under the nail. This is usually the result of some kind of injury to the blood vessels under the nail bed. For example, blood vessels can break and leak blood into the area underneath the nail when a door slams on a finger or a heavy object crushes a toe.
How long does it take for blood to pool in your nail bed?
Pooling of blood in the nail bed usually occurs within a day or two.
How to reduce swelling in feet?
To reduce swelling, the AOCD recommends elevating the affected foot or hand and icing the area for about 20 minutes at a time. To do this, wrap ice in a cloth or towel or create your own cold compress. Directly applying ice to skin can cause damage.
Does a nail heal from a subungual hematoma?
of a crushing injury and, unlike melanoma, will gradually clear as the nail heals. As the nail heals from a subungual hematoma, it grows a transverse groove. Trusted Source. across its surface. Your doctor will look for these and other signs in determining the cause of blood in your nail bed.
Do you need to follow up after replacing a nail?
Once a new nail replaces the old, there’s no need for further treatment or any kind of medical follow-up. Last medically reviewed on August 30, 2017.
Can subungual hematoma be worse?
In most cases, a subungual hematoma looks worse than it is. Your nail may throb and turn various shades of blue, purple, and brown. It may even fall off. But you can often manage a subungual hematoma with self-care and OTC pain relievers.
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 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.
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.
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 ...
Can a subungual hematoma be sutured?
The nail bed has been severely damaged. If your wound is very deep or there are lacerations in the surrounding skin of the subungual hematoma, your doctor may suture the wound. They may also ask for an X-ray to check if there are any broken bones in the finger or toe.
What does it mean when you have a hematoma under your toenail?
Diagnosis. Treatment. Recovery. 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.
How long does it take for a nail to fall off?
Recovery. Unless the area of bleeding is very small, an affected nail will usually fall off on its own after several weeks because the pooled blood has separated it from its bed.
How does a doctor burn a hole in a nail?
The doctor uses a heated wire (electrocautery device) or carbon laser to burn a hole or holes. The heated tip of the wire is cooled by contact with the hematoma, which prevents injury to the nail bed. This is a quick and painless procedure. Needle. The doctor uses a needle to make a hole in the nail.
How long after decompression do you need to use cold compresses?
You will need to keep the finger or toe bandaged and elevated -- and may also need to use cold compresses -- during the first 12 hours after decompression.
How long does it take for a new toenail to grow?
A new fingernail can regrow in as little as 8 weeks. A new toenail may not fully regrow for about 6 months. If there has been injury to the nail bed and/or surrounding tissues, the new nail may take longer to grow.
What is a subungual hematoma?
Subungual hematoma. A subungual hematoma is a collection of blood ( hematoma) underneath a toenail or fingernail (black toenail). It can be extremely painful for an injury of its size, although otherwise it is not a serious medical condition.
Can you remove a nail with anesthesia?
Although general anesthesia is generally not required , a digital nerve block is recommended if the nail is to be removed.
Is a subungual hematoma a serious medical condition?
It can be extremely painful for an injury of its size, although otherwise it is not a serious medical condition.
Can a deformed nail plate grow out?
The nail plate may also become thicker and more brittle as a result of the injury ( onychochauxis ). The deformed nail plate will gradually grow out and be replace d by new, normal-appearing nail plate in several months' time. Infrequently, the nail may become painful and require surgical drainage.
Can subungual hematomas be pulled off?
The pressure of the blood blister may cause separation of nail plate from the nail bed ( onycholysis ), but the nail should not be pulled off, as this can cause scarring of the nailbed and deformed nails.
What is subungual hematoma?
Subungual hematomas are an accumulation of blood beneath the fingernail or toenail, usually caused by direct crushing trauma to the digit that results in bleeding of the nail bed (Figure 1). Patients usually present with throbbing pain and swelling of the digit. Blue-purple-black discoloration beneath the nail.
What is the best treatment for subungual hematoma?
Trephination is preferred over nail removal for subungual hematomas that are painful and have intact nail folds. Trephi nation puts holes in the nail plate to drain the subungual hematoma which alleviates pain and promotes healing of the nail bed. This can be achieved using: Electrocautery. Presterilized needle.
Can you remove a nail plate for a subungual hematoma?
Removal of the nail plate is only recommended for subungual hematomas accompanied by nail bed lacerations (e.g. fingertip or toe avulsion). Removal of the nail plate for nail bed exploration is not recommended for subungual hematomas with: Intact nail plate and nail folds. At least partial adherence of the nail plate to the nail bed.
Is BC Emergency Medicine Network liable for any damages?
The BC Emergency Medicine Network is not liable for any damages, claims, liabilities, costs or obligations arising from the use of this document including loss or damages arising from any claims made by a third party. The BC Emergency Medicine Network also assumes no responsibility or liability for changes made to this document without its consent.
Can antibiotics be used for subungual hematoma?
There is no evidence that supports the use of prophylactic antibiotics to reduce infection after trephination of subungual hematoma. Subungual hematomas associated with an open fracture may require prophylactic antibiotics depending on the type of fracture and other patient factors (discussed elsewhere).
How long does it take for a hematoma to go away?
Depending on the cause, it can take anywhere from 1 to 4 weeks for a hematoma to go away. A hematoma is not a bruise. It is a pooling of blood outside of the blood vessels deeper in the skin than a bruise occurs. Trauma is the most common cause of a hematoma.
How to get rid of a hematoma on its own?
Sometimes, hematomas can go away on their own. If you have a muscular hematoma, doctors generally recommend the RICE method — rest, ice, compression, and elevation to reduce the swelling and give it time to heal.
What are the symptoms of intracranial hematoma?
The symptoms of an intracranial hematoma — one within the skull — can cause pressure on the brain over time and cause: 1 Headaches 2 Confusion 3 Skin discoloration 4 Seizures 5 Loss of bladder or bowel control 6 Abdominal pain
What is a bruised hematoma?
A hematoma is a localized collection of blood in the tissues of the body outside of the blood vessels. A bruise is a discoloration of the skin that is a result of leakage of blood from capillaries into the skin. Bruises and hematomas are most commonly caused by injury to the tissues. Both minor hematomas and bruises are common results of activities from daily living and usually require no specific treatment. Seek medical care for any hematoma or spontaneous bruising that occurs without any known cause.
Why is my hematoma lumpy?
It’s important to see your doctor if your bruise swells or becomes a firm lump, because it might mean something more severe happened under the skin.
What is intramuscular hematoma?
An intramuscular hematoma is one that occurs within the fascia — the tissue that holds muscles and organs in place. An intramuscular hematoma is one that forms inside the muscles. Some signs to watch for if you think you might have an inter or intramuscular hematoma are:
Where do hematomas occur?
There are different areas where hematomas occur including; inside the skull, on the scalp, ears, septum, bones, finger nails, toenails, and intra-abdominal.
Overview
- Melanoma is a serious form of skin cancer that can cause skin including the skin under the nails to discolor and sometimes bleed. Melanoma in the nail bed is rare, occurring in just about 1 in 1 million people. But it tends to get diagnosed later and therefore is more likely to be deadly.
Treatment
- Many subungual hematomas can be cared for at home. To reduce swelling, the AOCD recommends elevating the affected foot or hand and icing the area for about 20 minutes at a time. To do this, wrap ice in a cloth or towel or create your own cold compress. Directly applying ice to skin can cause damage. Over-the-counter (OTC) pain medications can also relieve discom…
- Evacuation of the hematoma not only provides immediate pain relief but also aids in minimizing additional damage to the nail bed and nail matrix. When the lesion is less than 48 hours old, piercing of the nail plate overlying the hematoma (referred to as trephination) can be performed using any of the following modalities: a hot paper clip cautery (held with a hemostat), a hot No. …
Causes
- A subungual hematoma can also result when toes are repeatedly jammed into the toe box of a too-tight shoe. This is especially true when the person wearing the ill-fitting shoe engages in sports with a lot of stop-and-start action, as in tennis, soccer, or basketball. It can also happen to runners and hikers, especially those who often run or hike downhill. When space is tight in the fr…
Symptoms
- According to the American Osteopathic College of Dermatology (AOCD), the first symptom of a subungual hematoma is a throbbing pain in the nail area, thanks to the pressure of blood pooling under the nail bed. The second symptom is the discoloration of the nail. What starts out as a reddish purple will eventually turn dark brown and black as the blood clots. Nail discoloration ca…
History
Location
- The affected digit often correlates with the sport the 4th and 5th toes in runners and joggers, the 2nd and 3rd toes in soccer and squash players, and the great toe in tennis players.
Diagnosis
- A doctor can often diagnose a subungual hematoma based on visual inspection of the nail and any recent trauma you report. For example, if you have symptoms and you recently whacked your finger with a hammer, your doctor will likely diagnose subungual hematoma. Your doctor may also X-ray the finger or toe to see if there is any fracture associated with the injury. To distinguish wh…
Prognosis
- 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. This could take anywhere from about eight weeks for a fingernail to six months for a toenail. Once the pressure is relieved, most peopl…
Prevention
- Some subungual hematomas like those that occur when you smash a finger in a door are just unfortunate accidents and thus hard to prevent. But others, especially those that involve the toes, are easier to avoid. Some overall recommendations: