High-Pressure Injection Injuries Workup

Updated: Apr 17, 2023
  • Author: Jugpal S Arneja, MD, MBA, FRCSC; Chief Editor: Harris Gellman, MD  more...
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Laboratory Studies

A complete blood count (CBC) may show leukocytosis. Paint and paint solvents can cause an acute chemical reaction associated with fever. [5, 15]

Electrolyte abnormalities may occur with systemic absorption of some substances. [35]

Cultures of the wound may be collected when appropriate; these can help direct future management. [27]


Imaging Studies

Preoperative radiography can help delineate the extent of the tissue involved and facilitate the planning of incisions and debridement. On radiography, marked soft-tissue swelling is visible 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. [5, 7, 14, 15]

Magnetic resonance imaging (MRI) can also show dispersion of injected materials in most circumstances; however, MRI is rarely required for assessing high-pressure injection (HPI) injuries.

Ultrasonography (US) has also been described as a potentially useful diagnostic tool for HPI injury to the hand. [43]