What's the diagnosis? By Dr. Jacob Martin

A 53 yo male presents to the ED with right hand pain.  Two hours prior to arrival he was using a pressure washer at work and sprayed himself accidentally.  He believes washer only uses water but cannot confirm the presense of solvents or additives.  The hand has wounds on the palmar surface but has normal sensation, strength, range of motion and capillary refill.  There is crepitus at the thenar eminence but compartments are soft.  An xray is shown.  What's the diagnosis?  Scroll down for answer.





Answer:  High pressure injection injury



  • Hand surgery consultation
  • Immobilization and elevation of affected limb
  • Tetanus prophylaxis
  • Broad spectrum antibiotics
  • Effective analgesia
  • Definitive treatment is early surgical decompression and debridement of injected area


Pearls and Pitfalls

  • Prognosis depends on composition of injected material, location, pressure (PSI), and time to surgical intervention
  • Often overlooked due to appearance of exterior wounds but are true surgical emergencies





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. 2007;32(4):394-399. doi:10.1016/J.JHSB.2007.02.003 


Cannon TA. High-pressure Injection Injuries of the Hand. Orthop Clin North Am. 2016;47(3):617-624. doi:10.1016/j.ocl.2016.03.007 


Long B, Koyfman A. Injuries to the Hand and Digits. In: Tintinalli JE, Ma O, Yealy DM, Meckler GD, Stapczynski J, Cline DM, Thomas SH. eds. Tintinalli's Emergency Medicine: A Comprehensive Study Guide, 9e. McGraw-Hill; Accessed July 30, 2020. https://accessmedicine-mhmedical-com.proxygw.wrlc.org/content.aspx?booki...