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June 19, 2013
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Subungual Hematoma (Bleeding Under Nail) (cont.)

Medical Author:
Scott D Fell, DO, FAAEM
Medical Editor:
Jerry R. Balentine, DO, FACEP
Jerry R. Balentine, DO, FACEP
Jerry R. Balentine, DO, FACEP

Dr. Balentine received his undergraduate degree from McDaniel College in Westminster, Maryland. He attended medical school at the Philadelphia College of Osteopathic Medicine graduating in1983. He completed his internship at St. Joseph's Hospital in Philadelphia and his Emergency Medicine residency at Lincoln Medical and Mental Health Center in the Bronx, where he served as chief resident.

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Medical Treatment for Subungual Hematoma

  • Several techniques are used to drain the blood beneath the nail. This procedure is also called releasing the hematoma or trephination.
    • No single technique is preferred.
    • How your hematoma is drained depends on the experience of the doctor and where it is done.
  • Occasionally, the finger or toe is numbed with a digital block. (Your fingers and toes are called digits.) Some doctors (health care professionals) opt not to numb up the digits as the injection itself can cause as much if not more pain than the actual drainage of the hematoma.
    • A numbing medication such as lidocaine is injected at the bottom of your finger or toe.
    • Injecting the medication here numbs the entire digit.
    • As soon as your finger or toe is numb, the procedure can take place.
  • The following are commonly used methods for draining your hematoma:
    • Cautery: A battery-operated device is used to burn a hole in the nail until the blood is reached and drains out of the hole. This technique should not be used if the patient is wearing artificial acrylic nails which might be flammable.
    • Needle: A large diameter needle is used to drill or bore into the nail to create a hole to allow the blood to drain out.
    • Paper clip: This technique, although an older one, is still used by some practitioners. A paper clip is opened so that the pointed end is free. Then the pointed end is heated up, usually by passing it through a flame, and used to burn through the nail. This technique uses a combination of the cautery method and the needle method.

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Subungual Hematoma (Bleeding Under Nail) - Causes

The eMedicineHealth physician editors ask:

What was the cause of your subungual hematoma?

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Read What Your Physician is Reading on Medscape

Hand, Subungual Hematoma Drainage »

Subungual hematomas are common nail bed injuries caused by blunt or sharp trauma to the fingers or toes.

Read More on Medscape Reference »


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