Thumbs down to nail injuries

Dear Alice,

I slammed my thumb in a car door and now the nail is about to fall off. I can see my flesh from underneath my nail and it looks all wrinkled and not very healthy. I am afraid that it won't grow back.

Is the skin going to hurt once the nail falls off?

Please let me know.

Thank you.

Dear Reader,

Ouch! Sounds like your thumb really got nailed! While the state of your injury might look gnarly right now, once the nail fails off, in the majority of cases, new skin will grow over the nail bed (the flesh under where your nail used to be) in about a week or so. This is when you will likely notice reduced or even no pain in your thumb. In the meantime, here are some ways to manage the pain:

  • Apply ice for 20 minutes every 2 hours on the first day, then 3 to 4 times a day after that.
  • Keep your hand above the level of your heart to reduce throbbing.
  • Take any prescription pain meds as directed by your health care provider. You can also get pain killers over the counter to help with pain and swelling, such as ibuprofen, naproxen, or acetaminophen. Don't take more than the amount recommended on the bottle, and speak with a health care provider if you have heart disease, kidney disease, high blood pressure, or had stomach ulcers or internal bleeding in the past before taking any pain medication.

Even once the pain has subsided, keep an eye out for signs of infection. These symptoms may include fever, redness, tenderness, increased swelling, persistent bleeding, or pus draining from the affected area. To protect yourself from infection:

  • Soak your thumb in a solution of one teaspoon of salt to four cups of warm water for 20 minutes, 2 to 3 times a day, during the first few days after the injury.
  • After soaking, carefully dry it off and apply an antibiotic ointment or petroleum jelly.
  • Cover the nail bed with a fresh adhesive bandage.
  • Keep the nail bed dry, clean, and covered. Apply a new adhesive bandage if the bandage becomes wet or soiled.

It might also be a good idea to speak with a health care provider about your injury, if you haven't already. While some minor nail injuries can be managed at home, it doesn’t hurt to have a professional evaluate the severity of the injury and determine a treatment plan. They can look for bruising, check to make sure that no bones were broken or fractured, and determine if you need a tetanus shot. This last part is crucial since tetanus can be deadly. If you suffer from diabetes, poor circulation, or any condition that may affect your body's ability to heal, it's wise to seek medical attention as soon as possible.

Your nail will most likely grow back on its own in about four to six months, but there is always a chance that it may be permanently deformed with grooves or dents. A health care provider may be able to give you more details on how your thumb will heal and how to make sure that every step of the recovery process goes smoothly.

Good luck,

Last updated Jan 27, 2023
Originally published Feb 16, 2007