Subungual hematoma

Subungual hematoma
Specialty	Dermatology

A subungual hematoma is a collection of blood (hematoma) underneath a toenail or fingernail. It can be extremely painful for an injury of its size although otherwise it is not a serious medical condition. A subungual hematoma that results from the repetitive thrusting of the longest toe into a shoe's toe box is called jogger's toe.

Causes

It often results from a traumatic injury such as slamming a finger in a door. The bleeding comes from the (vascular) nail bed underlying the (avascular) nail plate. A laceration of the nail bed causes bleeding into the constricted area underneath the hard nail plate. Throbbing pain is common. The nail develops a black discoloration overlying the nail bed but under the nail plate.

Treatment

Subungual hematomas are treated by either releasing the pressure by drilling a hole through the nail into the hematoma (trephining) or by removing the entire nail. Trephining is generally accomplished by using a heated instrument to pass through the nail into the blood clot. Removal of the nail is typically done when the nail itself is disrupted, a large laceration requiring suturing is suspected, or there is a fracture of the tip of the finger. Although anesthesia is generally not required, a digital nerve block may be performed if the nail is to be removed. Subungual hematomas typically heal without incident, though infection or disruption of the nail (onycholysis) may occur.

See also

• List of cutaneous conditions
• Jogger's nipple
• Tennis toe
• Turf toe
• Runner's toe, repetitive injury seen in runners