eMedicine Specialties > Orthopedic Surgery > Hand & Upper Extremity

High-Pressure Injection Injuries: Workup

Author: Jugpal S Arneja, MD, FRCSC, Assistant Professor, Division of Plastic Surgery, University of British Columbia; Attending Staff, Division of Plastic Surgery, British Columbia Children's Hospital
Coauthor(s): William Rennie, MD, Former Professor of Surgery, University of Manitoba; RB Turner, MD, FRCSC, Assistant Professor, Section of Plastic Surgery, University of Manitoba; W Reid Waters, MD, CM, FRCPSC, FACS, Associate Professor of Surgery, University of Manitoba; Former Head of Plastic Surgery Section, Winnipeg Regional Health Authority; Jonathan Toy, MD, Resident, Department of Surgery, Division of Plastic Surgery, University of Alberta Faculty of Medicine and Dentistry
Contributor Information and Disclosures

Updated: Jul 8, 2009

Workup

Laboratory Studies

  • A complete blood count (CBC) may show leukocytosis. Paint and paint solvents can cause an acute chemical reaction associated with fever.16,24
  • Electrolyte abnormalities may occur with systemic absorption of some substances.29
  • Cultures of the wound may be collected when appropriate; these can help direct future management.14

Imaging Studies

  • Preoperative radiographs can help delineate the extent of the tissue involved and can help in planning of incisions and debridement. On radiography, marked soft-tissue swelling is depicted in the involved hand. With radiopaque paint (especially lead-based paints) and grease (many commercial forms of grease have a lead component to prevent dissolution of lubrication), a random array of substances dispersed throughout the neurovascular bundles, synovial tendon sheaths, and lumbrical and interosseous muscles may be seen. Injected water may result in air densities on radiography. Some substances may be radiolucent.16,17,23,24
  • Magnetic resonance imaging (MRI) can also show dispersion of injected materials in most circumstances; however, MRI is rarely required for assessing HPI injuries.

More on High-Pressure Injection Injuries

Overview: High-Pressure Injection Injuries
Workup: High-Pressure Injection Injuries
Treatment: High-Pressure Injection Injuries
Follow-up: High-Pressure Injection Injuries
Multimedia: High-Pressure Injection Injuries
References
Further Reading
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References

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Keywords

high-pressure injection injury, high-pressure injury, HPI injury, hand injury, finger injury

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Contributor Information and Disclosures

Author

Jugpal S Arneja, MD, FRCSC, Assistant Professor, Division of Plastic Surgery, University of British Columbia; Attending Staff, Division of Plastic Surgery, British Columbia Children's Hospital
Jugpal S Arneja, MD, FRCSC is a member of the following medical societies: American Academy of Pediatrics, American Burn Association, American Cleft Palate/Craniofacial Association, American College of Surgeons, American Society of Maxillofacial Surgeons, American Society of Plastic Surgeons, Canadian Medical Association, Canadian Society of Plastic Surgeons, and Royal College of Physicians and Surgeons of Canada
Disclosure: Nothing to disclose.

Coauthor(s)

William Rennie, MD, Former Professor of Surgery, University of Manitoba
William Rennie, MD is a member of the following medical societies: Canadian Medical Association, Canadian Orthopaedic Association, and Quebec Medical Association
Disclosure: Nothing to disclose.

RB Turner, MD, FRCSC, Assistant Professor, Section of Plastic Surgery, University of Manitoba
RB Turner, MD, FRCSC is a member of the following medical societies: Canadian Medical Association, Canadian Medical Protective Association, and Canadian Society of Plastic Surgeons
Disclosure: Nothing to disclose.

W Reid Waters, MD, CM, FRCPSC, FACS, Associate Professor of Surgery, University of Manitoba; Former Head of Plastic Surgery Section, Winnipeg Regional Health Authority
W Reid Waters, MD, CM, FRCPSC, FACS is a member of the following medical societies: American Association of Plastic Surgeons, American College of Surgeons, American Society of Plastic Surgeons, Canadian Medical Association, Canadian Society of Plastic Surgeons, International College of Surgeons, and Royal College of Physicians and Surgeons of Canada
Disclosure: Nothing to disclose.

Jonathan Toy, MD, Resident, Department of Surgery, Division of Plastic Surgery, University of Alberta Faculty of Medicine and Dentistry
Jonathan Toy, MD is a member of the following medical societies: Alberta Medical Association, American Society of Plastic Surgeons, Canadian Medical Association, and Canadian Society of Plastic Surgeons
Disclosure: Nothing to disclose.

Medical Editor

Peter M Murray, MD, Associate Professor of Orthopedic Surgery, Mayo Clinic College of Medicine; Director of Education, Mayo Foundation for Medical Education and Research, Jacksonville; Consultant, Department of Orthopedic Surgery, Mayo Clinic, Jacksonville; Consulting Staff, Nemours Children's Clinic and Wolfson's Children's Hospital
Peter M Murray, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association for Hand Surgery, American Orthopaedic Association, American Society for Reconstructive Microsurgery, American Society for Surgery of the Hand, Florida Medical Association, Orthopaedic Research Society, and Society of Military Orthopaedic Surgeons
Disclosure: Small Bone Innovations Workshop Honoraria Speaking and teaching

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Thomas R Hunt III, MD, John D Sherrill Professor and Director of Orthopaedic Surgery, Surgeon in Chief of UAB Highlands Hospital, Director of Hand and Upper Extremity Fellowship, University of Alabama at Birmingham
Thomas R Hunt III, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association for Hand Surgery, American Orthopaedic Association, American Orthopaedic Society for Sports Medicine, American Society for Surgery of the Hand, AO Foundation, Mid-America Orthopaedic Association, and Southern Orthopaedic Association
Disclosure: Tornier Consulting fee Review panel membership

CME Editor

Dinesh Patel, MD, FACS, Associate Clinical Professor of Orthopedic Surgery, Harvard Medical School; Chief of Arthroscopic Surgery, Department of Orthopedic Surgery, Massachusetts General Hospital
Dinesh Patel, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association of Physicians of Indian Origin, American College of International Physicians, and American College of Surgeons
Disclosure: Nothing to disclose.

Chief Editor

Harris Gellman, MD, Consulting Surgeon, Broward Hand Center; Voluntary Clinical Professor of Orthopedic Surgery and Plastic Surgery, Departments of Orthopedic Surgery and Surgery, University of Miami School of Medicine
Harris Gellman, MD is a member of the following medical societies: American Academy of Medical Acupuncture, American Academy of Orthopaedic Surgeons, American Orthopaedic Association, American Society for Surgery of the Hand, and Arkansas Medical Society
Disclosure: Nothing to disclose.

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