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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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