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 RevolutionHealth.com.