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Bruised Finger Nails: How Do You Treat Them?

A colleague slammed his thumb in a door recently and got a black and blue nail.  He told me that he searched for how to treat it on the Internet, and was advised to stick holes in the nail to relieve the pressure.  I gazed at his thumb nail, peppered with tiny little needle divots and cringed as I imagined bacteria being introduced into the soft fleshy part under his thumb nail.  His thumb otherwise looked good – no mallet finger, no swelling – no blood under pressure that I could see.

I decided to do a little research on this issue, since all I’d ever done for a black and blue finger nail before is let nature take its course – it’s painful for a few days, the nail eventually falls off, and a new one grows.

However, in many cases creating a hole in the nail to let the blood escape can significantly relieve pain in the acute phase.  Making the hole is tricky – it has to be large enough to let the blood out, and it has to be done with a sterile instrument so that bacteria are not introduced below the nail.  Most physicians recommend a local anesthetic to ease the pain prior to making the hole.  The hole can be made with a large bore needle (but you have to be careful not to place the needle in too deep) after swabbing with alcohol, or by burning through the nail with the tip of a paperclip that has been heated with a butane lighter.  Creating the nail hole (known as trephination) is best done by a medical professional.

Routine antibiotic coverage is unnecessary. If the nail is loose, split, or a cut extends past the edge of the nail, the nail should be removed,
the cut closed with stitches, and the nail reapplied as a
dressing.  It’s also important to make sure that the thumb bone is not fractured.

Bottom line: black and blue nails (subungual hematomas) are very painful and may be relieved by having a medical professional place a hole in the nail.  But don’t try this at home, folks.This post originally appeared on Dr. Val’s blog at

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6 Responses to “Bruised Finger Nails: How Do You Treat Them?”

  1. ValJonesMD says:

    Dear readers: Dr. Bates’ link is outstanding (see in comment below).  If you need more information about bruised nails, she has done a fantastic job of summarizing the issues.  Thanks for the link!

  2. earthling says:

    Ewww…sort of an interesting blog post Val, but should have a “squeamish” alert at the top (the RH version of “spoiler alerts!) ;-0

  3. C Coleman Brown MD says:

    you also want to keep in mind that if 50% or more of the nail is hematoma, then there is probably a nail bed injury as well and this should be repaired. this is done by blocking (anesthetizing) the finger, tourniquet on the finger, lifting the nail plate, repairing the nail bed, replacing the nail plate and letting it regrow. this is important because nail bed injuries that are not repaired will result in distorted and potentially painful nail growth that become more difficult to repair down the line.

  4. RH Host Melissa says:

    I couldn’t IMAGINE trying this at home!!!  

  5. Adam says:

    Thanks for the write-up Dr. Val.  That was the most painful thing I have experienced in recent memory.  I really should have seen a doctor.

    *start squeamish alert*

    I actually used a very sharp exacto knife instead of a needle to make the holes in my nail.  Using a twisting motion with hardly any applied pressure, the tapered tip allowed me to make the hole with absolutely no pain.  The holes through my nail released all of the pressure and made this injury quite a bit less painful.  

    Now that I’ve written this, I can see that I totally should have gone to the hospital.  Wow.

    *end squeamish alert*

    I posted a quick pic of the offending finger over on my flickr account – not gross – just black and blue:

    Again, please do not try to fix this kind of damage at home – it’s not fun at all.

  6. doug mason says:

    I have a bad sore under my fingernail for about 3 weeks. It is a black bruised ,how to tread it,because i slam my finger while slamming car door.

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Richmond, VA – In an effort to simplify inpatient medical billing, one area hospitalist group has determined that “altered mental status” (ICD-9 780.97) is the most efficient code for use in any patient work up.

“When you enter a hospital, you’re bound to have some kind of mental status change,” said Dr. Fishbinder, co-partner of Area Hospitalists, PLLC. “Whether it’s confusion about where your room is located in relationship to the visitor’s parking structure, frustration with being woken up every hour or two to check your vital signs, or just plain old fatigue from being sick, you are not thinking as clearly as before you were admitted. And that’s all the justification we need to order anything from drug and toxin screens, to blood cultures, brain MRIs, tagged red blood cell nuclear scans, or cardiac Holter monitoring. There really is no limit to what we can pursue with our tests.”

Common causes of mental status changes in the elderly include medicine-induced cognitive side effects, disorientation due to disruption in daily routines, age-related memory impairment, and urinary tract infections.

“The urinalysis is not a very exciting medical test,” stated Dr. Fishbinder. “It doesn’t matter that it’s cheap, fast, and most likely to provide an explanation for strange behavior in hospitalized patients. It’s really not as elegant as the testing involved in a chronic anemia or metabolic encephalopathy work up. I keep it in my back pocket in case all other tests are negative, including brain MRIs and PET scans.”

Nursing staff at Richmond Medical Hospital report that efforts to inform hospitalists about foul smelling urine have generally fallen on deaf ears. “I have tried to tell the hospitalists about cloudy or bloody urine that I see in patients who are undergoing extensive work ups for mental status changes,” reports nurse Sandy Anderson. “But they insist that ‘all urine smells bad’ and it’s really more of a red herring.”

Another nurse reports that delay in diagnosing urinary tract infections (while patients are scheduled for brain MRIs, nuclear scans, and biopsies) can lead to worsening symptoms which accelerate and expand testing. “Some of my patients are transferred to the ICU during the altered mental status work up,” states nurse Anita Misra. “The doctors seem to be very excited about the additional technology available to them in the intensive care setting. Between the central line placement, arterial blood gasses, and vast array of IV fluid and medication options, urosepsis is really an excellent entré into a whole new level of care.”

“As far as medicine-induced mental status changes are concerned,” added Dr. Fishbinder, “We’ve never seen a single case in the past 10 years. Today’s patients are incredibly resilient and can tolerate mixes of opioids, anti-depressants, anti-histamines, and benzodiazepines without any difficulty. We know this because most patients have been prescribed these cocktails and have been taking them for years.”

Patient family members have expressed gratitude for Dr. Fishbinder’s diagnostic process, and report that they are very pleased that he is doing everything in his power to “get to the bottom” of why their loved one isn’t as sharp as they used to be.

“I thought my mom was acting strange ever since she started taking stronger pain medicine for her arthritis,” says Nelly Hurtong, the daughter of one of Dr. Fishbinder’s inpatients. “But now I see that there are deeper reasons for her ‘altered mental status’ thanks to the brain MRI that showed some mild generalized atrophy.”

Hospital administrators praise Dr. Fishbinder as one of their top physicians. “He will do whatever it takes to figure out the true cause of patients’ cognitive impairments.” Says CEO, Daniel Griffiths. “And not only is that good medicine, it is great for our Press Ganey scores and our bottom line.”

As for the nursing staff, Griffiths offered a less glowing review. “It’s unfortunate that our nurses seem preoccupied with urine testing and medication reconciliation. I think it might be time for us to mandate further training to help them appreciate more of the medical nuances inherent in quality patient care.”

Dr. Fishbinder is in the process of creating a half-day seminar on ‘altered mental status in the inpatient setting,’ offering CME credits to physicians who enroll. Richmond Medical Hospital intends to sponsor Dr. Fishbinder’s course, and franchise it to other hospitals in the state, and ultimately nationally.


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