Research Round Up 3: Puffy hand syndrome

Research Round Up 3: Puffy hand syndrome

Reviews of medical research relating to and/or informed by harm reduction

This week we have a fascinating little piece of research from the medical journal Joint Bone Spine about what is medically labeled as “Puffy hand syndrome”. Puffy hand syndrome is a condition in which long term IV drug users may develop chronically, non-painful, hand swelling. I’ve seen plenty of people with this condition, but it certainly doesn’t happen to everyone- so I was curious about this research. Why does puffy hand syndrome develop? What can be done if you have puffy hand syndrome? What can be done to prevent puffy hand syndrome?

According to the research in this journal (Chouk et al, 2017), the exact cause of puffy hand syndrome is unknown, but it is a complication of IV drug use and of injecting into one’s extremities (injecting in to the hands or feet may result in puffy hand or puffy feet, respectively). The researchers speculate that repeated injections into the extremities might lead to the break down of the lymphatic system in that area, causing lymphatic fluid to back up and lead to the puffy appearance. The destruction of the lymphatic networks in the hands and feet are exacerbated by missing shots, but infection and inflammation may also contributes to damage to the lymphatic system (another research study seems to show a correlation between staph infections and puffy hand syndrome (Amode et al, 2013)).

The article by Chouk et al (2017) describes some strategies to help avoid developing puffy hand syndrome. These include using a tourniquet, not injecting in to the hands (or feet), and not missing shots (easier said than done). Of course, with infection contributing to the risk of developing puffy hand syndrome, let’s add good injection hygiene as a preventative measure as well- so scrub your infection site with alcohol before injecting, use a tourniquet, use a cotton only once, and always use a new needle if possible.

Also worth noting, women tend to develop puffy hand syndrome more than men.

If you have puffy hand syndrome and want to treat it there have been several documented treatments involving long-term compression therapy (this is the same basic treatment track as used by women who have had lymphatic damage resulting from breast cancer and associated treatments). The article presents a case study of one man who had no longer injected in to his hands and who used compression therapy (in this case compression gloves, also sometimes known as arthritis gloves- often available at drug stores) every day for three months. At the end of the trial he had noticeable shrinking of his hands’ puffiness.


Chouk, M., Vidon, C., Deveza, E., Verhoeven, F., Pelletier, F., Prati, C., & Wendling, D. (2017). Puffy hand syndrome. Joint Bone Spine, 84(1), 83-85. doi:10.1016/j.jbspin.2016.05.001
Amode, R., Bilan, P., Sin, C., Marchal, A., Sigal, M.-L., & Mahé, E. (2013). Puffy Hand Syndrome Revealed by a Severe Staphylococcal Skin Infection. Case Reports in Dermatological Medicine, 2013, 376060.