Common Thumb Injury

Have you ever slammed your finger in the door or has your child hit their thumb with the head of a hammer?  If this has happened to anyone in your family you may recognize the bruised and bloodied nail bed, which is called a subungual hematoma.  Essentially this is a collection of blood, like a bruise, beneath the nail. 

This kind of trauma, albeit not life threatening, can cause a lot of pain and discomfort. Because the blood has no where to go due to the overlying protective coating of the nail, the injured finger or thumb just pounds and throbs as the blood pools under the nail.  

If the hematoma is fairly small and the injury minor, the nail just looks dark and the pain goes away fairly quickly and the nail may not even fall off. But with a bigger crush injury and more damage, the hematoma involves the entire nail bed and it is pretty painful and won't stop pounding.  

The treatment is really fairly simple and I can remember keeping a large paper clip at home for just this reason. With my own children and friends and neighbors, I often was the "hero" Mom for a second or two as I would clean the injured finger and then heat the tip of the paper clip and just "magically" poke a hole through the fingernail to let the oozing blood out!!! Voila, no more pressure or pounding and really no pain with the procedure. Kids loved to watch his trick! 

Modern medicine has advanced and we have now moved to an electric cautery in the office. It does the exact same thing, puts a hole in the nail and relieves the pressure of the blood beneath the nail. It is just a little "slicker" than that handy dandy paper clip. you go, my last patient was happy to oblige with this picture of the procedure and I promise you there were no tears. Maybe a few tears of joy when the nail quit throbbing! 





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