Subungual Hematoma

What is a subungual hematoma?

A subungual hematoma (also called a bruised nail) is an injury to your fingernail or toenail. It involves bleeding below the hard part of your nail (nail plate), which leads to swelling, nail discoloration and pain. Direct trauma to your nail — like something crushing or slamming it — typically causes a subungual hematoma. Such trauma damages the blood vessels just under your nail plate.

Despite how painful they can be, subungual hematomas are typically minor injuries, and the pain gets better in a few days. If needed, a healthcare provider can perform a simple draining procedure to relieve the pressure and give you relief. But if the trauma caused additional damage — like a broken bone (bone fracture) or deep cut — you likely need further treatment and more time to heal.

What are the symptoms of a subungual hematoma?

Symptoms of a bruised toenail or fingernail include:

• Pain. This may be severe or throbbing.
• Nail discoloration. The nail may look black-and-blue or black-and-purple.
• Nail sensitivity. The nail may be very tender to the touch. Even gentle pressure might hurt a lot.
• Separation of nail plate from nail bed. The pressure from pooling blood may cause the hard part of your nail to lift up from the tissues underneath.

What causes a bruised fingernail or bruised toenail?

Subungual hematomas usually happen from blunt force trauma (like hitting your nail with a hammer) or crush injuries (like slamming your finger in a door or dropping a heavy object on your toe). But they can also occur from repetitive pressure over time, like running in shoes that are too tight and press on one of your toenails.

The injury or pressure injures the blood vessels in your nail bed. They start to leak blood, which builds up underneath your nail plate. Normally, your nail plate and the tissues just below them (nail bed) are stuck to each other. There shouldn’t be any space between them. So, when there’s bleeding under your nail plate, the blood has nowhere to go. It pools and puts pressure on your nail plate, causing pain and discoloration.

What are possible complications of a subungual hematoma?

Subungual hematomas rarely lead to complications. But it’s possible to develop a bacterial infection in the area of the injury. Complications are more likely if the injury is more severe, particularly if it damages your bone.

How do healthcare providers diagnose a subungual hematoma?

Providers diagnose a subungual hematoma by closely examining your finger or toe. Your provider will look at every part, including the nail plate and the areas where your nail plate meets surrounding skin (nail folds). They may ask you to move or bend your finger or toe so they can evaluate the extent of the injury.

You may need imaging tests (like X-rays or ultrasound) to check for broken bones or other injuries that aren’t visible on the surface of your skin.

What kind of doctor treats a subungual hematoma?

Healthcare providers who may evaluate and treat your subungual hematoma include:

• A doctor in the emergency room.
• A nurse practitioner at an urgent care clinic.
• Your usual primary care provider.

If your provider believes your symptoms are due to an issue other than a hematoma, they’ll refer you to other specialists. For example, if your provider suspects subungual melanoma — a rare form of skin cancer — they’ll refer you to a dermatologist. But if symptoms occur right after trauma to the area, that means it’s likely a subungual hematoma.

What does subungual hematoma treatment involve?

Treatment for a subungual hematoma depends on what caused it. If you have a bruised nail but no other apparent damage, you should be able to care for yourself at home by applying ice to the area. Be sure to wrap the ice in a soft cloth before applying it to your skin. Ice should help ease swelling and pain.

But if your pain gets worse over the next few hours, you should seek medical care. Your provider may recommend a simple procedure called trephination. This is drainage of the hematoma to relieve pressure.

If you have a broken bone, a deep cut or other injuries, your provider may need to remove your nail plate to surgically repair the tissues underneath. Doing so can support proper healing of your nail. Your provider will tell you what’s necessary in your situation and explain why.

Can subungual hematomas be prevented?

It’s hard to prevent bruised toenails and fingernails. These injuries usually happen quickly and unexpectedly, and they can happen while you’re working or doing other necessary tasks. You can take some steps to lower your risk by:

• Being aware of where your hands and feet are when you close doors.
• Avoiding going barefoot or wearing open-toed shoes when lifting heavy objects or walking around.
• Avoiding distractions when using hammers or other tools that might slip or hurt your finger.
• Wearing gloves, shoes and/or boots appropriate to the task when doing manual labor.
• Making sure your shoes fit your feet well (for example, your workout shoes shouldn’t pinch or put pressure on your toes).

What can I expect if I have a bruised nail?

Most bruised fingernails and toenails heal with no complications. It’s likely you’ll have no lasting effects. Any pain should ease on its own within a few days or right away after drainage.

Your provider will tell you how to care for your finger or toe after treatment. In general, you should keep the area clean and dry. Your nail may bleed a bit right after draining the blood, but then the bleeding should stop. Follow your provider’s instructions for changing any bandages they apply to the area.

Despite treatment, your nail may still look discolored for many weeks. Rest assured this is normal, and the bruise will gradually go away as your nail grows back out.

If you have other injuries besides a bruised nail, like a broken finger or broken toe, you’ll need longer to recover. Your provider will tell you what you can expect. They’ll also tell you if you need to come back for any follow-up appointments.

Subungual hematoma healing stages

The bruise you see on your nail should gradually grow out over the next weeks or months. You’ll see more and more space appear between the discolored part of your nail and the base of your nail (at your cuticle). The color may initially look red or purple, but it’ll gradually turn dark brown or black.

It may take six to nine months for your nail to completely grow out and return to its normal color.

When should I see a healthcare provider?

A subungual hematoma generally isn’t a cause for worry. But it’s important to seek medical care right away if:

• You have intense pain or pain that worsens over time.
• You have a deep cut and/or bleeding that won’t stop.
• You believe a bone may be broken.

After drainage for a subungual hematoma, seek care if:

• You notice signs of an infection, like red/discolored skin around your nail, swelling, purulent drainage and/or fever.
• The pain returns.

Which questions should I ask my provider?

If you have a subungual hematoma, you may wish to ask your provider:

• Do I need treatment?
• What will treatment involve?
• How can I take care of myself at home as the injury heals?
• Do you have advice for preventing bruised nails in the future?

What does subungual hematoma mean?

Subungual hematoma is the medical term for a bruised nail. Here’s a breakdown of what each part means:

• “Sub” means below or beneath.
• “Ungual” means related to a fingernail or toenail.
• “Hematoma” means a collection of blood.

When blood pools below your nail plate, it may look black-and-blue like a bruise you’d see on your skin. The color may change over time as the injury heals.