eMedicine Specialties > Emergency Medicine > Trauma & Orthopedics

Hand Injury, High Pressure

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

Updated: Oct 1, 2009

Introduction

Background

A high-pressure injection injury should be considered a potential surgical emergency. Immediate decompression and thorough cleansing of the offending material from the tissue is required to preserve optimal function.

Pathophysiology

Acute injury is caused by introduction of a foreign material, under high pressure between 2,000 and 10,000 psi, into the poorly distensible digital or palmar tissues. The pathophysiology involves acute and chronic inflammation and foreign body granuloma formation. Damage results from the impact, ischemia due to vascular compression, chemical inflammation, and secondary infection. Highly viscous substances (eg, grease) require higher injection pressures than paint or solvents.

Fuel and paint injections lead to the most severe inflammatory response with a high incidence of subsequent amputation. Grease- and oil-based compounds may lead to oleogranulomas with chronic fistula formation, scarring, and eventual loss of digit function.

Mortality/Morbidity

Overall incidence of amputation approaches 48%.1 Morbidity is dependent to a large degree upon the material injected. Paint solvents appear to cause the greatest damage and result in amputation in 60-80% of the cases. Grease, the more common injectant, causes a less severe inflammatory response. Amputation is necessary in about 25% of these patients.2

Sex

These injuries are rare in women.

Age

High-pressure hand injuries usually occur in young men while working, most often to their nondominant index finger. The average age at time of injury in one large review was 35 years (range, 16-65 y). These injuries occurred to the nondominant hand 76% of the time.2

Clinical

History

  • The injection typically occurs to the fingertip when the operator is trying to wipe clear a blocked nozzle or to the palm when the operator is attempting to steady the gun with a free hand during the testing or operation of equipment.3,4
  • The left hand (usually nondominant) is involved in about two thirds of cases.
  • The most common site of injury is the index finger.
  • The palm and long finger are the next most frequently injured.

Physical

  • The innocuous appearance of the wound may hide the severity of the injury.5,1
  • With time, edema and intense pain develop and the digit may appear erythematous or cold.

Causes

Most injuries have resulted from grease guns, paint sprayers, or diesel fuel injectors. The cause of injury in one case report was from a high-pressure paint gun.6

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

  1. Verhoeven N, Hierner R. High-pressure injection injury of the hand: an often underestimated trauma: case report with study of the literature. Strategies Trauma Limb Reconstr. Apr 2008;3(1):27-33. [Medline].

  2. Gonzalez R, Kasdan ML. High pressure injection injuries of the hand. Clin Occup Environ Med. 2006;5(2):407-11, ix. [Medline].

  3. Vilke GM, Snyder B. High pressure paint spray gun injury. J Emerg Med. Aug 2002;23(2):203-4. [Medline].

  4. Valentino M, Rapisarda V, Fenga C. Hand injuries due to high-pressure injection devices for painting in shipyards: circumstances, management, and outcome in twelve patients. Am J Ind Med. May 2003;43(5):539-42. [Medline].

  5. Dailiana H, Kotsaki D, Varitimidis S, Moka S, Bakarozi M, Oikonomou K. Injection injuries: seemingly minor injuries with major consequences. Hippokratia. Jan 2008;12(1):33-6. [Medline].

  6. Oktem F, Ocguder A, Altuntas N, Bozkurt M, Tellioglu AT. High-pressure paint gun injection injury of the hand: a case report. J Plast Reconstr Aesthet Surg. Jun 2009;62(6):e157-9. [Medline].

  7. Kon M, Sagi A. High-pressure water jet injury of the hand. J Hand Surg [Am]. May 1985;10(3):412-4. [Medline].

  8. Goetting AT, Carson J, Burton BT. Freon injection injury to the hand. A report of four cases. J Occup Med. Aug 1992;34(8):775-8. [Medline].

  9. Almind M, Broeng L. A high velocity, high temperature injection injury. J Hand Surg [Br]. Apr 1993;18(2):249-50. [Medline].

  10. Atkinson RE. Injection injuries of the hand: Caveat doctor. Hawaii Med J. Sep 1989;48(9):364-6, 395. [Medline].

  11. Bekler H, Gokce A, Beyzadeoglu T. [Dissemination pathways in high-pressure injection injuries of the hand: an experimental animal model]. Acta Orthop Traumatol Turc. 2007;41(2):147-51. [Medline].

  12. Bekler H, Gokce A, Beyzadeoglu T, Parmaksizoglu F. The surgical treatment and outcomes of high-pressure injection injuries of the hand. J Hand Surg Eur Vol. Aug 2007;32(4):394-9. [Medline].

  13. Geller ER, Gursel E. A unique case of high-pressure injection injury of the hand. J Trauma. May 1986;26(5):483-5. [Medline].

  14. Harter BT, Harter KC. High-pressure injection injuries. Hand Clin. Aug 1986;2(3):547-52. [Medline].

  15. Hogan CJ, Ruland RT. High-pressure injection injuries to the upper extremity: a review of the literature. J Orthop Trauma. Jul 2006;20(7):503-11. [Medline].

  16. Larsen JM, Bindiger A, Sherman R, Kuschner SH. Insecticide injection injuries to both hands: a case report. J Hand Surg [Am]. Nov 1992;17(6):1073-5. [Medline].

  17. Lewis HG, Clarke P, Kneafsey B, Brennen MD. A 10-year review of high-pressure injection injuries to the hand. J Hand Surg [Br]. Aug 1998;23(4):479-81. [Medline].

  18. Loveday I. High-pressure injection injuries. Emerg Nurse. Nov 2007;15(7):22-3. [Medline].

  19. Luber KT, Rehm JP, Freeland AE. High-pressure injection injuries of the hand. Orthopedics. Feb 2005;28(2):129-32. [Medline].

  20. Mizani MR, Weber BE. High-pressure injection injury of the hand. The potential for disastrous results. Postgrad Med. Jul 2000;108(1):183-5, 189-90. [Medline].

  21. Neal NC, Burke FD. High-pressure injection injuries. Injury. Nov 1991;22(6):467-70. [Medline].

  22. Schnall SB, Mirzayan R. High-pressure injection injuries to the hand. Hand Clin. May 1999;15(2):245-8, viii. [Medline].

  23. Subramaniam RM, Clearwater GM. High-pressure water injection injury: emergency presentation and management. Emerg Med (Fremantle). Sep 2002;14(3):324-7. [Medline].

  24. Vasilevski D, Noorbergen M, Depierreux M, Lafontaine M. High-pressure injection injuries to the hand. Am J Emerg Med. Nov 2000;18(7):820-4. [Medline].

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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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