Star InactiveStar InactiveStar InactiveStar InactiveStar Inactive

Higher the Pressure Higher the Stakes

Author: Jonathan P. Coss, MD 
Peer-Reviewer: Mark Hopkins, MD, CAQ-SM
Final Editor: Will Denq, MD, CAQ-SM 

A 37-year-old male presents after accidentally shooting a high pressure paint gun into his right index finger at work. The paint was water based. He denies pain, there is no swelling, and he has full range of motion without pain at arrival to the ED.  

Image 1. Picture of the injured right index finger. Image courtesy of Mark Hopkins, MD, CAQ-SM


[1] Bean B, Cook S, Loeffler BJ, Gaston RG. High-pressure water injection injuries of the hand may not be trivial Orthopedics. 2018;41:e245–51

[2] Couzens G, Burke FD. Veterinary high pressure injection injuries with inoculations for larger animals. J Hand Surg Br. 1995 Aug;20(4):497-9. [PubMed]

[3] Hadeed A, Anthony JH, Hoffler CE. Hand High Pressure Injury. [Updated 2023 Jun 26]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from:

[4] Hogan CJ, Ruland RT. High-pressure injection injuries to the upper extremity: a review of the literature. J Orthop Trauma. 2006 Jul;20(7):503-11. [PubMed]

[5] Mirzayan R, Schnall SB, Chon JH, Holtom PD, Patzakis MJ, Stevanovic MV. Culture results and amputation rates in high-pressure paint gun injuries of the hand. Orthopedics. 2001 Jun;24(6):587-9. [PubMed]

[6] Rimmer MG, King JB, Franklin A. Accidental injection of white spirit into the hand in golfers. J Hand Surg Br. 1993 Oct;18(5):654-5. [PubMed]

[7] Rosenwasser MP, Wei DH. High-pressure injection injuries to the hand. J Am Acad Orthop Surg. 2014 Jan;22(1):38-45. [PubMed]

[8] Stark HH, Ashworth CR, Boyes JH. Paint-gun injuries of the hand. J Bone Joint Surg Am. 1967 Jun;49(4):637-47. [PubMed]

[9] Sirio CA, Smith JS, Graham WP. High-pressure injection injuries of the hand. A review. Am Surg. 1989 Dec;55(12):714-8. [PubMed]

[10] Wieder A, Lapid O, Plakht Y, Sagi A. Long-term follow-up of high-pressure injection injuries to the hand. Plast Reconstr Surg. 2006 Jan;117(1):186-9. [PubMed]