Fact-sheet: Puffy hand syndrome


Updated on 11/07/2025 at 11:03 AM

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Definition

Bilateral lymphedema of the hands and wrists occurring in 7 to 16% of drug users, related to repeated IV drug injections and the lymphatic toxicity of drugs.

Clinical features

Bilateral, painless, non-pitting hand edema

Radiography

No bone or joint involvement

Diffuse subcutaneous soft tissue swelling

MRI

  • Bilateral edematous infiltration of the hypodermis of the hands and wrists
  • Dorsal predominance
  • Rules out any other articular or tendinous cause of wrist swelling

Differential diagnosis

Anasarca: heart failure, nephrotic syndrome, cirrhosis, hypoalbuminemia

Deep vein thrombosis of the upper limbs

Infection

Complex regional pain syndrome

Axillary lymph node dissection or radiotherapy

Filariasis

Rheumatologic conditions: Rheumatoid arthritis, crystal-induced arthropathies, scleroderma, connective tissue disease, nephrogenic systemic fibrosis, RS3PE syndrome