Subungual Hematoma

Have you ever had your finger caught between the door or had your toe hit something really hard before? I did. And I will tell you a little story of mine at the closing stage of this post.

So what is subungual hematoma? It is a common traumatic injury that causes bruising under the finger or toe nail. The capillaries are severe by the traumatic force and sub-dermal bleeding occurs. Just like any other bruises, the injury site has a blackish-blue colouration to it. You will feel a constant sensation of pain as pressure is building up where blood is pooling in a particular area. Usually, mild forms of subungual hematoma will recover without any intervention. The discolouration of the nail bed will slowly, but surely return to normal with time. When it is a severe subungual hematoma, the old nail would most likely detach when the new nail is growing. The old nail then comes off harmlessly.

I am going to teach you, from my personal experience, what are the things you should and should not do when you sustain such an injury.

What you SHOULD NOT do:

• Do not rub your injured finger/toe - Friction causes heat, and both friction and heat will cause more capillaries to rupture and severe, potentially aggravating the injury. 

• Do not place anything warm such as a towel soaked with warm water over the injury, the reason is the same as the above-mentioned.

• Do not place further strain on the injured finger/toe. Stop activities such as soccer, heavy lifting, basketball ect. until the injury is healed

• Do not perform self-remedies. I know some people do that by heating a sewing needle over fire. When the needle is hot enough, they place the sharp point on the nail, melting the nail and then slightly piercing the nail bed, causing blood to release thus relieving the pressure and pain. Please don't do that. You are not a doctor and you may pierce deeper than you intended to. There is a high possibility that infections may occur if you are a diabetic or you have some type of blood disease which causes your wounds to heal slower than normal.   

• Do not try to remove your old nail forcefully when the new one is growing. Just let it come off naturally.     

What you SHOULD do: 

• Consult a General Practitioner quickly. There may be lacerations on the nail bed and stitching is required, but for that to happen, the doctor will have to remove the entire nail first. The preferable time-frame is within an hour of the incident. It is because your blood tends to coagulate at the injury site, and that makes things trickier. Speaking from personal experience, I will explain to you why that is a problem later when I do a recollection of my story.     

• Rest the injured area.

• If the injury is at the finger, you may want to raise you arm above the heart level, so that you could sleep better at night. If the injury is at the toe, you may want to place a pillow or two to elevate your leg where the injured toe is, so that the toe doesn't hurt as much when you sleep at night.   

  

Yep, I believe that's my finger. That's subungual hematoma at the index finger of my right hand. Luckily, I am a lefty.

Okay, here's how my story goes...

It was a misfortune that I got my finger caught between the door when I was at a party three months ago. At first, I just felt a sharp pain when the door slammed onto my finger, and the only thing that came to my mind at that moment was a scientific formula: Force = Mass x Acceleration

It didn't hurt much until the next day. My finger got pretty puffy and I was surprised at how quick the entire nail changed colour the next day. The pain was excruciating. On the pain index from 1 to 10, I was at 7, but I still refused to go to the doctor. 

For the next 3 nights, I couldn't sleep well as the pain was very pronounced. It was throbbing pain. I could literally count my heartbeats through my injured finger every night. If you thought counting sheep was bad, try counting heartbeats.

The next night, I took it no more. I went to a hospital to get my finger checked as I feared that there may be a hairline fracture in my digit. 

At the hospital, they did an x-ray for me. Luckily there was no fracture. I pleaded to the doctor to help me ease the pain by relieving the pressure through a process known as trephination. 

Alas, the doctor said that it's too late, my blood has already coagulated. There was no point drilling a hole in it, not much blood would be let out, and so the pressure will still be there.

The doctor had also advised against my second option of pulling the entire nail out because I am a diabetic. Diabetes and wounds don't really rhyme well with each other.   

In the end, I decided to go with what the doctor had suggested - let it heal naturally. All he did was give me antibiotics and painkillers. The x-ray, medication and consultation cost me $80. Healthcare in Singapore is very affordable unaffordable. 

The story doesn't end there...

The pain completely subsided in about 2 weeks, and I could see my nail has started to detach from the groove and eponychium. I don't know what came over me, I guess it was impatience that day, that I tried to remove the detached nail forcefully with a clipper. I accidentally tore some tissues from the skin bed and it started bleeding like hell. But strangely, I felt no pain from that. So I went back to the same hospital and got it checked, cleaned, and bandaged. I got a good scolding from the doctor as well. I deserved it, anyway. It took me about two months or a little more for my finger to heal and for the new nail to grow to a decent length.

So folks, don't make the same mistakes like I did. Keep safe and good luck. I shall do up Wound Management Part 2 soon, when my grandma gets back home from holiday next week. See you!