What does it feel like?
A throbbing, distracting pain at the end of the finger, under the nail, with discoloration from bleeding under the nail. Often the fingertip feels markedly swollen and crushed.
What is it?
It is a traumatic injury to the nail, usually from a crush or direct blow, such as slamming your finger in a door or dropping a heavy object on the fingertip. In workplace settings, machinery such as drop saws or a misfired drill or a hammer striking the fingernail can also cause this injury.
What causes it?
Direct trauma, whether penetrating, sharp or blunt, can break or fracture the nail, as well as lacerate or tear the bed upon which the nail sits. This causes bleeding under the nail, termed a subungual haematoma, which is extremely painful, as the blood expands in an enclosed space.
What are my treatment options?
Nailbed injuries are common. All of these injuries should be assessed and have an X-ray taken to ensure there is no underlying fracture or break in the bone beneath the nailbed (the distal phalanx).
Because it is a small area of the body, many people choose to ignore the injury and as a result may have long-lasting nail deformities.
If the subungual haematoma (or bleeding under the nail) involves more than half of the nailbed, prompt surgical treatment is generally recommended. Under anaesthesia, this will involve removal of the nail and accurate repair under magnification of the torn nailbed. Outcomes from surgery are better and more predictable if repair is performed within 72 hours of the injury, which highlights the importance of seeking medical attention when the injury occurs and promptly obtaining a referral to a hand surgeon, if warranted.