Hand Swelling: Why Your Hands Are Swollen

Common harmless causes

Swollen hands when walking or exercising

Many people notice puffy fingers during or after walking, running or hiking. Blood vessels in the hands widen to release heat, and arms swinging downward push blood into the hands. It settles within an hour. Swinging your arms, making fists, and raising your hands now and then helps.

Heat

Hot weather widens blood vessels and fluid leaks into the tissues, especially in the hands and feet.

Salt and alcohol

A salty meal or alcohol makes the body hold onto water, so rings feel tight the next morning.

Morning puffiness

Lying still overnight lets fluid collect. Puffiness that goes down within 30 minutes of moving is normal. Stiffness lasting more than 30 minutes, especially with joint pain, can be a sign of inflammatory arthritis.

Hormones and pregnancy

Fluid retention before periods and in pregnancy commonly causes swollen hands and fingers. In pregnancy, sudden swelling of the hands and face with headache can signal preeclampsia.

Arthritis and joint causes

Causes of one swollen hand

• Injury: sprains, fractures and dislocations swell quickly. A finger that cannot bend or straighten after injury may have a tendon injury.
• Infection: a paronychia (infected nail fold), felon (fingertip pad abscess), cellulitis or a flexor tendon sheath infection. Bites, especially from cats and humans, often become infected.
• Insect stings and bites: large local reactions can swell the whole hand for several days.
• Blood clot: an upper limb DVT causes swelling of the arm and hand, often after IV lines, a pacemaker, or heavy repeated arm use.
• Lymphedema: after breast cancer surgery or radiation that removes or damages armpit lymph nodes.
• Complex regional pain syndrome: swelling, burning pain, color and temperature changes after an injury or surgery.
• Ganglion cysts and tenosynovitis: localized swelling over a tendon or the back of the wrist.

Allergic and other medical causes

• Allergic reactions and angioedema: swelling of the hands, lips and eyelids, often with hives. ACE inhibitor blood pressure medicines can cause angioedema even after years of use.
• Medicines: calcium channel blockers, steroids, NSAIDs and hormones.
• Heart, kidney or liver disease, usually with swollen feet as well.
• Carpal tunnel syndrome: a feeling of swelling with numbness and tingling in the thumb, index and middle fingers, often at night. See carpal tunnel syndrome.
• Underactive thyroid.

How doctors find the cause

Expect questions about when the swelling started, which joints are involved, morning stiffness, injuries, bites, rashes and medicines. The doctor will examine each joint, the skin, nails and lymph nodes.

Tests may include:

• blood tests: inflammation markers (CRP, ESR), rheumatoid factor and anti-CCP antibodies, uric acid, kidney and thyroid function
• X-ray or ultrasound of the hand
• fluid drawn from a joint to check for gout crystals or infection
• Doppler ultrasound if a clot is possible

What helps swollen hands

• Remove rings as soon as you notice swelling.
• Raise your hands above heart level and open and close your fists.
• Move: gentle finger exercises and arm circles pump fluid back.
• Cold packs wrapped in a cloth for 15 minutes after an injury or for inflamed joints.
• Cut down salt and drink enough water.
• Compression gloves for mild arthritis swelling or lymphedema.
• Over-the-counter pain relief: acetaminophen (paracetamol) or ibuprofen, following the label dose. Avoid NSAIDs if you have kidney problems, stomach ulcers or heart failure.
• Treat the cause: antibiotics or surgical drainage for infections, disease-modifying medicines for rheumatoid arthritis, and specific treatment for gout.

Early treatment of inflammatory arthritis protects the joints from permanent damage, so persistent joint swelling should be seen within weeks, not months.

Frequently asked questions

Why do my hands swell when I walk?

Walking moves blood into your hands as your arms swing, and blood vessels widen to release heat. Fluid leaks into the tissues, causing puffy fingers. It is harmless and settles within an hour or so. Raising your hands and making fists while walking helps.

Why are my hands swollen in the morning?

Fluid builds up while your hands are still overnight, especially after salty food or alcohol. Puffiness that eases within 30 minutes is normal. Morning stiffness and swelling of the finger joints lasting longer can be a sign of rheumatoid arthritis and should be checked.

What does it mean when one hand is swollen?

Swelling of one hand usually points to a local problem: an injury, infection, insect bite or gout. Swelling of the whole arm and hand can mean a blood clot or lymphedema. A red, hot, painful hand needs prompt medical care.

Can swollen hands be a sign of something serious?

Usually not, but they can be. Seek emergency help for hand swelling with swollen lips or trouble breathing. See a doctor promptly for a red, hot, painful hand, a bite, sudden swelling of one arm, or persistently swollen, stiff joints.

How do I get a ring off a swollen finger?

Raise your hand above your heart for a few minutes, then apply soap or lotion and twist the ring gently. Wrapping dental floss tightly around the finger below the ring can compress it. If the finger is turning pale or blue, go to an ER to have the ring cut off.