special subjects
High Pressure Injection Injuries
Diagnosis of HPI Injuries
Clinical evaluation Plain x-rays Prompt and correct diagnosis is critical to managing high-pressure injection injury. Because the initial symptoms and signs are sometimes mild, these injuries are easily overlooked or minimized, delaying accurate diagnosis and prompt surgical treatment. Recognition of an HPI injury is apparent by history. The extent of the injury is assessed based on symptoms and examination of all neurologic, vascular, and tendinous structures in the injured body part . Plain x-rays are taken to check for fractures and, if radiopaque foreign materials are injected, to determine the extent of the injury. Ultrasonography and MRI or CT are sometimes done, but there is no consensus on when they are indicated. Photographs of the injured body part, taken in the acute care setting before surgical exploration, may be useful. 