Swollen arms and hands (oedema)
A swollen arm means fluid has built up in the tissues: the hand feels tight, a ring will not come off, a watch strap leaves a deep groove, the fingers will…
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On this page
- The first question: one arm or both
- When swelling means nothing much
- One arm only: this is the urgent version
- Swelling after cancer treatment: lymphoedema
- Both arms, the face and breathlessness: looking beyond the arm
- Medicines that make hands swell
- When help cannot wait
- What you can do while the cause is being found
- Online consultation
A swollen arm means fluid has built up in the tissues: the hand feels tight, a ring will not come off, a watch strap leaves a deep groove, the fingers will not close properly into a fist. The reasons behind it range from entirely everyday to the kind where swelling is the only early sign of something serious. What separates them is not how puffy the arm looks but a handful of straightforward circumstances, and those are really what this page is about.
The first question: one arm or both
Every doctor starts here, and it is worth settling for yourself before reading on.
One arm has swollen. The problem is almost always in that arm: in its veins, its lymph vessels, the skin or the joints. Here you look for a blockage to drainage, inflammation or injury.
Both arms have swollen. That usually points to fluid in the body as a whole, meaning the heart, the kidneys, the liver, the thyroid, medicines, or simply heat and sitting still.
After that, a few more things are worth noting: whether the swelling came on over hours or built up over weeks, whether the arm hurts, whether the skin has changed colour, whether it feels hot or normal, whether there is a temperature, and whether anything else is swollen, such as the face, the abdomen or the legs. With those four or five details a conversation with a doctor becomes far more useful, and over the phone or online they are what settles the question.
When swelling means nothing much
Most of the time the cause turns out to be harmless and the swelling clears by itself.
- Hot weather. In the heat the blood vessels widen, fluid moves more easily into the tissues, and by evening the fingers puff up. The same happens in the first days of a holiday somewhere warm.
- The arm held still for a long time. A flight, a long journey, sleeping in an awkward position, working with the arms hanging down. If the muscles are not working, the fluid is not pumped back.
- A salty meal the day before. Salt holds water, and in the morning it shows in the hands and the eyelids.
- The days before a period. Fingers swelling in the few days before menstruation is common and normal, and it settles once the period starts.
- Long walks with the arms hanging down, especially while hiking or carrying bags: the hands fill up by the end of the day and are back to normal by morning.
The marks of harmless swelling: it affects both sides, it does not hurt, the skin is its usual colour, it clearly goes down overnight or after resting with the arm raised, and the explanation is obvious. If that is you, there is nothing to worry about, but the rest of this page is worth keeping in mind.
One arm only: this is the urgent version
Swelling of a single arm is always a reason to be seen, even when it is mild. All the more so if the arm hurts, if the skin has turned red or dusky, if it feels warm, or if a pattern of widened veins has come up under the skin.
The first thing considered here is deep vein thrombosis of the arm: a clot blocks the vein and the blood cannot drain away. It is less common in the arms than in the legs, but it does happen, and mostly in two situations. The first is after a catheter in a vein: a central or peripheral line left in for a long time, a port for chemotherapy, a pacemaker. The second is after heavy shoulder effort in young, athletic people, when the vein is squeezed between the collarbone and the first rib. The signs: the arm swelled over hours or a day, it feels heavy and bursting, the veins stand out more than usual, and the skin has a bluish tinge. This does not wait a week; it needs to be seen the same day, and the diagnosis is made with an ultrasound scan of the veins.
Other causes of one swollen arm: cellulitis and other infections of the skin and the tissue beneath it, an infected cut or bite, a fracture, a sprain or a torn muscle, a flare of arthritis, and less often a tumour or enlarged glands in the armpit pressing on the vessels.
Swelling after cancer treatment: lymphoedema
This is a separate and very common story. When someone has had lymph nodes removed from the armpit or radiotherapy to that area — most often for breast cancer, but also for melanoma or lymphoma — the drainage route for lymph from the arm is damaged. Fluid gradually collects, and lymphoedema develops.
The catch is that it may not appear straight away: sometimes months, sometimes years after treatment, and it is often set off by something small, such as overusing the arm, a burn, a cut or an infection. It begins with a feeling of heaviness and tightness, with a sleeve or a ring becoming snug; at first the swelling settles overnight, and in time it stops doing so.
Two things matter here. First, lymphoedema can be treated, and the earlier it is started the better the result: what is needed is a specialist in lymphatic drainage and compression therapy, not diuretics, which do nothing for lymphoedema and are prescribed for it to no purpose. Second, an arm with lymphoedema is vulnerable to infection, so any redness with pain and a temperature means being seen urgently rather than waiting it out.
Both arms, the face and breathlessness: looking beyond the arm
Combinations in which the cause of the swelling lies elsewhere:
- Both arms swollen together with breathlessness, particularly if lying flat makes breathing harder and extra pillows are needed, and the ankles swell by evening as well — that points to the heart.
- A puffy face and eyelids in the morning, along with swollen hands and changes in the urine — frothy urine, noticeably less of it or noticeably more — that points to the kidneys. See a doctor, with urine and blood tests.
- Swelling of the face, neck and both arms, distended veins over the neck and chest, and swelling that worsens on bending forward or lying down can mean compression of the superior vena cava, the large vein that returns blood from the upper half of the body. The cause is usually a tumour inside the chest or a clot around a long-standing catheter. It is uncommon, which is exactly why it is worth knowing about: that combination needs investigating urgently, not when there is time.
- Puffy hands together with feeling the cold constantly, dry skin, weight gain and sluggishness are a reason to check the thyroid.
- Stiff, swollen fingers in the morning lasting more than half an hour are a reason to look for inflammatory joint disease, not to blame salt.
Medicines that make hands swell
This is the most frequently forgotten cause, even though it takes a minute to check against your own list of tablets. Fluid retention and puffy hands can come from:
- calcium channel blockers, widely used for high blood pressure, with which swelling is an everyday occurrence;
- hormone treatments: steroids, hormonal contraception, hormone replacement therapy, testosterone;
- anti-inflammatory painkillers taken regularly;
- some diabetes medicines, in particular the thiazolidinedione group;
- certain antidepressants and epilepsy medicines.
If the swelling started in the first weeks after a new prescription or a dose change, a connection is very likely. Do not stop a medicine on your own, least of all one for blood pressure or diabetes. The right move is different: show the list to a doctor and ask about a substitute. Within the same purpose there is nearly always a drug that does not cause swelling.
When help cannot wait
Call an ambulance (112 works as a single emergency number across Europe) if the swelling comes with:
- swelling of the lips, tongue, eyelids or throat, a changed voice, wheezing, difficulty breathing or swallowing;
- an itchy nettle-type rash over the body together with feeling very unwell, sudden weakness or dizziness;
- sudden breathlessness, chest pain, coughing up blood;
- severe pain in the arm with pale, cold skin and no pulse at the wrist.
The first two are an allergic reaction, and it can move very fast; if the person carries an adrenaline auto-injector it is used immediately, and an ambulance is still called.
See a doctor the same day if: the arm is hot, bright red and painful, with a temperature or shivering (that looks like infection); one arm swelled over hours or a day; the swelling began after a catheter or port was put in; you have had cancer treatment and the arm has started to swell; the swelling is growing quickly, or blisters and numb patches have appeared on the skin.
What you can do while the cause is being found
These measures make things easier, but they do not replace finding the cause, and they are not the place to start if you still do not know why the arm has swollen.
- Keep the arm raised when sitting or lying, on a cushion, above the level of the heart.
- Move the arm. Clenching and opening the hand, rolling the shoulder and ordinary walking with the arms swinging all act as a pump and push fluid back. Keeping it still makes swelling worse.
- Take rings off while they still come off, and avoid tight bracelets, watches and narrow sleeves.
- Look after the skin: wash and dry the hands thoroughly, moisturise, and clean any cuts and torn cuticles. Infection takes hold more easily in a swollen arm.
- Go easy on salt and drink as usual: thirst and dehydration do not reduce swelling, they add to it.
- In hot weather try not to overheat, and cool the hands with cool water.
Better not to: take diuretics on your own — they do nothing for lymphoedema or vein thrombosis, and in heart or kidney disease the dose is a doctor's decision; bandage the arm tightly without being told to; knead or rub a swollen, painful arm hard; or apply heat to it if infection is a possibility.
Online consultation
A swollen arm is a problem that suits a remote appointment surprisingly well, because almost everything turns on the questions and on how the arm looks. The doctor will pin down the essentials: one arm or both, how quickly it came on, whether there is pain, fever or a change in skin colour, what happened the day before, which medicines you take, and whether there have been operations, catheters or radiotherapy. From photographs they will compare the two arms. You then come away with a clear conclusion: this is harmless fluid retention; this is worth blood tests and an unhurried appointment; this needs an ultrasound scan of the veins today; or this is an ambulance now. A remote appointment is also a good place to go through your medicines looking for the culprit, to review results and scans you already have, and to sort out how to care for an arm after cancer treatment.
This material is for information only and does not replace medical advice.
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