eMedicine Specialties > Emergency Medicine > Trauma & Orthopedics

Hand Injury, High Pressure: Follow-up

Author: Glen Vaughn, MD, Director, Department of Emergency Medicine, Defiance Hospital
Contributor Information and Disclosures

Updated: Oct 1, 2009

Follow-up

Further Inpatient Care

  • Extravasation of the injected material may further jeopardize the limb.
  • Prompt decompression and directed debridement of the nonviable tissue is an important strategy to prevent further tissue damage.
  • Less-aggressive therapy may have a role in injection injuries with less irritating substances (eg, Freon).7,8

Further Outpatient Care

  • Outpatient management of high-pressure hand injuries is contraindicated.

Transfer

  • Transfer patient to a facility with a hand specialist if none is available at the receiving hospital.

Complications

  • Amputation is more likely if debridement is delayed more than 10 hours, especially with low viscosity substances.
  • Tissues that survive the initial injection injury but still contain grease, paint, or oil heal slowly and may develop multiple oleogranulomas of varying sizes.
  • In time, the oleomas drain through sinuses or open directly through the skin.

Prognosis

  • Factors that determine the severity of the injury
    • Type and viscosity of the material injected
    • Time interval between injury and treatment
    • Amount of material injected and velocity of the injectant
    • Pressure of the appliance
    • Anatomy and distensibility of the site of injection
    • Presence of secondary infection
  • Injection of irritating substances under high pressure has the potential for disability and amputation despite prompt aggressive therapy.

Miscellaneous

Medicolegal Pitfalls

  • This injury is a common cause of litigation when evaluated by the unwary physician.
  • The innocuous appearance of the wound obscures the potential severity of the injury.
  • Without diagnosis and treatment, a compartment syndrome with subsequent necrosis usually destroys tissue viability.

Special Concerns

  • A digital block for pain control, via injection of the finger, is contraindicated. Unlike a metacarpal block, this technique may increase tissue distention and vascular insufficiency.
 


More on Hand Injury, High Pressure

Overview: Hand Injury, High Pressure
Differential Diagnoses & Workup: Hand Injury, High Pressure
Treatment & Medication: Hand Injury, High Pressure
Follow-up: Hand Injury, High Pressure
References
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References

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Further Reading

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Keywords

hand injury, injection injury, high-pressure injection injury, grease gun injury, paint sprayer injury, diesel fuel injector injury, oleogranulomas, chronic fistula formation, chemical inflammation, finger amputation, fingertip injury, high pressure hand injury

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Contributor Information and Disclosures

Author

Glen Vaughn, MD, Director, Department of Emergency Medicine, Defiance Hospital
Disclosure: Nothing to disclose.

Medical Editor

Dan Danzl, MD, Chair, Department of Emergency Medicine, Professor, University of Louisville Hospital
Dan Danzl, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, Kentucky Medical Association, Society for Academic Emergency Medicine, and Wilderness Medical Society
Disclosure: Nothing to disclose.

Pharmacy Editor

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

Managing Editor

Eric L Legome, MD, Chair, Department of Emergency Medicine, St Vincent's Hospital Manhattan; Associate Professor, Department of Emergency Medicine, New York Medical College
Eric L Legome, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, Council of Emergency Medicine Residency Directors, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Rick Kulkarni, MD, Assistant Professor of Surgery, Section of Emergency Medicine, Yale-New Haven Hospital
Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: WebMD Salary Employment

 
 
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