Splinter hemorrhages

Answer 1

Definition

Splinter hemorrhages are small areas of bleeding (hemorrhage) under the fingernails or toenails.

Alternative Names

Fingernail hemorrhage

Considerations

Splinter hemorrhages appear as narrow, red to reddish-brown lines of blood beneath the nails. They run in the direction of nail growth and are named splinter hemorrhages because they look like a splinter beneath the fingernail. The hemorrhages may be caused by tiny clots that damage the small capillaries under the nails.

Splinter hemorrhages are associated with infection of the heart valves (endocarditis) and may be caused by vessel damage from swelling of the blood vessels (vasculitis) or tiny clots that damage the small capillaries (microemboli).

Common Causes

• Trauma to the nail
• Subacute or acute bacterial endocarditis

Home Care

There is no specific care for splinter hemorrhages. Follow your health care provider's instructions for treating endocarditis.

Call your health care provider if

Contact your health care provider if:

• You notice splinter hemorrhages and you haven't had any recent trauma to the nail

Note: Splinter hemorrhages usually appear late in endocarditis. Likely other symptoms will cause you to visit your health care provider before splinter hemorrhages appear.

What to expect at your health care provider's office

Your doctor will examine you to determine the cause of the splinter hemorrhages. Your doctor may ask you the following medical history questions:

• When did you first notice this?
• Have you had trauma to the nails recently?
• Do you have a known diagnosis of endocarditis, or has your health care provider suspected endocarditis?
• What other symptoms do you have, such as shortness of breath, fever, general ill feeling, or muscle aches?

Physical examination may include special attention to the heart and blood circulation systems.

Laboratory studies may include:

• Blood cultures
• CBC
• ESR

In addition, your health care provider may order:

• Chest x-ray
• Echocardiogram
• ECG

After seeing your health care provider:

You may want to add a diagnosis related to splinter hemorrhages to your personal medical record.

References

Seidel HM, Ball JW, Dains JE, Benedict GW. Mosby's Guide to Physical Examination. 6th ed. Mosby: Philadelphia, Pa; 2006.

Holzberg M. Common nail disorders. Dermatol Clin. 2006;24:349-354.

Answer 2

Definition

Splinter hemorrhages are small areas of bleeding (hemorrhage) under the fingernails or toenails.

Alternative Names

Fingernail hemorrhage

Considerations

Splinter hemorrhages look like thin, red to reddish-brown lines of blood under the nails. They run in the direction of nail growth.

They are named splinter hemorrhages because they look like a splinter under the fingernail. The hemorrhages may be caused by tiny clots that damage the small capillaries under the nails.

Splinter hemorrhages can occur with infection of the heart valves (endocarditis). They may be caused by vessel damage from swelling of the blood vessels (vasculitis) or tiny clots that damage the small capillaries (microemboli).

Common Causes

• Bacterial endocarditis
• Injury to the nail

Home Care

There is no specific care for splinter hemorrhages. Follow your health care provider's instructions for treating endocarditis.

Call your health care provider if

Contact your health care provider if:

• You notice splinter hemorrhages and you haven't had any recent injury to the nail

Note: Splinter hemorrhages usually appear late in endocarditis. Likely other symptoms will cause you to visit your health care provider before splinter hemorrhages appear.

What to expect at your health care provider's office

Your health care provider will examine you to determine the cause of splinter hemorrhages. The health care provider may ask you the following medical history questions:

• When did you first notice this?
• Have you had an injury to the nails recently?
• Do you have endocarditis, or has your health care provider suspected that you have endocarditis?
• What other symptoms do you have, such as shortness of breath, fever, general ill feeling, or muscle aches?

Physical examination may include special attention to the heart and blood circulation systems.

Laboratory studies may include:

• Blood cultures
• Complete blood count (CBC)
• Erythrocyte sedimentation rate (ESR)

In addition, your health care provider may order:

• Chest x-ray
• ECG
• Echocardiogram

After seeing your health care provider, you may want to add a diagnosis of splinter hemorrhages to your personal medical record.

References

Tosti A. Diseases of hair and nails. In: Goldman L, Ausiello D, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 450.

Mackowiak PA, Durack DT. Fever of unknown origin. In: Mandell GL, Bennett JE, Dolin R, eds. Principles and Practice of Infectious Diseases. 7th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2009:chap 51.

Reviewed By

Review Date: 08/15/2011

Linda J. Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington, School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.