The Case:

A 42-year-old right hand dominant male with no known past medical history presents with pain in his right thumb. He works as a painter and was using an industrial paint sprayer when he injected a water-based paint into his right distal thumb pad. He states he had significant pain initially, but it quickly settled to a dull throbbing. He waited five days from the injury to visit his primary care doctor who instructed him to come directly to the ED. His vital signs are within normal limits. There is a small punctate wound on the volar surface of the distal right thumb that is mildly tender to palpation without surrounding erythema, swelling, or drainage. There is no tenderness more proximally. Compartments of the hand and forearm are soft and compressible. The digit is neurovascularly intact excluding an area of decreased sensation at the tip of the thumb. X-ray of the right hand and thumb are shown below.

Adam Roussas, MD