BACKGROUND: Hands are frequently closest to the primary beam during fluoroscopy and can sustain cumulative exposure. Case reports of focal digital neuropathy in proceduralists are rare; imaging may be nondiagnostic, and treatment pathways unclear.

CASE REPORT: A 36-year-old interventional physiatrist developed 9 months of cyclical, severe allodynia localized to the radial half of the right index distal phalanx. Infectious/inflammatory treatments and hand therapy were ineffective. MRI was nonspecific; ultrasound showed focal hyperemia. Given typical hand positioning during procedures, radiation-induced digital neuropathy was suspected. A targeted radial digital nerve block at the distal interphalangeal level achieved near-complete pain relief by day 10 with durable benefit at 12 months.

CONCLUSION: In clinicians with focal fingertip allodynia and nondiagnostic imaging, consider radiation-induced digital neuropathy. When conservative care fails, a targeted digital nerve block may provide rapid, durable relief and underscores best-practice radiation safety.

KEYWORDS: Digital neuropathy; ionizing radiation; fluoroscopy; occupational exposure; interventional physiatry; digital nerve block; allodynia; hand pain; case report