Nail Bed Injury

The nail bed is the soft tissue under a fingernail or toenail that is the origin for new nail growth. Various types of injuries can occur at the nail bed. These injuries may involve bruising or bleeding under the nail, cuts (lacerations) in the nail or nail bed, or loss of a part of the nail or the whole nail (avulsion). In some cases, a nail bed injury accompanies another injury, such as a break (fracture) of the bone at the tip of the finger or toe. Nail bed injuries are common in people who have jobs that require performing manual tasks with their hands, such as carpenters and landscapers.

The nail bed includes the growth center of the nail. If this growth center is damaged, the injured nail may not grow back normally if at all. The regrown nail might have an abnormal shape or appearance. It can take several months for a damaged or torn-off nail to regrow. Depending on the nature and extent of the nail bed injury, there may be a permanent disruption of normal nail growth.

CAUSES

Damage to the nail bed area is usually caused by crushing, pinching, cutting, or tearing injuries of the fingertip or toe. For example, these injuries may occur when a fingertip gets caught in a door, hit by a hammer, or damaged in accidents involving electrical tools or power machinery.

SYMPTOMS

Symptoms vary depending on the nature of the injury. Symptoms may include:

  • Pain in the injured area.

  • Bleeding.

  • Swelling.

  • Discoloration.

  • Collection of blood under the nail (hematoma).

  • Deformed or split nail.

  • Loose nail (not stuck to the nail bed).

  • Loss of all or part of the nail.

DIAGNOSIS

Your caregiver will take a medical history and examine the injured area. You will be asked to describe how the injury occurred. X-rays may be done to see if you have a fracture. Your caregiver might also check for conditions that may affect healing, such as diabetes, nerve problems, or poor circulation.

TREATMENT

Treatment depends on the type of injury.

  • The injury may not require any special treatment other than keeping the area clean and free of infection.  

  • Your caregiver may drain the collection of blood from under the nail. This can be done by making a small hole in the nail.  

  • Your caregiver may remove all or part of your nail. This might be necessary to stitch (suture) any laceration in the nail bed. Before doing this, the caregiver will likely give you medication to numb the nail area (local anesthetic). In some cases, the caregiver may choose to numb the entire finger or toe (digital nerve block). Depending on the location and size of the nail bed injury, an avulsed nail is sometimes stitched back in place to provide temporary protection to the nail bed until the new nail grows in.

  • Your caregiver may apply bandages (dressings) or splints to the area.

  • You might be prescribed antibiotic medication to help prevent infection.

  • For certain injuries, your caregiver may direct you to see a hand or foot specialist.  

You may need a tetanus shot if:

  • You cannot remember when you had your last tetanus shot.

  • You have never had a tetanus shot.

  • The injury broke your skin.

If you get a tetanus shot, your arm may swell, get red, and feel warm to the touch. This is common and not a problem. If you need a tetanus shot and you choose not to have one, there is a rare chance of getting tetanus. Sickness from tetanus can be serious.

HOME CARE INSTRUCTIONS

  • Keep your hand or foot raised (elevated) to relieve pain and swelling.  

  • For an injured toenail, lie in bed or on a couch with your leg on pillows. You can also sit in a recliner with your leg up. Avoid walking or letting your leg dangle. When you walk, wear an open-toe shoe. 

  • For an injured fingernail, keep your hand above the level of your heart. Use pillows on a table or on the arm of your chair while sitting. Use them on your bed while sleeping.  

  • Keep your injury protected with dressings or splints as directed by your caregiver.  

  • Keep any dressings clean and dry. Change or remove your dressings as directed by your caregiver.  

  • Only take over-the-counter or prescription medications as directed by your caregiver. If you were prescribed antibiotics, take them as directed. Finish them even if you start to feel better.  

  • Follow up with your caregiver as directed.  

SEEK MEDICAL CARE IF:

  • You have pain that is not controlled with medication.  

  • You have any problems caring for your injury.  

SEEK IMMEDIATE MEDICAL CARE IF:

  • You have increased pain, drainage, or bleeding in the injured area.  

  • You have redness, soreness, and swelling (inflammation) in the injured area.

  • You have a fever or persistent symptoms for more than 2–3 days.

  • You have a fever and your symptoms suddenly get worse.

  • You have swelling that spreads from your finger into your hand or from your toe into your foot.  

MAKE SURE YOU:

  • Understand these instructions.

  • Will watch your condition.

  • Will get help right away if you are not doing well or get worse.