High-pressure injection injuries to the hand can be surgical emergencies. The injected material and subsequent edema increase the risk for infection, ischemia, compartment syndrome, and limb loss. This is a case report of a 53-year-old male who presented to the emergency department with a superficial two-centimeter laceration to the dorsum of his left hand. He had no obvious signs of infection and the surrounding structures were neurovascularly intact. The patient had been using a gas-powered pressure washer when he sustained the injury to his hand. Physical exam revealed marked crepitus throughout the left hand extending up to the mid forearm. Radiographs of the left hand and left forearm demonstrated extensive subcutaneous emphysema. Hand surgery was emergently consulted and recommended admission for serial exams and antibiotics. This case illustrates a key point: despite initially benign presentations, high-pressure injection injuries should be approached as emergent processes that can be easily overlooked if the proper history and appropriate diagnostic measures are not executed.TopicsHand, orthopedics, x-ray, high-pressure injection injury.