Abstract Our hands serve many purposes. Hands help us eat, dress, write, earn a living, create art, and do many other functions and daily chores. To do these tasks and activities, our hands require sensation and movement, such as joint motion, tendon gliding, and muscle contraction. When a problem takes place in the hand, care must be given to all the different types of tissues that make function of the hand possible, achievable and attainable. Presentations of high-pressure water jet injuries to the emergency departments are varied. However, these injuries are sometimes described as a ‘benign variant’ of high-pressure injection injuries; external appearances can be deceptive. These injuries can produce an unexpected pattern of severe and grave internal injury with infectious and vitiating complications. High-pressure water jet injuries from high-pressure jet devices are surgical emergencies characterized by small entry wounds with extensive internal damage. Often subtle and inconspicuous on initial clinical presentation, these injuries can lead to potentially extensive tissue damage underneath. Unfortunately, because the injection itself is often painless, and the lesion usually has a benign appearance, physicians not familiar with the pathophysiology may treat these cases with expectant observation. Three major issues are involved in these injuries. Physical injury is caused by soft tissue disruption and vascular and nerve damage. Chemical injury, depending on the chemical constituents of the injected water, can exacerbate compressive vascular injuries with increased edema and inflammation. Biological injury occurs when injected water, contaminated with virulent organisms and other foreign matter, leads to unusual infections. The key to managing this injury is swift diagnosis and decompression, but delays remain common. Review of high-pressure water jet injuries suggest that prompt diagnosis and early decompression offer the best prospects of digit survival.1,2