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10.08 Subungual Ecchymosis


Presentation

The patient will have had a crushing injury over the fingernail; getting it caught between two heavy objects for example, or striking it with a hammer. The pain is initially intense, but rapidly subsides over the first half hour, and by the time he is examined only mild pain and sensitivity may remain. There is a light brown or light blue-brown discoloration beneath the nail.

What to do:

What not to do:

Discussion:

Unlike the painful space-occupying subungual hematoma, the subungual ecchymosis only represents a thin extravasation of blood beneath the nail or a mild separation of the nail from the nailbed. Doing a trephination will not relieve any pressure or pain, and may indeed cause excruciating pain, as well as open this space to possi ble infection. The patient's familiarity with nail trephination (above) may give him the erroneous expectation that he should have his nail drilled.

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from Buttaravoli & Stair: COMMON SIMPLE EMERGENCIES
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Craig Feied, MD
Mark Smith, MD
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