Causes / typical injury mechanism: High-pressure injection injuries are caused by human or equipment error while using an injection gun or high-pressure system, with resulting injection of substances into the body.

The combination of pressure and chemical inflammation can lead to compartment syndrome and soft tissue necrosis with superimposed infection. Delay in treatment can lead to amputation. It is important to note the time of injury and the irritant injected.

Classic history and presentation: The patient is a worker using a pressure gun or hydraulic system with accidental firing into their hand. The index finger of the nondominant hand is most commonly affected. The exterior injury may appear as a small punctate wound, and the patient may initially not have severe pain.

Prevalence:

• Age – Typically young, working age (mid-30s).
• Sex / gender – Males are more commonly injured.

Risk factors:

• Work environment where high-pressure tools are used
• Fatigue
• Improper equipment training
• Equipment failure

Pathophysiology: The resulting damage is from a combination of pressure from the device and the chemicals injected. The pressure dissects through the hand in the plane of least resistance, affecting the neurovascular structures and causing vascular compromise and possible compartment syndrome.