Achenbach’s syndrome
Achenbach’s syndrome — also called paroxysmal hand hematoma or "finger apoplexy" — is a benign, self-limiting vascular phenomenon. It presents with sudden, spontaneous bruising and pain in the fingers or hands, often alarming to patients but not dangerous.
👩⚕️ Clinical Presentation
- Sudden onset of localized finger pain (often the index or middle finger 👉).
- Rapid development of bluish discolouration/bruising without trauma.
- Mild swelling and tenderness.
- Symptoms resolve within 3–6 days with no permanent damage.
- Patients may report recurrence (up to 30%), but attacks remain isolated and benign.
🔬 Aetiology & Pathophysiology
- Likely due to spontaneous rupture of digital capillaries/venules.
- Minor unnoticed trauma may precipitate episodes in some patients.
- Underlying mechanism remains uncertain — thought to involve vascular fragility and local microcirculatory changes.
- ⚠️ Importantly, it is not associated with systemic vascular or clotting disorders.
📊 Epidemiology & Risk Factors
- Most common in middle-aged and older women (40–70 yrs).
- No clear link to cardiovascular risk factors (e.g. diabetes, hypertension).
- Not inherited, though recurrent cases reported.
🧪 Investigations
- Diagnosis is clinical — history of sudden finger bruising without trauma is key.
- Blood tests usually normal; no evidence of coagulopathy.
- Ultrasound may be used if doubt exists → rules out thrombosis/vascular anomalies.
- Further haematology/vascular work-up only if atypical or widespread bruising.
🔍 Differential Diagnosis
- Traumatic injury: usually clear history.
- Vasculitis: tends to be painful, multisite, and systemic.
- Bleeding disorders: bruising at multiple sites + abnormal labs.
- Raynaud’s phenomenon: colour changes (white → blue → red) rather than sudden bruise.
💊 Management
- Reassurance: cornerstone of care — it is harmless and self-resolving.
- Symptomatic relief: Cold compresses 🧊 and simple analgesia if painful.
- No long-term treatment required.
- Follow-up: Only in recurrent or atypical cases to rule out rare mimics.
🌟 Prognosis
- Excellent — complete resolution within days.
- No tissue necrosis, no vascular compromise, no systemic complications.
- Recurrences possible but harmless.
📌 Conclusion
✨ Achenbach’s syndrome is a benign cause of sudden, spontaneous finger bruising.
Though dramatic in presentation, it is entirely self-limiting and carries no systemic risk.
👉 Key clinical lesson: recognise the pattern, reassure the patient, and avoid unnecessary tests.
