High-Pressure Injection Injury
A small puncture wound caused by pressurised paint, grease, fuel or other material that can produce devastating deep tissue injury.
Why it is dangerous
Industrial injectors can force material through a tiny skin opening and along tendon sheaths, neurovascular planes and deep tissues. The extent of injury is often far greater than the puncture suggests.
Symptoms
Pain, swelling and reduced movement can evolve rapidly. Some materials are directly toxic to tissues, and vascular compromise can develop.
Initial management
The hand should be elevated, rings removed, tetanus and analgesia addressed, and urgent hand-surgery consultation obtained. The wound should not be squeezed or treated as a simple puncture.
Imaging
X-rays may show radiopaque material or air and help define spread, but treatment urgency is based on the mechanism and clinical findings.
Surgery
Many injuries require urgent operative exploration, decompression and extensive debridement. Repeat procedures may be necessary.
Outcome
Prognosis depends on injected material, pressure, volume, location and time to treatment. Delay can increase the risk of tissue necrosis, stiffness and amputation.
Any high-pressure injection injury to the hand is an emergency even if the entry wound is tiny and initial pain seems modest.