Management of High-Pressure Injection Injury of the Hand in the Emergency Department Clinical Presentation

Updated: Mar 20, 2020
  • Author: Stewart O Sanford, MD; Chief Editor: Trevor John Mills, MD, MPH  more...
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Presentation

Physical

In cases of high-pressure injection (HPI) injury, a complete history should be obtained that includes mechanism of injury, materials injected, timeline, and pressure of machine at the time of injury.

The physical examination should include circulation in the digit and evaluation for compartment syndrome.

Radiographs may be helpful to help facilitate the surgical strategy by localizing subcutaneous air, debris, or unanticipated fractures. [17]

The entrance site of an HPI injury is often deceptively small, and the injected material acts as a projectile. The physician must look for possible exit sites as well.  Some clinicians may send the patient home with analgesia and reassurance because the injury seems benign, only to have the patient return to the hospital with excruciating pain and and an inability to move the involved finger or hand. [15, 16]

Depending on the volume and  type of materials injected, the finger may be distended, swollen, and tender on palpation. If vessels ihave been thrombosed or compressed, the digit may be pale, anesthetic, or even ischemic. Associated crepitus and subcutaneous emphysema are possible in cases of an air-injection injuries.