Subungual Hematoma


We have all done it: closed our own finger or somebody else’s finger in a door, or missed with a hammer and slammed one of our fingernails. We may have dropped a weight or had someone else drop a heavy object on our toe. How about stubbing your toe into something immovable?  This can be can be extremely painful. Before you know it, the nail turns red, blue, black, purple, or a combination of these colors. The medical term for this is a subungual hematoma. Knowing when to seek treatment from an orthopedic specialist is important. Certainly, if your pain is significant and debilitating you should see an orthopedic surgeon as soon as possible. There are easy and quick techniques that can be done in the office to significantly relieve the pain and pressure under the nail.

The patho-anatomy of a blue/black nail has to do with the crush injury to the bone and skin beneath the finger/toe nail. Often x-rays are needed to rule out a fracture. It is important to understand that the skin cells beneath your nail are highly specialized. When they are injured through a type of crush injury, fracture, or laceration those cells become injured and bleed. This causes the color change under the nail. The bleeding may affect nail growth and the cosmetic appearance of your nail. Sometimes if the injury is severe these skin cells can be repaired surgically. Sometimes your nail may “fall off” over time. Most nail bed injuries can be treated nonoperatively. The most important step is making sure one is seen by an orthopedic surgeon who can make the determination of what type of treatment is needed.

Relieving the pain and pressure under the nail can be very easily and painlessly done in the office, and it will promote healing and possibly minimize nail bed deformity. Our nails are our protectors, and it is important to care for them.