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Monthly Archives: April 2015

Subungual Hematoma

A Subungual Hematoma is a transient condition where blood and fluids collect underneath the toenail or fingernail. This is usually caused by a traumatic injury as in hitting your thumb with a hammer or stubbing a toe. It can also occur by wearing tight fitting shoes which traps blood between the toes, leading to blood pressure within the blood vessels of the toe. In either case the injury leads to the breakage of small blood vessels underneath the nail. The nail may feel sore or tender to touch. As blood pools under the nail, the pressure from the blood can cause severe pain. The pressure caused by blood colour under the nail will change over time, initially red to purple and later to dark brown and black as the blood clots. The pain usually resolves days after the injury and the nail looks worse that it feels.

Causes of Subungual Hematoma:

Most often, a Subungual Hematoma is an immediate consequence of a crush-type injury involving the tip of the finger or toe. Common example include:

  • Slamming your finger  e.g in a car door or house door ect.
  • Hitting your finger with a heavy object such as a hammer.
  • Dropping a heavy object such as a dumbbell on your toe.
  • Stubbing your toe on a hard surface.
  • Side effect of insulin shots, blood thinners, aspirin, NSAIDs etc.
  • From a surgery that went wrong
  • People with bleeding disorders, low platelet count, blood cancer, chronic liver disease
  • Wearing tight – fitting shoes, that place a lot of pressure on the toenail.

In some cases, the nail can cause a darkened area that resemble a Subungual Hematoma. If you have a darkened area under a nail, and no history of trauma to the nail, you should have it evaluated by your health care provider. The spot will grow with the nail if it’s a Subungual Hematoma.


The most common symptom of a subungual hematoma is severe, throbbing pain generated by the pressure of blood collecting between the nail and the nail bed. Other symptoms include:

  • A dark-colored discoloration (red, maroon, or purple-black) under all or part of the affected nail.
  • Tenderness and swelling of the tip of the affected finger or toe.
  • The pain may also be caused by other injuries such as a fracture (break) to the underlying bone, a cut in the nail bed, or bruising to the finger or toe itself.


Treatment for Subungual Hematoma:

A painless and small subungual hematoma usually does not require any medical treatment, however the pressure generated by the pooled of blood under the nail can be extremely painful. To relieve the pain your health care provider may perform decompression also called trephination, which allows the underlying blood to drain.


If a large area of the nail is damaged, it may be removed by your doctor. If the nail was not removed, it may separate and fall off in the next two weeks. In almost all cases, the nail will grow back from under the cuticle. This takes a few weeks to start and is complete in about 4-6 months for a fingernail and 12 months for a toenail. If the nail bed was damaged, the nail may grow back with a rough or irregular shape. Sometimes the nail may not regrow at all.


Prevention of Subungual Hematoma:


  • Being careful so as not to drop heavy objects and tools on your toes or getting your fingers rammed by doors
  • Wearing steel-toed shoes while engaging in certain high-risk professions, such as construction and engineering.
  • Being watchful of children’s hands so not to accidentally slam your car door on to their hands
  • Be fully attentive towards the task that you are involved into finger injuries frequently occur when an individual is distracted while using a tool, such as a hammer.
  • Avoid lifting something is too heavy for you to handle. Always ask for assistance while carrying heavy objects so that you do not drop them on the toes.


Diagnosis of a Subungual Hematoma:

If a subungual Hematoma was caused by a severe blow to a finger or toe, either seek immediate medical attention from your health care provider or go to an emergency room. In addition to the hematoma, you may have broken bones or serious to the nail bed surrounding tissues. The health care provider will examine you nail and you’ll likely undergo an X-ray to either confirm or rule out a bone fracture or other injury.



Lest We Forget

They shall grow not old,

as we that are left grow old:

Age shall not weary them,

nor the years condemn.

At the going down of the sun

and in the morning,

We will remember them.

Subungual Exostosis

A Subungual Exostosis is a bony projection which can arise underneath the toenail. They generally are a result of some form of trauma to the toe that results in the formation of bony irregularity or prominence. This condition usually affects teenagers and young adults, and is predominantly seen in females.

Causes of Subungual Exostosis:

The cause of Subungual Exostosis is unclear, however it is thought to occur as a reaction to:

  • Constant irritation
  • Previous Trauma
  • Chronic Infection
  • Inherited conditions such as multiple Exostoses Syndrome

Symptoms of Subungual Exostosis:

  • Exostosis grows gradually over weeks and months
  • It presents as a hard painful swelling under or beside the toenail, usually on its inner side.
  • As it grows it presses against the nail, causing pain, which may be confined to the nail fold.
  • With further growth, it separates the nail form the nail bed and erodes the overlying skin ( making it prone to infections).

Treatment for Subungual Exostosis:

As the Subungual Exostosis continues to grow, damaging the surrounded tissues, causing a lot of pain to the toenail; the best treatment option is to remove the bony projection altogether, resulting in surgery. The procedure is done under local anaesthesia. The Exostosis is removed, along with the attached nail bed. The surface of the underlying bone is scraped to ensure complete removal of the exostosis and prevent is recurrence in the future.