Hand or Finger Swelling: Causes, Clues and Treatment

Swelling in both hands

Common harmless causes:

• Exercise and walking: blood flow to the hands increases and arm swinging pushes fluid down. This is common in hikers and runners.
• Heat: blood vessels widen in hot weather.
• Salt: a salty meal causes temporary fluid retention.
• Pregnancy: mild hand swelling is common, especially in the third trimester.
• Hormones: before a period.
• Morning puffiness after lying still overnight.

Medical causes:

• Rheumatoid arthritis: swollen, warm knuckles and middle finger joints on both hands, with morning stiffness lasting more than 30 minutes.
• Carpal tunnel syndrome: a puffy feeling in the hands with numbness and tingling, often at night.
• Fluid retention from heart, kidney or liver disease: swelling of the hands is less common than leg swelling but appears in more advanced fluid overload.
• Medicines: calcium channel blockers, NSAIDs, steroids and estrogen.
• Scleroderma: puffy fingers with Raynaud's color changes.
• Preeclampsia: sudden swelling of hands and face in pregnancy with headache or vision problems.

Swelling of one hand or finger

Injury

Sprains, jammed fingers, dislocations and finger fractures cause swelling and bruising. A finger that cannot straighten at the tip after a knock may be a mallet finger, a tendon injury.

Infection

• Paronychia: infection of the nail fold; red, swollen and painful, sometimes with pus.
• Felon: a tense, painful infection of the fingertip pad.
• Flexor tendon sheath infection: the whole finger swells, is held bent and hurts to straighten. This can destroy the tendon and needs urgent surgery.
• Cellulitis and bites: spreading redness. Bites carry a high infection risk.

Tendon and joint problems

• De Quervain's tenosynovitis: pain and swelling on the thumb side of the wrist, worse when gripping or lifting a baby.
• Trigger finger: a painful nodule in the palm with catching or locking of the finger.
• Gout: a red, hot, swollen finger joint or wrist.
• Osteoarthritis: bony swellings at the finger joints near the nails and at the base of the thumb.
• Dactylitis: a whole finger swollen like a sausage, seen in psoriatic arthritis.

Other causes

• insect bites and stings
• Ganglion cyst: a smooth, firm lump on the wrist or finger
• lymphedema, after breast cancer treatment
• a blood clot in the arm vein, with swelling of the whole arm

Hand swelling just above the wrist

Swelling on the back of the hand or just above the wrist joint has a short list of usual causes:

Swollen hands and the heart

Heart failure causes fluid to collect in the lowest parts of the body first, so ankle and leg swelling usually appear well before hand swelling. Swollen hands alone are rarely from the heart. Swelling of the hands together with swollen legs, rapid weight gain and breathlessness needs medical review. Swelling of the arms, face and neck with prominent chest veins suggests a blocked large vein in the chest (superior vena cava obstruction) and needs urgent assessment.

How doctors find the cause

A doctor asks about injury, timing, which joints are affected, morning stiffness, other symptoms and medicines. The exam checks joints, tendons, skin, pulses and sensation. Tests may include:

• X-rays for fractures and arthritis
• ultrasound for tendon problems, cysts, joint fluid and vein clots
• blood tests: inflammation markers, rheumatoid factor and anti-CCP antibodies, uric acid, kidney function
• joint fluid test

Treatment and home care

• Remove rings early, before swelling makes them stuck.
• Raise the hand above heart level.
• Cold packs for injuries, 15 to 20 minutes at a time in the first 48 hours.
• Make fists and open your hands repeatedly to move fluid, especially when walking.
• Pain relief: acetaminophen (paracetamol) or an NSAID, following the label dose.
• Specific treatment: splints and steroid injections for tendon problems, antibiotics or drainage for infections, medicines for rheumatoid arthritis or gout, and treatment for heart or kidney problems.

Frequently asked questions

Why are my hands swollen in the morning?

Lying still overnight lets fluid settle in the hands. Mild morning puffiness that goes away within an hour is usually harmless. Swollen, stiff joints that last more than 30 minutes, especially on both hands, can be a sign of rheumatoid arthritis and should be checked.

What causes swelling above the wrist joint?

Common causes are de Quervain's tenosynovitis on the thumb side, a ganglion cyst on the back of the wrist, wrist arthritis and fractures after a fall. A red, hot swelling may be infection or gout. An X-ray or ultrasound usually confirms the cause.

Can heart problems cause swollen hands?

Rarely by themselves. Heart failure usually causes swelling of the ankles and legs first. Hand swelling with leg swelling, weight gain and breathlessness can be a sign of worsening heart failure and needs medical review.

Why is one of my fingers swollen?

A single swollen finger is usually from an injury, an infection around the nail, gout, a tendon problem or arthritis. If the whole finger is swollen, held bent and painful to straighten, see a doctor urgently, because it may be a tendon sheath infection.

Why do my hands swell when I walk?

Walking increases blood flow to the hands, and swinging the arms pushes fluid toward the fingers. Heat makes it worse. It is harmless. Raising your arms occasionally, making fists, and removing rings before a long walk can help.