High-pressure spray represents a common mode of delivery for many industrial products. Lymphangitis and acute renal failure caused by injected wax solvent and acute lead intoxication after injection of lead-based paint into the hand have also been reported. The most common specific sites are the terminal segments of the left middle and index fingers. Injuries to the digits are associated with more morbidity than those to the hand because of earlier development of compartmental syndrome. The injury usually occurs at work and often appears quite minimal to the unsuspecting examiner.
Most patients report either a stinging sensation or no pain at all.
Delay in seeking treatment ensues because workers often complete their daily activities before symptoms develop. The clinical course of a patient with a high-pressure injection injury usually follows a common sequence. Within 1 to 2 hours after the injury, increasing edema is noted. Discoloration and numbness follow, with or without pain. The test is performed by first occluding the radial and ulnar arteries with the thumb and index finger.