Subungual hematoma

Subungual hematoma
Classification and external resources
Subungual hematoma of the left big toe
ICD-10	L60.8 (ILDS L60.872)
ICD-9	924.3, 923.3
eMedicine	article/827104 article/82926

A subungual hematoma is a collection of blood (hematoma) underneath a toenail or fingernail (black toenail). It can be extremely painful for an injury of its size although otherwise it is not a serious medical condition.

Causes

The condition often results from a traumatic injury such as slamming a finger in a door or from sports activities such as climbing or hiking rugged terrain. A subungual hematoma that results from the repetitive thrusting of the longest toe into a shoe's toe box is called jogger's toe^[1] or runner's toe.

The bleeding comes from the (vascular) nail bed underlying the (avascular) nail plate. A laceration of the nail bed causes bleeding into the constricted area underneath the hard nail plate.^[2] Throbbing pain is common. The nail develops a black discoloration overlying the nail bed but under the nail plate.

Treatment

Subungual hematomas are treated by either releasing the pressure conservatively when tolerable or by drilling a hole through the nail into the hematoma (trephining), or by removing the entire nail. Trephining is generally accomplished by using a heated instrument^[3] to pass through the nail into the blood clot. Removal of the nail is typically done when the nail itself is disrupted, a large laceration requiring suturing is suspected, or there is a fracture of the tip of the finger. Although general anesthesia is generally not required, a digital nerve block is recommended to be performed if the nail is to be removed.

Subungual hematomas typically heal without incident, though infection or disruption of the nail (onycholysis) may occur.^{[citation needed]}

See also

• List of cutaneous conditions
• Tennis toe
• Turf toe
• Runner's toe, repetitive injury seen in runners

References

1. ^ Mailler, E A; Adams, BB (2004). "The wear and tear of 26.2: dermatological injuries reported on marathon day". British Journal of Sports Medicine 38 (4): 498–501. doi:10.1136/bjsm.2004.011874. PMC 1724877. PMID 15273194. http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=1724877. 
2. ^ Selbst, SM, Attia, M (2006). "Lacerations". Textbook Of Pediatric Emergency Medicine. Hagerstown, MD: Lippincott Williams & Wilkins. p. 1571. ISBN 0781750741. 
3. ^ http://lifeinthefastlane.com/2010/03/minor-injuries-001/