Bruise over the palm

A construction worker in his 50s was hit on his right hand by a metal pipe. He consulted his family doctor two hours later with diffuse pain of his right hand that was exacerbated by movement of his fingers. His right hand was swollen with a bruise on the palm. He had no history of coagulopathy and did not use anticoagulants. He was diagnosed with a soft tissue injury and treated with analgesics. However, as the pain increased and did not respond to analgesics, he went to his local emergency room five hours after the injury. On examination, the hand was swollen with extensive bruising over the palm (fig 1). The radial and ulnar pulses were palpable. The fingers were flexed, and tactile sensation of the hand was intact. Passive extension, adduction, and …