Splinter hemorrhages are small areas of bleeding (hemorrhage) under fingernails or toenails. They take the shape of straight lines and may be caused by damage to the blood vessels.

Splinter hemorrhages appear as narrow, red-to-reddish-brown hemorrhages 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 microscopic clots that damage the small capillaries under the nails.

Splinter hemorrhages are associated with endocarditis (infection of the heart valves) and may represent vessel damage from inflammation of the blood vessels (vasculitis) or microscopic clots that damage the small capillaries (microemboli).

• Trauma to the nail (most common cause)
• Subacute or acute bacterial endocarditis

There is no particular care for splinter hemorrhages. Strictly adhere to your health care provider's instructions for the treatment of endocarditis.

• You notice splinter hemorrhages in the absence of recent trauma to the nail

Your doctor will examine you to determine the cause of the splinter hemorrhages. Medical history questions documenting splinter hemorrhage in detail may include:

• When did you first notice this?
• Have you had trauma to the nail(s) recently?
• Do you have a known diagnosis of endocarditis, or has endocarditis been suspected by your health care provider?
• What other symptoms are also present, such as shortness of breath, fever, general ill feeling, muscle aches?

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

Laboratory studies may include:

• CBC
• ESR
• Blood cultures

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.