Podnogtevaya hematoma on the finger and toes

Light injuries in everyday life and at work are considered a daily occurrence. Sometimes we just do not notice them, and we are very surprised to find bruises and scratches on the body. But if it concerns the area of the nail 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 the subungual hematoma

No matter how frightening the dark speck under the fingernail looked, there is nothing unusual in its appearance. Damaging mechanical action on soft tissues is accompanied by rupture of the vessels inside them, and a bluish or brown spot is just a result of hemorrhage. In other words, podnogtevaya hematoma - this is nothing more than the accumulation of blood in the space between the nail bed and the nail plate.

It is difficult to say where the hematomas most often appear under the fingernails: on the hands or on the legs. In principle, both lower and upper extremities are equally prone to injury. For example, the cause of the appearance of a bruise under the fingernail of one of the fingers can be a strong blow to it or the entrapment of the distal phalanx by the door.

Fingers on the legs are hardly jeopardized. But it is quite possible to fall on a leg of a heavy object or a tangible blow with your finger (usually large) over something hard. 

To damage the nail on the leg is quite easy when walking barefoot, simply hitting it hard against the ground or an object lying on the ground (for example, a stone). The same situation is observed during the game of football. Unsuitable footwear or lack of it can become a very unexpected reason for the appearance of subungual hematoma on the big toe.

[1], [2], [3], [4]

Risk factors

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

• wearing an uncomfortable or tight shoe that squeezes your fingers in the area of the nail plate,
• reception of anticoagulants and other drugs that reduce blood coagulability and can provoke small hemorrhages,
• diseases, in which there is a low viscosity of blood and a tendency to bleeding,
• increased fragility of the vessels, as a result of which even a minor injury can be accompanied by vascular rupture and hemorrhage.
• decreased sensitivity of the lower extremities, associated, for example, with the development of polyneuropathy against the background of diabetes mellitus (such patients can walk in tight shoes and not feel pressure on the fingers, leading to the appearance of a hematoma under the nails)
• a disproportionate length of one of the fingers, which results in a strong pressure on the shoe (for example, if Martynov's disease is excessive, the second finger on the leg differs, it is clear that he is more prone to injury than others).

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

[5], [6], [7]

Symptoms of the subungual hematoma

As we have already said, if a bruise on the body can appear imperceptibly even from slight impact or compression of soft tissues, the appearance of subungual hematoma precedes a strong mechanical effect on the nail plate and soft tissue of the fingers. Not to notice such an effect is simply impossible, it's another matter how to react to it.

The first signs of trauma, accompanied by the appearance of subungual hematoma, are:

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

Then you can see:

• short loss of sensitivity of the finger (in case of severe trauma, numbness can be observed for a long time)

• swelling of the tissues of the damaged finger, as a result of which it slightly increases in size,
• the color change of the stain under the nail from reddish to cyanotic, burgundy, dark brown and even violet-black (all depends on the force of impact and the amount poured under the nail plate of blood),
• in some cases there is a complete or partial detachment of the nail from the nail bed, its deformation.

As for the pain, after the impact it is stronger than after wearing and removing tight shoes, but in the latter case, the pain can be felt for a longer time, especially when the load on the finger.

Complications and consequences

Careless attitude to domestic injuries, which is observed everywhere, alas, can have its unpleasant consequences. Well, they bruised a finger, a dark speck appeared on it, so is this an excuse to immediately run to the doctor, if it gradually descends as the nail grows? This is what so many of us think, not suspecting of possible complications.

Perhaps the bruise itself does not pose a particular danger. But the deformation of the nail plate (more often its cleavage) 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 on the topic of cosmetic ugliness of the defect of the nail, because such injuries can have more unpleasant consequences in the form of falling under the nail infection. Bacteria, hitting the floor of the nail plate, begin to multiply actively, causing inflammation and suppuration of the tissues, and this is already threatened if not by infection of the blood, by the loss of the nail and by serious treatment with local (and in case of septic damage and systemic) antibiotics.

By the way, there is a danger of infection with an incorrect approach to the treatment of hematoma. The nail plate usually accumulates blood, and the more it is, the more unpleasant the sensations caused by blood pressure on various tissues of the finger. If the blood is removed, the patient becomes much easier. But in the absence of detachment of the nail, it is possible to remove the blood from under it only by piercing the nail plate. Making a puncture yourself with improvised means without appropriate processing of the instrument and the surface of the nail, it is very easy to bring the infection inside, and instead of blood under the nail pus will accumulate.

Inaction after a finger injury also carries a certain danger. Not paying attention to the pain and the appearance of a bruise under the fingernail, a person may simply ignore a more serious problem - fracture of the bone of the distal phalanx or damage to its joint. Such injuries, in turn, can lead to impaired mobility of the finger.

There is one more important point. Under the guise of a hematoma, a more dangerous disease may also be concealed - melanoma or skin cancer, the treatment of which must be started in the early stages of the development of the process. And the faster, the better, because melanoma has a tendency to rapid growth and spread of metastases.

[8], [9], [10]

Diagnostics of the subungual hematoma

Having missed something hard on the finger, pressing it with a door or just hitting it hard, we usually do not rush to run to the doctor. In some cases, this is even justified. For example, a small subungual hematoma that occurs as a result of trauma and covers less than 25% of the surface of the nail is unlikely to require the intervention of a specialist. Such bruises go off independently, moving upward as the nail grows.

In what cases should I see a doctor for advice and first aid:

• if a dark spot under the fingernail (regardless of its size) appeared not as a result of injury and is not accompanied by pain,
• if severe pain after trauma does not pass after the expiration of the day,
• if the hematoma is large, that is, its area is larger than the fourth part of the nail, which indicates a significant amount of accumulated under the nail plate of blood,
• if the trauma is accompanied by a strong pain syndrome (acute pain, increasing at the slightest load on the finger and walking, may indicate a fracture of the bones), sometimes in this case there is even a slight crunching in contact with the bones.

Diagnosis of finger damage with the formation of a nail hematoma is performed by a trauma doctor, who, if necessary, directs the patient to other specialists, for example, to a surgeon, dermatologist or dermatoonologist.

The examination begins with a physical examination and an anamnesis. The doctor will ask the patient if there was an episode of a finger injury in the recent past, what was the nature of the injury and its symptoms. If acute pain is not present and the mobility of the finger is preserved, it is a common injury with the appearance of a hematoma. Otherwise, there is a suspicion of fracture of the bones of the distal phalanx or intraarticular fracture.

If you suspect a fracture of your finger, the patient is referred for an X-ray examination.

Differential diagnosis

The cause of the appearance of a dark spot under the fingernail is not always a trauma. Some people have such specks since birth. The thing is that moles (nevi) can be localized on the skin in any place, including the nail bed. The subungual nevus has a certain similarity with the hematoma that arose as a result of a nail injury.

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

This is a very dangerous situation, requiring consultation of an oncologist and surgical treatment. The frequency of development of subungual melanoma is about 3-4% of all cancers.

If you suspect a melanoma nail, the patient is referred for dermatoscopy - a survey that allows you to examine the condition of the tissues under the nail. To confirm the diagnosis of skin cancer, tissue biopsy in the lesion area is additionally assigned. Histological examination of the biopsy material is considered the most accurate analysis, on the basis of which the final diagnosis is made.

[11], [12], [13], [14],

Treatment of the subungual hematoma

If there was a minor injury to the nail, as a result of which a small hemorrhage occurred underneath, the treatment will consist only in decreasing the intensity of the pain syndrome. For this purpose, you can use ice cubes or frozen products in the package. Cold fit to the site of injury, thereby reducing pain and swelling. It is advisable to adjust the ice every half hour for 3-5 minutes, until the pain subsides.

If the pain is strong enough, you can take painkillers: analgesics or non-steroidal anti-inflammatory drugs that are in the home medicine chest. It can be "Analgin", "Tempalgin", "Ibuprofen", "Nimid", and with strong pains "Ketorolac" or "Ketanov".

In addition, as an absolutely safe anesthetic and anti-inflammatory agent, you can take a decoction prepared from the herb and St. John's wort flowers. Drinking the medicinal composition is recommended several times a day little by little at intervals of 3 hours. A quick result from natural medicine should not be expected, but after a couple of days you can observe a noticeable decrease in the pain syndrome.

As an option, they suggest attaching a fresh leaf or a cabbage gruel to a sick finger. It must be said that the effectiveness of this recipe remains in doubt. Although uncomplicated subungual hematoma is an excellent reason to check it.

The same can be said about the softening of the nail plate in order to remove the dried blood with a hot solution of potassium permanganate, which must have a rich cherry color. It is assumed that the desired effect can be achieved by lowering the damaged finger into the hot (as far as possible to endure, not to get a burn) water for a quarter of an hour.

This recipe is recommended only if the injury was earlier, the pain was gone, leaving only a bruise under the fingernail.

Usually, first aid is enough to make the pain and inflammation recede. If the unpleasant sensations during the day do not pass, there is pressure and discomfort in the nail, indicating a severe bruise, for help, you must always consult a specialist. Specialists may also need help if the nail plate has split off from the skin as a result of the injury or a fracture occurred in it. The doctor will examine the wound and prescribe the appropriate treatment.

If the blood clot 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 remove the accumulated blood from under it, which gives patients noticeable relief and prevents the exfoliation of the nail.

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

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

• puncture is done with a sufficiently thick medical needle, screwing it into the nail plate as in the case of drill,
• The nail plate in the place of the hematoma is burned with a special device - a thermocouter.

Through the formed hole, the blood begins to protrude outward. To slightly accelerate this process, lightly press on the nail plate. Further on the finger impregnated with an antiseptic cloth, which is fixed with a bandage. Since the blood from the hole in the nail can drip for a day or more, the bandage should be periodically changed (at least once a day).

A prerequisite for the success of this procedure is sterility, because getting the 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. As a antiseptic, a solution of hydrogen peroxide is used. In its absence, you can use other excellent antiseptics: an alcohol solution of iodine, an aqueous solution of potassium permanganate or furacilin. The use of the drug "Chlorhexidine" with a pronounced antibacterial effect is indicative. It is customary for him to handle not only wounds, but also hands and surgical instruments before and after the operation.

On the Internet, you can find a description of the drainage of the nail at home using a clip that needs to be heated over the fire, then to pierce it with a fingernail to extract blood outwards. The surface of the nail before the procedure is recommended to lubricate with iodine, and after removing drainage and blood - hydrogen peroxide with the application of impregnated dressings impregnated with the same solution.

In theory, if you perform an operation under conditions of good disinfection of the clip and nail, infection should not occur. However, often this self-treatment has sad results. Patients have to consult a doctor already about the suppuration of the nail.

In the case of very voluminous bruises covering most of the nail, and also when spontaneous exfoliation of the nail plate is observed, doctors often resort to surgical treatment - removal of the nail with subsequent treatment of the tissues under it.

Treatment is understood as the removal of accumulated blood, treatment of the cavity with an antiseptic and the application of an aseptic dressing that prevents the infection from entering the open wound.

In some cases, the entire nail is not excised, but only the deformed exfoliated part of the nail, which can later be re-injured.

Surgical removal of the nail may be necessary in the event that 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 antibacterial ointments effective effective in such damages (tetracycline, sintomycin, erythromycin, etc.) is applied. An aseptic bandage must always be applied from above. The wound needs to be processed and bandaged daily.

In severe injuries, if the nail is peeled off independently, and it was necessary to remove it, doctors can apply seams using the self-resorbable materials at the site of tissue damage. Repeated reception with inspection of the joints can be scheduled for 3-4 days after injury.

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

Prevention

Avoid the appearance of subungual hematoma due to regular compression of the toes can be selected by the appropriate size and shape of shoes. During training and playing soccer it is recommended to use a special sports shoes with a sufficient degree of finger protection from impact. Special footwear should also be for workers in construction specialties, because they have a higher risk of injuring their legs.

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

Do not forget about the fingers of your hands, which because of our inattention and carelessness so often fall into the sharply narrowing lumen of the door. Especially often young children suffer, who do not yet understand the whole danger of the doorway. Children often get injured by their parents, who close the door in an apartment or car, ignoring the location of the hands of children who are in the vicinity. To warn such traumas again attention and caution will help.

If the injuries could not be avoided, the severity of her symptoms and, possibly, the appearance of a subungual hematoma, urgent application of the ice to the site of injury will help. This five-minute treatment is recommended to be performed every half hour, observing the sensations and changes in the damaged limb. Lack of relief of symptoms during the day in any case is a sure occasion to visit the medical institution.

[15], [16], [17]

Forecast

Podnogtevaya hematoma - a rather unpleasant phenomenon, but its forecast is generally favorable. If the treatment is conducted competently, complications do not arise and in a short time a person forgets about the injury of the finger. Although the hematoma itself in the form of a dark patch will remind the incident for a long time, until the nail is sufficiently grown and cut off in the dark area.

The prognosis worsens if the bones and soft tissues were damaged during a trauma, or a purulent process developed on the spot of the hematoma. In this case, the growing nail may have an irregular shape and various defects. An untreated fracture can adversely affect the functionality of the finger. Pain and bone displacement can disrupt mobility, as well as change the shape of a damaged phalanx or joint.

A double prognosis can be given to melanoma, masked under the hematoma. If the malignant process was detected in time in the early stages, the chances of forgetting the disease for a long time are about 70-100% of the percentage, depending on the size of the lesion. Detection of skin cancer in advanced stages reduces the percentage of survival after treatment to 30-50%.

But back to our hematoma, resulting from injury. If its cause is precisely traumatic damage to the nail and tissues under it, prevention of this condition can be considered prevention of domestic and workplace injuries. First of all, this is caution and accuracy.

[18], [19]