What is a Subungal Hematoma?
A subungal hematoma usually appears as a black toenail or black fingernail
Quickcare or ER
A subungal hematoma should be seen in a Quickcare. Many patients will have this condition for days before seeing a doctor.
A Red Flag is pain. The subungal hematoma itself is not an emergency. Pain control is key, A severe pain that keeps you up all night may send you to the ER.
What will your doctor ask?
Remember, a symptom is your description of your condition to your doctor. It is your story.
Answers to these questions will help your doctor understand.
- Where is the pain?
- What happened? Was the finger crushed?
- Is it sharp/dull/throbbing?
- What makes the pain better?
- What makes the pain worse?
- Can you move your finger?
What will your doctor look for?
Your doctor will look for signs. Remember, a sign is an objective finding by your doctor.
After a crush injury, it is possible that the finger is broken. It is reasonable to xray it to make sure.
A doctor will look for adequate movement (range of motion) of the finger. A lack of movement could be a tendon disruption.
If there are no cuts (lacerations) to sew up, and no broken bones on xray, then we can focus on the nail.
A bruised toe nail may appear black under the toe nail.
What is your doctor thinking
Your doctor will create a mental list of possible reasons for your signs and symptoms. This list is called a differential diagnosis.
Doctor now is thinking whether it is broken or if there is just the subungal hematoma.
A simple xray will make that distinction.
Also need to make there is no tendon damage. This is tested by demonstrating full movement of the finger joints.
What is the treatment of a Subungal Hematoma?
Trephination will help with a subungal hematoma. This procedure will help to let out the blood from under the nail. Hmmm. How can we do that? In the clinic, we use a cautery that heats up nice and hot. I then poke into the nail. A little squirt of blood usually shoots out. Ahhhh. Instant relief.
I have never had to remove the nail all together.
How long will you be sick?
The opening will ooze for a day or two.
It will need to stay covered with a bandage. I like to add a topical antibiotic cream.
Let me tell you a story….John “Mountain Man” always had keys hanging from his side. Dozens of pieces of metal were clipped to his Wranglers clanging wherever he went. Even at home at dinner time, his dozens of keys made a jingle and a jangle as he went to get a hot tortilla from the stove. Why did he always have those keys? What was he going to unlock in his kitchen? Maybe all that noise gave him a sense of power. It gave him a control which compensated for his illiteracy.
On the job, Big John thought he was being clever. He was going to show the new hires that he was still “THE MAN.” When all the youngsters said there was too much work to do in the allotted time, Mountain Man pushed them aside, took the hammer and started banging at lighting speed. That is when mistakes happen. With one swing, the hammer came crashing on to his thumb.
John’s pain was local throbbing. Any movement made the pain worse.
I never saw such a big man cry (real tears) like that before.
When I told him of the cautery, he asked, “Is it gonna hurt?”
After the blood squirted out of The Man, a simple bandage was needed. In no time at all, Mountain Man stopped crying. Instant relief.
The world was good again
I hope this helps