Blood under the nail (hematoma under the nail) - what to do, how to get rid of it. How to treat bruises under the toenails? Hematoma on the toenail does not go away

The toes are most often susceptible to bruises and injuries. This leads to dislocations or broken bones. But most often a bruise forms under the nail. A hematoma appears as a result of injury to the capillaries and hemorrhage under the nail plate.

With timely treatment, it resolves, and the nail remains in place. If help is not provided, the frozen blood pushes the plate out, and a new one grows in its place.

Reasons

Typically, a subungual hematoma forms on the big toe (ICD 10 code: S 60.1).

Most often it is formed under the influence of the following factors:

• in case of kicks or other mechanical bruises - if a person accidentally catches furniture with his foot, or a hard object falls on the foot, etc.;
• accidental pinching of the foot;
• constantly wearing tight and uncomfortable shoes;
• infection with fungal infections causes subungual hemorrhages;
• dislocations or fractures;
• dark spots may also indicate serious heart disease, diabetes mellitus and other disorders of the endocrine gland. In these cases, the help of a doctor is required; he will tell you what the patient should do and how to distinguish an ordinary bruise from a symptom of pathology.

After impacts, the integrity of the capillaries is disrupted, hemorrhage occurs and bruises form under the toenails.

The main symptoms include: swelling of the foot, redness of the skin, sharp pain in the damaged area. The victim also feels a pulsation.

How does a hematoma develop?

Often, after a bruise, people wonder why the nail on their big toe turned blue. After the blow, the foot swells and turns red. After one to two hours, a hematoma forms. This occurs due to damage to the blood vessels under the nail plate. Blood under the nail accumulates and a blue stain appears.

In medicine, there are several stages of this process:

1. A pink spot forms under the plate. The victim feels first numbness and then severe pain.
2. In place of the pink spot, a dark purple spot is formed. The painful sensations are a little dull.
3. After 1–2 days, the bruise under the thumbnail decreases in size and turns blue. Its boundaries become clearly defined. Pain is felt if you press hard on it.
4. Gradually the spot turns black and decreases. Doesn't cause any pain. After a week it may resolve on its own. Usually a bruise without punctures resolves after 3 to 4 weeks.

The main danger is that the blood has nowhere to go; it pushes out the plate, and a new one grows in its place. Also, the affected skin is vulnerable; fungi, bacteria and other microorganisms can join them.

You can see the stages of bruise formation in the photo above.

How to recover at home

Immediately after a bruise, you need to apply ice or any cold object to the injured area. You can even put your foot under a stream of cold water. This will prevent subungual hemorrhages.

If it was not possible to cool the bruise site, a hematoma will form. It requires a different treatment - the plate is pierced to release the caked blood.

The piercing procedure is simple. It is best done in a hospital, but in exceptional cases it can be done at home.

1. Disinfect the damaged nail plate and a regular needle with an antiseptic (alcohol solution, potassium permanganate).
2. Heat the needle over the fire.
3. Pierce your nail with it. Count on the puncture to hit the central part of the hematoma. The plate melts easily, the procedure is unpleasant, the person feels painful sensations, but they are tolerable.
4. After the puncture site, dried blood came out under the nail. Treat the affected area with antiseptics and apply a bandage or plaster.
5. Change bandages daily and disinfect the wound. For three days after the piercing, you can only wear open shoes.

Treatment with medications

For swelling of the feet, it is necessary to use anti-inflammatory ointments that increase blood flow. Among the most used ointments: “Bodyaga”.

In difficult cases, when the hematoma occupies the surface of the entire nail plate, you will need the help of a doctor. Typically, surgeons make punctures and release the blood. But sometimes it may be necessary to remove the entire nail.

Relieving pain helps with treatment if the bruise is caused by injuries or bruises. But if the cause is serious pathologies (the bruise appeared without a contusion), then special complex therapy is necessary. For heart pathologies, the course is prescribed by a cardiologist, and for diabetes, an endocrinologist.

If the bruises are caused by fungi, then treatment is necessary. These are gels and varnishes for external use. You will probably also need oral tablets. All these methods will help to gradually cope with fungi.

Treatment with traditional methods

Advice from healers will help relieve pain. Before using recipes, you should consult your doctor and make sure there are no allergic reactions to the ingredients used.

1. Crush the plantain leaves and apply the paste to the bruise under the big toe nail as a compress. The herb will relieve increased swelling and inflammation.
2. Taking baths with added sea salt will help hemorrhages resolve quickly. Prepare 3 liters of hot water (average temperature about 40 degrees). Add a tablespoon of salt and a few drops of any essential oil. The duration of the procedure is 15 minutes.
3. A bodyagi mask will help cure hemorrhage. To do this, dilute 15–20 grams of dry powder with warm water. Make a homogeneous paste and spread on the sore nail. After 20 minutes, rinse with chamomile decoction. Make the mask for three days.
4. You can reduce pain with St. John's wort tincture. It is sold in any pharmacy. Take orally three times daily as directed.

Traditional methods are aimed at treatment without puncture; they are effective for small hematomas. If it occupies the entire surface of the bed, then you should consult a doctor to get a puncture.

Conclusion

Preventive measures will minimize the risks of bruised toes and hematomas. You must be careful when carrying heavy objects and wear comfortable shoes of your size.

Severe overloads should also be avoided. If a subungual hematoma does form on the big toe, then the patient needs to be given first aid. If you experience severe pain or a large injury, you should contact the clinic.

If a bruise occurs under the big toe nail, you should seek help from a doctor, because injury to the plate is dangerous and has serious consequences. Common causes of the disease are mechanical shocks and fungal infections. If a hematoma occurs, you need to give yourself first aid, drink painkillers and take measures to eliminate the pathological condition.

What is a bruise under the nail

After mechanical impact, hitting furniture or a door, a bruise may appear on the nail of the big toe. This formation is characterized by burst vessels under the plate, the appearance of hemorrhage, and blood stagnation. The blood first turns bluish, then purple, and finally turns black. Over time, redness and swelling decrease and become less pronounced.

What does a bruise look like under the big toe nail?

Externally, a bruise under the toenail is characterized by blackening of the plate, and throbbing pain is felt under the nail. As a result, the blood does not come out from under the nail, so it stagnates, the finger swells, and most of it turns red. Over time, these symptoms subside, but the hematoma cannot resolve on its own and disappears only after the healthy plate has completely grown back. Rarely, a bruise appears on the finger itself.

How does a hematoma form?

About 1-2 hours pass from the moment of injury, after which a hematoma begins to form under the big toe nail. Swelling and redness of the foot immediately appear, but the bruise itself appears after blood is released from the burst vessels and accumulates under the plate. Stages of hematoma development:

1. A small pink spot appears, the nail bed turns crimson, and the nail turns blue. The person feels numbness and pain.
2. Formation of a large purple spot, pain reduction.
3. After a few days, the hematoma turns blue, its edges become sharp, the area decreases, pain is present only when pressed, there is no discomfort.
4. After a week, the bruise turns black and decreases to 3-5 mm in diameter. The edges remain clear and there is no pain. Within a week, the hematoma can resolve on its own.

Causes

Subungual hematoma on the big toe occurs for various reasons. Common factors causing the disease are:

• mechanical shock - an object fell on the leg, the finger was pinched by the door;
• fracture;
• constantly wearing uncomfortable shoes - if the pressure of the sock is on the big toe;
• professional deformation - wearing specific winter shoes by skiers and skaters, which exert strong pressure;
• taking medications that affect blood clotting can damage blood vessels;
• cardiovascular failure - all organs, including the skin, receive less oxygen, the body weakens, and pathology begins;
• melanoma, skin cancer, diabetes;
• fungus – combined with nail peeling, itching, discoloration.

What is the danger of a hematoma?

If a bruise occurs under the thumbnail, treatment should be started immediately, otherwise the lack of therapy will lead to serious consequences and problems:

• when a void forms between the cornea and the nail bed, bacteria and infection can get there;
• the dead part is attached to the finger until it is completely renewed, but it becomes fragile; during the process of fusion, shoes press on the hole, and it happens that because of this the new plate is deformed.

How to treat a bruise under a toenail

First aid for a hematoma is to cool the bruised area to reduce pain. Wrap your finger in gauze, place it under running cold water, or apply a plastic bag with pieces of ice to the bump. Leave for 3-6 minutes, remove for 15 minutes and repeat the procedure. Apply until the pain goes away. You can speed up the healing process by opening the nail (if the hematoma is small). You can do this with a doctor or on your own:

• prepare the nail: disinfect the plate with iodine, potassium permanganate or hydrogen peroxide;
• use antibacterial agents to treat the needle, heat its tip until it turns red;
• pierce the central part of the hematoma through the nail so that blood flows out of the hole;
• fix a sterile plaster on the wound;
• For three days, do not leave the house or wear open shoes so that your feet do not suffer.

Drug therapy

To treat a bruise under the big toe nail, experts advise using the following medications and useful remedies:

• analgesic antispasmodics - eliminate pain (Analgin, Spazmalgon, Sedalgin);
• compresses with Dimexide;
• anti-inflammatory ointments - eliminate swelling of the limb, increase the activity of blood flow (Bodyaga, Arnica, Larkspur);
• For a local effect on inflammation, Heparin ointment is used; it quickly eliminates bruising and stimulates the process of capillary restoration.

Traditional methods

In the treatment of a hematoma that occurs on the big toe, you can use traditional medicine methods:

1. Baths with sea salt, essential oils, aloe juice to accelerate the growth of a healthy plate. For three liters of water at a temperature of 40 degrees, take a tablespoon of salt or 7-10 drops of ethers. Keep your feet in the bath for 15 minutes, then lubricate them with a non-greasy cream.
2. Bodyagi mask - mix 10-20 g of dry powder with water to obtain a thick paste consistency. Apply to the bruise, hold for 15-20 minutes, wipe with chamomile decoction. Repeat 2-3 times a day.
3. Ointment – ​​grind 35 g of laundry soap, mix with 30 ml of ammonia, camphor laurel oil, 50 ml of lamp oil, 250 ml of turpentine. Treat the clot site every 4 hours for a week.
4. Lotions made from a solution containing 250 ml of apple cider vinegar, dry wine and 10 g of sea salt. Dissolve the ingredients, moisten a napkin, and apply to the bruise every two hours.
5. To relieve pain, take a decoction of St. John's wort.
6. Vitamin C and rutin will help the patient speed up the healing of blood vessels.

Subungual hematoma - This is a blood clot that has formed under the nail. Such damage can occur on both the fingers and toes. The formation of a hematoma is caused by mechanical trauma - impact, compression, etc.

Reasons for education

A blow to the finger is one of the reasons for the formation of a hemotoma.

Subungual hematomas or bruises located under the nails are formed as a result of the accumulation of some amount of blood in the space under the nail plate.

Reasons for the formation of hematomas under the nails:

• hit on the finger;
• pinching a finger in a door and other squeezing effects;
• subungual hematomas on the toes can be formed due to wearing tight shoes;
• The formation of a bruise under the nails on the toe can be caused by playing football in unsuitable shoes or other injuries;
• much less often, subungual hematomas are formed as a result of taking medications that affect blood clotting.

Clinical picture

When a finger is injured in the nail area, the patient feels pain and blood begins to accumulate in the subungual space. The pain is pulsating, “tugging”, and sometimes there is a feeling of fullness. Swelling may form on the injured finger.

The main symptoms of a subungual hematoma are a change in the color of the nail; it becomes red with a bluish tint, then gradually darkens, becoming purple-black.

If the formation of a subungual hematoma is associated with wearing tight shoes, then the pain is not so acute, but does not go away for a long time even after the shoes or shoes are removed. In this case, the nail has a bluish tint, which subsequently acquires a black tint.

You should know that blackening or other discoloration of the nail is not always evidence of the formation of a subungual hematoma. For example, bluish-black spots can be a symptom of the development of melanoma or malignant degeneration of nevi (moles).

First aid for a nail injury

If you injure your finger, the first thing you need to do is apply ice.

If a finger is injured with damage to the nail, it is necessary to apply ice to the area of ​​the bruise or pinching as quickly as possible. If ice is not available, any available cooling methods can be used. For example, use frozen food packages.

To reduce the likelihood of the inflammatory process spreading, you should take some kind of anti-inflammatory drug. For example, Ibuprofen.

If the nail plate is removed as a result of an injury, it is necessary to wash the affected area with antibacterial soap, apply an ointment that contains an antibiotic (Tetracycline, Erythromycin, Synthomycin, etc.) and apply a sterile bandage. With such an injury, the patient must consult a doctor.

To quickly resolve the hematoma, you can use ointments and gels - Troxevasin, Venitan, Venoruton, etc.

In what cases is medical help needed?

If the hematoma is small (no more than a quarter of the area of ​​the nail plate) and there is no severe pain, you can get by with home treatment.

However, there are cases when you cannot do without medical help. You need to contact a medical facility if:

1. The hematoma is widespread and occupies more than a quarter of the area of ​​the nail plate.
2. If the patient feels acute pain. Intense pain may be a sign of a finger fracture.
3. If the change in nail color occurred without injury.

Diagnosis methods

Diagnosis of a subungual hematoma is made on the basis of an external examination and anamnesis (presence of injury in the recent past).

An x-ray may be ordered to ensure there is no bone damage.

Treatment

Important! The choice of treatment regimen and technique is made by the doctor.

To remove blood from the subungual space, drainage is performed. To do this, using a special sterile instrument, a puncture is made in the nail plate in the center of the blood clot.

A sterile bandage must be applied to the finger after removing the blood.

After removing the blood, a damp, sterile bandage is applied to the injured finger. This is necessary to cool the injured area and prevent the nail from healing too quickly. Typically, no other treatment is required after this procedure.

For severe injuries, complete removal of the nail and suturing may be indicated. In this case, another 1-2 consultations with a doctor will be required. Suture material, as a rule, is self-disintegrating, which means no suture removal is required.

If nylon was used for suturing, then removal of the suture material is carried out for 5 - 7 days.

Treatment with traditional methods

Treatment with traditional methods can be used only for small subungual hematomas and full confidence that there is no bone damage.

The best remedy for hematoma, including subungual hematoma, is cold. The sooner a cold object (ice) is applied to the site of the injury, the smaller the bruise will be.

To treat subungual hematoma, use a solution of potassium permanganate.

If the hematoma has already turned black and the pain has subsided, you can use a solution of potassium permanganate. To do this, prepare a strong (dark cherry-colored) solution of potassium permanganate and heat it. The solution should be hot, but not scalding. Dip your finger into the solution and leave for 15 - 20 minutes. This bath helps soften the nail plate and remove dried blood.

To relieve the “tugging” pain, you can tie a leaf of white cabbage to the injured finger.

Prevention and prognosis

After draining the subungual hematoma, the pressure decreases and the pain subsides. Recovery occurs quite quickly. If the nail injury was serious, a complication may arise in the form of nail deformation and abnormal growth.

Prevention of the formation of subungual hematoma consists of following safety rules when performing various works. In addition, you need to be careful to avoid injuries at home.

When choosing shoes, you should give preference to comfortable models that will not put pressure on your fingers and nails.

A bruise under the big toe nail is a consequence of internal hemorrhage with blood soaking into nearby tissue structures. Subungual hematoma occurs due to impact, which ruptures small subcutaneous vessels. In the area of ​​​​damaged vessels on the nail of the big toe, a hematoma formation causes pain to a person, bruises under the nails can reach large volumes.

Why do they arise?

A hematoma under the nail plate can form due to numerous reasons.

Some of the few causes of bruising on the nails are:

• On the human body, subcutaneous hemorrhage can occur in any area that has been subjected to external shock. It is impossible to insure against a bruise under a fingernail or toenail. You can get injured in any way: when closing doors, hammering nails, falling tools, dragging heavy objects. A bruise under a toenail due to an injury is very painful, and such a nail is unpleasant to look at. Due to injury and the formation of a hematoma under the nail of the big toe, the nail may become deformed.
• A bruise on the nail appears when a person is seriously hurt or has a dislocated limb. With this option, hematomas spread to large areas of the body and can even form under the toenails.
• Hemorrhage on the big toe can occur due to wearing shoes that are not the right size.
• Hemorrhages of the big toes appear due to weakened vascular walls. Such hemorrhages also occur in any area of ​​the body and cause pain.
• Angiopathy due to diabetes mellitus causes bruising of the subungual area.
• If a person practices ballet or dancing for a long time, this will also cause hematomas of the subungual area.
• Sometimes bruises under the nail area are formed due to taking medications that increase blood clotting.
• Heart and vascular failure, oncological processes, mycoses and other pathologies also provoke the appearance of bruises in the subungual area.

How does a hematoma appear under the nail?

Why did the bruise appear under the nail plate? When an impact occurs, blood accumulates under the nail plate from damaged vascular tissues. This blood does not flow beyond the nail area because it is too dense, so the blood is trapped under the nail. Blood clotting occurs, after a certain period its color changes until it is completely absorbed.

A few minutes after a person is injured, the nail area becomes red, after a certain period it turns blue. When the blood has clotted, the nail plate will turn black.

The process of resorption of the blood clot is long, the nail slips and is replaced by a new nail plate. Accumulated hemorrhage under a burst nail, if the injury is not treated, is the cause of the addition of an infectious process, which will lead to the destruction of tissue structures.

The soles of the feet and hands with nail plates become covered with black spotted formations due to mycoses and skin melanoma. They are similar to hemorrhages, but as the nails grow, they do not disappear, but destroy the nail plate.

About treatment

How to treat hemorrhages on the nail plate of the thumb? If the leg is damaged and the hematoma covers the entire nail area, the entire hematoma is treated, and not just the damaged nail. At the moment when the finger was injured, cold is applied to it through the tissue surface.

The duration of such exposure should not exceed 20 minutes, then a pause is necessary. This manipulation will reduce pain and the area of ​​the hematoma.

The doctor prescribes medications to relieve pain.

You can apply gels locally to relieve pain. After a few days, an ointment containing a heparin component is used. Non-traditional methods of treatment can also complement basic treatment measures, which should be used after consulting with a doctor.

About traditional methods of treating bruises

How to remove a bruise? The following methods will help you do this:

• Using a compress with finely grated onion in the form of a paste will help cure a bruise.
• A plantain compress will cool the injured area. Finely chopped leaves will relieve swelling and inflammatory processes.
• St. John's wort tincture is used. The proportion of its preparation is as follows: one tablespoon of flowers to the same volume of boiled water. Take 3 times a day until pain disappears.
• If you use baths that contain essential oils and sea salt, the blood clots under the nail will resolve faster.

When the nail is opened

If an extensive bruise in the subungual area has formed, you can get help at a medical facility. Such help is appropriate only until blood clotting occurs under the nail. The nail plate is perforated with a special drill or surgically removed.

For this purpose, a medical needle or wire heated by a burner is also used. A hot needle melts tissue structures without pain or blood loss from under the nail. The operated finger is bandaged with a sterile bandage; after a certain period, the nail plate will slide off.

Thanks to this manipulation, a healthy nail will grow faster. If necessary, use agents that destroy bacteria and relieve inflammation.

About prevention

It is better to prevent hemorrhages from appearing under the nail plates, and the following measures can help prevent these hemorrhages:

• You need to eat a balanced diet rich in ascorbic acid. Vitamin C will strengthen vascular tissues.
• Shoes should be worn in the correct size so that your toes are not pinched.
• Strong overloads on the legs are unacceptable.
• Be sure to follow safety precautions at work.
• Be careful when lifting heavy objects.
• High heels are not allowed.
• If hemorrhages appear in any area of ​​the body, you should consult a doctor.

Preventive measures will always help prevent bruises. But if an injury occurs and a bruise forms on the nail area of ​​the thumb, or simply the person’s body is covered with bruises for no apparent reason, then it is better to consult a specialist and receive appropriate treatment.

Minor injuries at home and at work are considered an everyday occurrence. Sometimes we simply don’t notice them, and we are very surprised to find bruises and scratches on our bodies. But when it comes to the nail area on the fingers or toes, such damage does not go unnoticed, because they are accompanied by severe pain and the appearance of a strange dark spot hiding under the nail plate and causing noticeable discomfort. This is a subungual hematoma, often accompanying severe mechanical injuries to the fingers. And today we will talk about how to treat such damage.

Causes of subungual hematoma

No matter how scary the dark spot under the nail may look, there is nothing unusual in its appearance. A damaging mechanical effect on soft tissue is accompanied by rupture of the vessels inside them, and a bluish or brown spot is just the result of hemorrhage. In other words, a subungual hematoma is nothing more than an accumulation of blood in the space between the nail bed and the nail plate.

It is difficult to say where hematomas under the nails most often appear: on the hands or feet. In principle, both the lower and upper extremities are equally susceptible to injury. For example, the cause of a bruise under the nail of one of the fingers may be a strong blow to it or the distal phalanx being pinched by a door.

The toes are unlikely to be pinched. But it is quite possible for a heavy object to fall on your foot or for a perceptible blow with your finger (usually the thumb) to something hard.

It is quite easy to damage a toenail when walking barefoot, simply by hitting it hard on the ground or an object lying on the ground (for example, a stone). An identical situation occurs during a game of football. Inappropriate shoes or lack of them can be a very unexpected cause of the appearance of a subungual hematoma on the big toe.

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Risk factors

Risk factors for the formation of a bruise under the nail can also be considered:

• wearing uncomfortable or tight shoes that squeeze the toes in the area of ​​the nail plate,
• taking anticoagulants and other medications that reduce blood clotting and can cause minor hemorrhages,
• diseases in which there is low blood viscosity and a tendency to bleeding,
• increased fragility of blood vessels, as a result of which even a minor injury can be accompanied by rupture of blood vessels and hemorrhages.
• decreased sensitivity of the lower extremities, associated, for example, with the development of polyneuropathy due to diabetes mellitus (such patients may walk in tight shoes and not feel pressure on the fingers, leading to hematoma under the nails),
• a disproportionately large length of one of the toes, which leads to strong shoe pressure on it (for example, with Martynov’s disease, the second toe is excessively long, it is clear that it is more susceptible to injury than others).

You can get a nail injury both at home and at work. Such an injury is always accompanied by a certain discomfort, and sometimes can even have unpleasant consequences, so it is important to take the issue of its diagnosis and treatment carefully and seriously.

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Symptoms of subungual hematoma

As we have already said, if a bruise on the body can appear unnoticed even from a slight blow or compression of soft tissues, then the appearance of a subungual hematoma is preceded by a strong mechanical impact on the nail plate and soft tissues of the fingers. It is simply impossible not to notice such an impact; how to react to it is another matter.

The first signs of injury accompanied by the appearance of a subungual hematoma are:

• sharp and severe pain at the site of the injury, which is pulsating in nature and is often accompanied by a feeling of fullness
• redness of the tissue under the nail plate,
• deterioration in the functioning of the finger due to pain or bone damage.

• short-term loss of sensation in the finger (in case of severe injury, numbness can be observed for a long time),

• swelling of the tissues of the injured finger, as a result of which it slightly increases in size,
• a change in the color of the spot under the nail from reddish to bluish, burgundy, dark brown and even purple-black (it all depends on the force of the blow and the amount of blood spilled under the nail plate),
• in some cases, complete or partial detachment of the nail from the nail bed and its deformation are observed.

As for the pain, after an impact it is stronger than after wearing and taking off tight shoes, but in the latter case the pain can be felt for a longer time, especially when putting pressure on the toe.

Complications and consequences

A careless attitude towards domestic injuries, which is observed everywhere, unfortunately, can have its unpleasant consequences. Well, you hurt your finger and a dark spot appeared on it, so is this a reason to immediately run to the doctor if it gradually goes away on its own as the nail grows? This is exactly what many of us think, unaware of the possible complications.

Perhaps the bruise itself does not pose any particular danger. But deformation of the nail plate (more often its splitting) or its detachment can cause frequent injury to the nail and discomfort when walking if the nail of the big toe is damaged.

We will not touch upon the topic of the cosmetic ugliness of a nail defect, because such injuries can also have more unpleasant consequences in the form of infection under the nail. Bacteria, having hit the nail plate, begin to actively multiply, causing inflammation and suppuration of the tissues, and this already threatens, if not blood poisoning, then loss of the nail and serious treatment with the use of local (and in the case of septic lesions, systemic) antibiotics.

By the way, there is also a danger of infection if the approach to treating a hematoma is incorrect. Blood usually accumulates under the nail plate, and the more of it, the more unpleasant the sensations caused by the pressure of blood on various tissues of the finger. If the blood is removed, the patient becomes much better. But in the absence of detachment of the nail, blood can be removed from under it only by piercing the nail plate. By making a puncture yourself using improvised means without appropriate treatment of the instrument and the surface of the nail, you can very easily introduce an infection inside, and instead of blood, pus will begin to accumulate under the nail.

Inaction after a finger injury also poses a certain danger. Ignoring the pain and bruising under the nail, a person can simply ignore a more serious problem - a fracture of the distal phalanx bone or damage to its joint. Such injuries, in turn, can lead to impaired finger mobility.

There is one more important point. Under the guise of a hematoma, a more dangerous disease can be hidden - melanoma or skin cancer, the treatment of which must begin in the early stages of the development of the process. And the sooner the better, because melanoma has a tendency to grow rapidly and spread metastases.

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Diagnosis of subungual hematoma

Having dropped something heavy on our finger, crushed it with a door, or simply hit it hard, we are usually in no hurry to run to the doctor. In some cases this is even justified. For example, a small subungual hematoma resulting from trauma and covering less than 25% of the nail surface is unlikely to require specialist intervention. Such bruises go away on their own, moving upward as the nail grows.

In what cases should you consult a doctor for advice and first aid:

• if the dark spot under the nail (regardless of its size) does not appear as a result of injury and is not accompanied by pain,
• if severe pain after an injury does not go away after 24 hours,
• if the hematoma is large, that is, its area is more than a quarter of the nail, which indicates a significant amount of blood accumulated under the nail plate,
• if the injury is accompanied by severe pain (acute pain, intensifying with the slightest load on the finger and when walking, may indicate a bone fracture), sometimes in this case there is even a slight crunching sound when the bones touch.

The diagnosis of finger injury with the formation of a nail hematoma is carried out by a traumatologist who, if necessary, refers the patient to other specialists, for example, a surgeon, dermatologist or dermato-oncologist.

The examination begins with a physical examination and history taking. The doctor will ask the patient if there has been an episode of finger injury in the recent past, what the nature of the injury was, and its symptoms. If there is no acute pain and the mobility of the finger is preserved, we are talking about a normal bruise with the appearance of a hematoma. Otherwise, there is suspicion of a fracture of the distal phalanx or an intra-articular fracture.

If a finger fracture is suspected, the patient is sent for an X-ray examination.

Differential diagnosis

The cause of a dark spot under the nail is not always an injury. Some people have these spots from birth. The thing is that moles (nevi) can be localized on the skin anywhere, including the nail bed. A subungual nevus has a certain resemblance to a hematoma resulting from a nail injury.

The danger of any moles is that under the influence of negative factors (for example, injury to a nevus), they can degenerate into a malignant neoplasm - melanoma. It turns out that trauma to the nail can cause pathological processes in the pigmented skin underneath, resulting in malignancy of cells, and they begin to divide uncontrollably, causing tumor growth and the spread of the process inside the body.

This is a very dangerous situation that requires consultation with an oncologist and surgical treatment. The incidence of subungual melanoma is about 3-4% of all cancers.

If melanoma of the nail is suspected, the patient is referred for dermatoscopy - an examination that allows one to examine the condition of the tissues under the nail. To confirm the diagnosis of skin cancer, a tissue biopsy in the affected area is additionally prescribed. Histological examination of the material taken during biopsy is considered the most accurate analysis, on the basis of which the final diagnosis is made.

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Treatment of subungual hematoma

If there was a minor injury to the nail, as a result of which a slight hemorrhage occurred under it, treatment will consist only of reducing the intensity of the pain syndrome. You can use ice cubes or packaged frozen foods for this purpose. Cold is applied to the site of the injury, thereby relieving pain and swelling. It is advisable to apply ice every half hour for 3-5 minutes until the pain subsides.

If the pain is severe enough, you can take painkillers: analgesics or non-steroidal anti-inflammatory drugs, which are in your home medicine cabinet. This can be “Analgin”, “Tempalgin”, “Ibuprofen”, “Nimid”, and for severe pain “Ketorolac” or “Ketanov”.

Additionally, as an absolutely safe pain reliever and anti-inflammatory agent, you can take a decoction prepared from the herb and flowers of St. John's wort. It is recommended to drink the medicinal composition several times a day, little by little, at intervals of 3 hours. You should not expect quick results from a natural medicine, but after a couple of days you can observe a noticeable decrease in pain.

As an option, they suggest applying a fresh leaf or pulp of white cabbage to the sore finger. It must be said that the effectiveness of this recipe remains in doubt. Although an uncomplicated subungual hematoma is an excellent reason to get it checked.

The same can be said about softening the nail plate in order to remove dried blood using a hot solution of potassium permanganate, which should have a rich cherry color. It is assumed that the desired effect can be achieved by immersing the injured finger in hot (as hot as can be tolerated without getting burned) water for a quarter of an hour.

Usually first aid is enough for the pain and inflammation to subside. If the unpleasant sensations do not go away within 24 hours, pressure and discomfort arise in the nail area, indicating severe bruising, you should definitely consult a specialist for help. The help of a specialist may also be needed if the nail plate is detached from the skin as a result of an injury or there is a break in it. The doctor will examine the wound and prescribe appropriate treatment.

If an accumulation of blood is observed under an intact nail plate, the doctor will perform a drainage operation to remove it. The essence of the operation is to pierce the nail and extract accumulated blood from under it, which brings noticeable relief to patients and prevents peeling of the nail.

Puncture of a subungual hematoma is not a painful procedure, because the nail plate itself does not have nerve endings, and removing blood does not require violating the integrity of the soft tissues. Nevertheless, some people psychologically prepare themselves for pain, begin to worry, and make sudden movements. To avoid this, your doctor may suggest local anesthesia with lidocaine. In other cases, the puncture site is irrigated with an anesthetic solution.

After pre-treatment of the nail plate with an antiseptic, drainage begins. The procedure for extracting blood from under the nail can be done in two ways:

• the puncture is made using a fairly thick medical needle, screwing it into the nail plate as in the case of a drill,
• the nail plate at the site of the hematoma is burned with a special device - a thermal cautery.

Through the resulting hole, blood begins to leak out. To speed up this process a little, lightly press on the nail plate. Next, a napkin soaked in an antiseptic is applied to the finger, which is fixed with a bandage. Since blood can ooze from the hole in the nail for a day or more, the bandage should be changed periodically (at least once a day).

A prerequisite for the success of this procedure is sterility, because infection at the puncture site will provoke the development of a purulent process under the nail plate, the treatment of which may require its removal. It is customary to use a solution of hydrogen peroxide as an antiseptic. If it is not available, you can use other excellent antiseptics: an alcohol solution of iodine, an aqueous solution of potassium permanganate or furatsilin. The use of the drug “Chlorhexidine” with a pronounced antibacterial effect is indicative. It is customary to treat not only wounds, but also hands and surgical instruments before and after surgery.

On the Internet you can find a description of draining a nail at home using a paper clip, which needs to be heated over a fire, and then pierced with it to draw blood out. It is recommended to lubricate the surface of the nail with iodine before the procedure, and after removing the drainage and blood - with hydrogen peroxide and applying a bandage soaked in the same solution.

In theory, if the operation is carried out under conditions of good disinfection of the paper clip and nail, infection should not occur. However, such self-medication often has disastrous results. Patients have to consult a doctor already about suppuration of the nail.

In the case of very large hematomas covering most of the nail, as well as when spontaneous detachment of the nail plate is observed, doctors often resort to surgical treatment - removal of the nail followed by treatment of the tissues underneath it.

Treatment means removing accumulated blood, treating the cavity with an antiseptic and applying an aseptic dressing to prevent infection from entering the open wound.

In some cases, not the entire nail is subject to excision, but only the deformed exfoliated part of it, which can subsequently be subject to repeated injury.

Surgical removal of the nail may also be necessary if a purulent-inflammatory process has begun under the nail plate. In this case, the wound is washed, treated with an antiseptic, and then one of the effective antibacterial ointments (tetracycline, syntomycin, erythromycin, etc.) is applied on top. An aseptic bandage must be applied on top. The wound must be treated and bandaged daily.

In case of severe injuries, if the nail peeled off on its own and had to be removed, doctors can apply sutures using self-absorbing materials at the site of tissue damage. A repeat appointment with inspection of the sutures can be scheduled 3-4 days after the injury.

At the request of the doctor at home, the seams will have to be washed with soap and water and antibiotic ointments applied to them; after all, any wound is the path of least resistance for the penetration of pathogenic microorganisms that cause purulent-inflammatory processes.

Prevention

You can avoid the appearance of a subungual hematoma due to regular squeezing of your toes by choosing shoes that are suitable in size and shape. When training and playing football, it is recommended to use special sports shoes with a sufficient degree of toe protection from impact. Construction workers should also have special shoes, because they usually have a higher risk of foot injuries.

When lifting excessively heavy loads, do not forget about the danger of dropping them on your foot. You need to learn to correctly calculate your strength.

Let’s not forget about our fingers, which, due to our inattention and carelessness, so often end up in the sharply narrowing opening of the door. Young children who do not yet understand the danger of a doorway are especially often affected. Children's injuries are often caused by their parents, who close the door in an apartment or car, not paying attention to the location of the hands of children nearby. Again, attention and caution will help prevent such injuries.

If the injury could not be avoided, urgent application of ice to the site of injury will help reduce the severity of its symptoms and, possibly, avoid the appearance of a subungual hematoma. This five-minute treatment is recommended to be carried out every half hour, observing the sensations and changes in the damaged limb. In any case, the lack of relief of symptoms within 24 hours is a good reason to visit a medical facility.

The prognosis worsens if the injury damaged bones and soft tissues or a purulent process developed at the site of the hematoma. In this case, the growing nail may have an irregular shape and various defects. An untreated fracture can negatively impact the functionality of the finger. Pain and bone displacement can impair mobility and change the shape of the damaged phalanx or joint.

An ambivalent prognosis can also be given for melanoma masquerading as a hematoma. If the malignant process was detected on time in the early stages, the chances of forgetting about the disease for a long time are about 70-100%, depending on the size of the tumor. Detection of skin cancer in late stages reduces the survival rate after treatment to 30-50%.

But let's return to our hematoma resulting from injury. If its cause is precisely traumatic damage to the nail and the tissues underneath it, the prevention of this condition can be considered the prevention of household and work-related injuries. First of all, it is caution and accuracy.