Blood Under the Nail: Subungual Hematoma

5. Medical Treatment

If the pain from the hematoma becomes intolerable despite simple treatment, the only option is to release the pressure under the nail by draining the blood or by removing the nail entirely. The drainage procedure, trephining, involves creating a small hole or holes above the hematoma to allow the blood to drain out. This can be done with a drill, cautery, scalpel or, less commonly, a laser.

Removal of the entire nail may be necessary if it is badly damaged or there are lacerations around the area. Depending on the severity and the plan for treatment, doctors may use a digital nerve block or local anesthesia to painlessly remove the nail.