Subungual Ecchymosis: (Tennis Toe)

Presentation

The patient had a mild to moderate crushing injury to a fingernail, such as being caught in a closing drawer or being struck by a heavy object. The pain was initially intense but rapidly subsided over the first few minutes to 0.5 hour. Usually, by the time the patient is examined, there is only mild pain and tenderness. There is a light brown or blue-brown discoloration beneath the nail ( Fig. 155.1 ). The patient may be concerned about the need to have the blood drained.

A similar but painless condition can occur with repeated minor trauma to a toe nail. This can occur inside a sport shoe when rapid thrusting of the athlete’s toes into the toe box occurs as a result of abrupt stops, such as on a tennis or basketball court (“tennis toe”). Jogging may also be the cause of such a toe injury. The patient may state that the toe hurt for a brief period of time, but the pain has since resolved. On examination, there is a light brown or light blue-brown discoloration beneath the nail ( Fig. 155.2 ).