High-pressure injection injuries to the hand are associated with severe morbidity if treated improperly. Injuries typically occur in the nondominant hand of patients using industrial equipment in the workplace. Tissue damage is produced by the delivery of both kinetic energy and foreign substances into the hand. The initial clinical course can be deceptively benign and lead to delay in instituting therapy. Early conservative management dramatically increases the likelihood that the injured part will eventually require amputation. Thorough examination for functional and structural impairment is mandated. Aggressive and definitive operative debridement is then undertaken. Postoperatively, a physical program of early mobilization is warranted to prevent fibrosis and the formation of contractures. Although the institution of prophylactic antibiotics is warranted the use of corticosteroids in the management of these injuries remains controversial.