Nailbed & Fingertip Injuries

Dr Jacqueline Tan

Senior Consultant Hand Surgeon

MBBS (SG) | MRCS (Edin) | MMed (Surgery) | FAMS (Hand Surgery)

Nailbed and fingertip injuries involve damage to the tissue beneath the nail, the bone, or the soft tissue at the tip of the finger or thumb. Sometimes, these injuries may also affect the flexor and extensor tendons, which are the tissues that help bend and straighten the finger. They often occur during accidents at home, work, or recreational activities and may involve sharp cuts, crushing, or tearing. Without treatment, they can lead to ongoing pain, increased sensitivity, numbness, deformity, or loss of movement.

Symptoms Causes Diagnosis Treatment Prevention FAQ

Symptoms of Nailbed & Fingertip Injuries

Symptoms vary depending on the type and severity of the injury. Common symptoms include:

Pain and Swelling: The fingertip often becomes tender and swollen, with throbbing pain in cases of significant tissue damage.
Bleeding or Bruising: Blood trapped under the nail, known as a subungual haematoma, appears as a dark patch and causes throbbing pain and pressure.
Deformity: The nail or fingertip may appear misshapen, such as a flattened nail, exposed nailbed, or displaced soft tissue, particularly after crush or tearing injuries.
Numbness or Tingling: Nerve damage can result in altered sensation, ranging from tingling to loss of feeling in the fingertip.
Impaired Nail Growth: Severe nailbed injuries can interfere with normal nail regrowth, causing ridges, splits, or deformities.

Causes and Risk Factors

Nailbed and fingertip injuries often result from trauma. Common causes include:

Crush Injuries: Caused by the fingertip being caught between objects or struck by heavy items such as doors or tools. These injuries can damage the nailbed, soft tissues, and the fingertip bone.
Lacerations: Sharp objects, including knives or glass, can cut the nail, nailbed, or surrounding tissues. Deep cuts may involve tendons or expose bone.
Tearing of the Nail (Avulsion): High-impact trauma, such as a finger being pulled or jammed, can cause the nail and underlying tissue to detach from the fingertip.
Burns: Thermal or chemical burns may damage the skin, soft tissues, and nailbed.
Workplace or Sports Accidents: Handling machinery, lifting heavy objects, or participating in contact sports often exposes fingers to high-impact or repetitive stress injuries.

Diagnosis of Nailbed & Fingertip Injuries

Physical Examination

The injured fingertip is examined for bleeding, swelling, deformity, exposed bone, and signs of nerve or tendon involvement. The assessment evaluates nailbed integrity, soft tissue condition, and range of motion.

X-rays

Imaging is used to detect fractures of the fingertip bone, which are common with crush or tearing injuries. X-rays provide details about bone alignment and the severity of any fractures.

Treatment Options

Treatment focuses on restoring fingertip function, managing pain, and preserving the appearance of the nail and finger. Early treatment measures help stabilise the injury and prevent complications.

Non-Surgical Treatment

Wound Care and Dressing

Wounds are cleaned to remove debris, and dressings are applied to protect the area and support healing. A tetanus injection may be given if necessary, and antibiotics are prescribed for open wounds or nailbed breaches to prevent infection.

Subungual Haematoma Drainage

A sterile needle or small puncture is used to relieve pressure and pain caused by blood trapped under the nail.

Splinting

Stable fractures or soft tissue injuries are immobilised using splints to maintain alignment during healing. Splints are typically used for several weeks, depending on the injury.

Pain Relief

Non-prescription medications such as ibuprofen or paracetamol are commonly used to manage pain and reduce inflammation.

Surgical Treatment

Nailbed Repair

Fine sutures are used to repair lacerations of the nailbed, preventing scarring and deformities. In some cases, the nail is temporarily removed to facilitate accurate repair.

Nail Reattachment

For partially avulsed nails, the nail is repositioned and temporarily secured to protect the nailbed. This method supports proper healing and guides nail regrowth.

Prevention and Management

Taking precautions can help reduce the risk of nailbed and fingertip injuries. Wearing gloves during manual tasks or sports, using ergonomic tools, and handling sharp equipment carefully are effective ways to minimise risk. Protective guards or shields may also be useful in high-risk occupations. For those recovering, adhering to wound care instructions, follow-up appointments, and physical therapy (if recommended) supports healing and reduces complications. Maintaining nail hygiene, such as keeping nails trimmed and clean, can help prevent minor injuries from worsening.

Frequently Asked Questions

Are nailbed injuries painful even after healing?

Some individuals may continue to experience pain or heightened sensitivity after healing, especially if the injury involves nerve damage.

What is the recovery time for nailbed and fingertip injuries?

Recovery time varies based on the severity of the injury. Minor injuries typically heal within 1 to 2 weeks, while more severe injuries that require surgery may take several months.

How is sensation restored after nerve damage in the fingertip?

In some cases, nerves heal on their own over time, gradually restoring sensation. For significant nerve damage, surgical procedures such as nerve repair or grafting may be needed.

Dr Jacqueline Tan

Senior Consultant Hand Surgeon

MBBS (SG)

MRCS (Edin)

MMed (Surgery)

FAMS (Hand Surgery)

Dr. Jacqueline Tan is a hand surgeon in Singapore with over 18 years of experience in managing hand, wrist, and nerve conditions. Formerly the Head of Department of Hand and Reconstructive Microsurgery at Singapore General Hospital, she has continued to contribute significantly to her profession.

Director of Micro-Reconstruction Service and the Director of Peripheral Nerve and Paralytic Upper Limb Service
Upon the completion of her training as a hand surgeon in Singapore, Dr Tan was awarded the prestigious Health Manpower Development Plan scholarship by the Ministry of Health (MOH).
Completed a one-year advanced fellowship in Taiwan under the tutelage of internationally-acclaimed Hand and Orthopedic Microsurgeon – Professor Yuan-Kun Tu
Dr Tan’s field of expertise is in early and late brachial plexus reconstruction, peripheral nerve disorders, reconstructive microsurgery of the extremities and wrist disorders.

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Mt Elizabeth Novena Specialist Centre

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