Makindo Medical Notes

🩺 Introduction

• 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.