What Is a Splinter Hemorrhage?

Jacquelyn Gilchrist
Jacquelyn Gilchrist
Blood tests may be run to rule out underlying causes of splinter hemorrhages.
Blood tests may be run to rule out underlying causes of splinter hemorrhages.

A splinter hemorrhage, sometimes called a fingernail hemorrhage, is a medical condition that only occurs underneath a person's toenails or fingernails. It is a localized area of bleeding that tends to appear in a straight line, traveling in the direction in which the nail grows. While this condition is most often not a cause for alarm, it can sometimes indicate a more serious underlying medical condition. Along with addressing the underlying cause, if there is one, the standard course of treatment is to allow the nail to grow out so that the discoloration gradually disappears.

Splinter hemorrhages may occur underneath a toenail because of injury to the area.
Splinter hemorrhages may occur underneath a toenail because of injury to the area.

Often, a patient acquires a splinter hemorrhage when the nail suffers physical trauma, such as an impact injury. Athletes may be at a higher risk of this type of injury, which occurs when the capillaries, or small blood vessels, underneath the nail have been damaged. Rarely, a splinter hemorrhage may be caused by medication. Blood thinners, such as aspirin, as well as other over-the-counter pain relievers may occasionally result in bleeding under a nail.

Taking aspirin may occasionally result in bleeding under a nail.
Taking aspirin may occasionally result in bleeding under a nail.

A splinter hemorrhage may also rarely be caused by an underlying medical condition. Patients who experience recurring hemorrhages may need to be examined by a doctor to rule out a more serious problem. A fungal infection like onychomycosis may contribute to this condition. Nail psoriasis may also be a factor, because it causes the nail to thin, which makes the small blood vessels more vulnerable to injury.

A chest X-ray may be performed if a doctor suspects that a patient has an underlying cause for the abnormal appearance of nails.
A chest X-ray may be performed if a doctor suspects that a patient has an underlying cause for the abnormal appearance of nails.

More serious conditions like lupus and Raynaud's disease are also associated with splinter hemorrhages. Microemboli, which are tiny blood clots, and vasculitis, which occurs when the blood vessels are inflamed, have also been linked to this nail condition. Patients with a heart valve infection called endocarditis may occasionally develop bleeding under the nails; however, usually more serious symptoms are noticed first.

Cold or numbness in the toes may be a symptom of Raynaud's disease, which is also associated with splinter hemorrhages..
Cold or numbness in the toes may be a symptom of Raynaud's disease, which is also associated with splinter hemorrhages..

When a doctor suspects that a patient has an underlying cause for the abnormal appearance of his nails, tests will likely be done to check for potential problems. It is essential that the patient discloses all other symptoms he has, even if they may seem unrelated. The doctor may order blood tests, such as a complete blood count (CBC) and an erythrocyte sedimentation rate (ESR), which checks for systemic inflammation. Imaging tests like an echocardiogram or a chest x-ray may also be helpful.

A fungal toenail infection may lead to a splinter hemorrhage.
A fungal toenail infection may lead to a splinter hemorrhage.

There is no specific treatment for the splinter hemorrhage itself. It will eventually disappear as the nail grows out. Patients should avoid irritating the area and prevent further trauma to the nail. Those that have an underlying medical condition will undergo treatment for that diagnosis.

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    • Blood tests may be run to rule out underlying causes of splinter hemorrhages.
      By: inkaone
      Blood tests may be run to rule out underlying causes of splinter hemorrhages.
    • Splinter hemorrhages may occur underneath a toenail because of injury to the area.
      By: johnnydao
      Splinter hemorrhages may occur underneath a toenail because of injury to the area.
    • Taking aspirin may occasionally result in bleeding under a nail.
      By: Kadmy
      Taking aspirin may occasionally result in bleeding under a nail.
    • A chest X-ray may be performed if a doctor suspects that a patient has an underlying cause for the abnormal appearance of nails.
      By: Photographee.eu
      A chest X-ray may be performed if a doctor suspects that a patient has an underlying cause for the abnormal appearance of nails.
    • Cold or numbness in the toes may be a symptom of Raynaud's disease, which is also associated with splinter hemorrhages..
      By: Andrew Lewis
      Cold or numbness in the toes may be a symptom of Raynaud's disease, which is also associated with splinter hemorrhages..
    • A fungal toenail infection may lead to a splinter hemorrhage.
      By: Leonid Smirnov
      A fungal toenail infection may lead to a splinter hemorrhage.
    • An echocardiogram may be used to help explain a splinter hemorrhage.
      By: nyul
      An echocardiogram may be used to help explain a splinter hemorrhage.
    • One hour into an ESR test, the distance that the red blood cells have fallen below the top of the clear fluid is measured to give the ESR level.
      By: reineg
      One hour into an ESR test, the distance that the red blood cells have fallen below the top of the clear fluid is measured to give the ESR level.