I have a needle injury in my upper arm with no other trauma, not using a sling which makes it feel heavy - what's the best course of action?

Management of Needle Injury to Upper Arm Without Sling

You need immediate first aid followed by urgent evaluation for nerve injury and assessment of whether the "heaviness" represents nerve damage, vascular compromise, or simple post-injury inflammation.

Immediate First Aid Actions

Wash the needle puncture site immediately with soap and water for at least 1 minute using thorough scrubbing motion. 1

• After washing, apply 70% alcohol and/or 10% povidone iodine using a circular rubbing motion 1
• If using povidone iodine, allow 2-3 minutes for full bacteriostatic action before covering 1
• Do NOT squeeze the wound to make it bleed more—this causes additional tissue damage without proven benefit 1
• Do NOT use bleach or hydrogen peroxide, as these damage tissue without reducing infection risk 1

Critical Assessment for Nerve Injury

The "heaviness" you describe is concerning for nerve injury, which occurs when needles are placed near the brachial plexus in the upper arm. 2

Examine for the following nerve injury signs:

• Weakness or inability to move fingers, wrist, or elbow suggests motor nerve damage 2
• Numbness, tingling, or altered sensation in specific distributions indicates sensory nerve involvement 2
• Pain radiating down the arm may indicate nerve irritation or partial injury 2

The median nerve is adjacent to brachial veins in the upper arm, making it vulnerable to needle trauma. 2

Assess for Vascular Compromise

Check your radial pulse immediately and compare blood pressure in both arms to rule out arterial injury. 3

Look for the "6 P's" of arterial compromise:

• Pain, Pallor, Pulselessness, Paresthesias (numbness), Poikilothermia (cool limb), Paralysis 3
• If pulse is absent or significantly diminished, this requires immediate vascular surgery consultation 3

Evaluate for Venous Obstruction or Hematoma

Unilateral arm swelling or heaviness without other cause suggests possible hematoma formation or venous injury. 4

• Hematoma formation manifests with obvious discoloration and swelling 4
• If swelling develops, apply direct compression to the bleeding site without occluding distal outflow 4
• Elevate the arm and rest it to reduce physiologic swelling 4

Infection Risk Management

Document the injury details immediately:

• Type of needle, depth of injury, whether blood was visible, circumstances of injury 1
• Your hepatitis B immunization status 1

Baseline testing if needle was used on another person:

• Draw baseline blood for HBsAg, anti-HBs, hepatitis C antibody, and HIV antibody within hours of injury 1
• Test source patient for HIV, HBV, and HCV if needle was used on a patient 1

Post-exposure prophylaxis decisions:

• If unimmunized and source is HBsAg-positive: receive HBIG and begin hepatitis B vaccine series immediately 1
• Initiate HIV PEP within 2 hours (no later than 24 hours) if source is HIV-positive or unknown high-risk 1
• No prophylaxis available for HCV—requires monitoring only 1

When to Seek Immediate Emergency Care

Go to the emergency department immediately if you experience:

• Absent or significantly diminished radial pulse 3
• Progressive weakness or paralysis of the arm 3
• Numbness spreading beyond the injection site 3
• Severe pain out of proportion to the injury 2
• Rapidly expanding swelling or hematoma 4

Supportive Management for Simple Needle Injury

If nerve and vascular examination are normal, the heaviness likely represents local inflammation and muscle fatigue from compensating without sling support.

• Use a sling to support the arm and reduce strain on injured tissues 2
• Apply ice for 20 minutes at a time with a barrier (thin towel) between ice and skin to reduce inflammation 2
• Limit each cold application to 20 minutes; if uncomfortable, limit to 10 minutes 2
• Do NOT apply heat—cold application is superior for acute injury 2

Follow-Up Schedule

• Reassess within 48-72 hours to evaluate response and ensure no progression of symptoms 4
• Schedule formal evaluation at 6 weeks if heaviness or other symptoms persist 4
• Follow-up HIV antibody testing at 6 weeks, 3 months, and 6 months post-exposure 1
• HCV antibody and ALT testing at 4-6 weeks and 4-6 months 1

Common Pitfalls to Avoid

Do not dismiss persistent heaviness as benign—nerve injuries can present with subtle findings initially and progress. 2

• Fascicular nerve injury from needle trauma is rare (only 3 injuries in 400 needle punctures in cadaveric study), but when it occurs, early identification is critical for maximizing return of function 5, 6
• Sharp pain during injection suggests the needle touched a nerve ending, which happens randomly and typically causes no permanent damage 2
• However, persistent pain, weakness, or sensory changes require urgent nerve evaluation 2, 6