Extremities is a term used to describe the arms and legs, including the feet and hands. Swelling may occur in the limbs for many reasons.
Most people notice when their limbs swell. The swelling can not only be seen, but also often causes discomfort or even pain. Swelling may occur in only one limb or all of them.
The healthcare professional will want to know: when the swelling startedwhether the swelling came on slowly or quicklywhich limbs are affectedwhether there is any history of heart problems, liver problems, kidney problems, or blood clotswhether the person has ever had swelling in the pastwhat medications the person takeswhether or not the swelling goes away when the limb is elevatedwhat other symptoms are present. These may include things such as increased or decreased urination, shortness of breath, fever, pain, or a skin rash.whether there is any family history of swelling in the limbs
Other questions may also be asked to help figure out the cause of the swelling, depending on the history and the physical findings.
Swelling in the limbs can be due to any of several problems. Some of these conditions affect only one limb, or only the legs, while others may affect all the limbs at once. Examples of causes include: congestive heart failure lung disorders, such as pulmonary edema problems in the veins of the leg, such as varicose veins or blood clots, also called deep venous thrombosis liver failure, such as from cirrhosis acute or chronic kidney failure kidney disorders, such as nephrotic syndrome hypothyroidism tumors or cancer infections, such as cellulitis pregnancy certain medications, such as nifedipine, estrogen or corticosteroidslow protein in the blood, called hypoalbuminemia, which may be due to malnutrition, kidney disease such as glomerulonephritis, or liver disease, such as hepatitis trauma to the lymph drainage system of a limb, such as swelling in the arm after breast cancer surgery
Other causes are also possible. Sometimes, the cause cannot be found.
Prevention is related to the cause. Most cases cannot be prevented. However, many can be treated.
Sometimes the diagnosis is obvious from the history and physical exam. In most cases, however, more tests are needed, depending on the suspected condition. For example, blood tests are commonly ordered.
If heart failure is suspected, an electrocardiogram (ECG) may be obtained. This test looks at the electrical activity of the heart. A chest x-ray and an echocardiogram to look at the heart may also be done in this case. Blood tests and special x-ray tests may also be used to diagnose blood clots and liver or kidney problems. Other tests may be ordered to evaluate other possible causes for the swelling.
If a large amount of swelling is allowed to remain for too long, the skin may break down. Chronic skin changes, skin ulcers, and infections can occur with skin breakdown. However, most long-term effects are related to the cause. For example, liver, heart or kidney diseases can lead to serious disability or even death. Infections of a limb may go away completely and have no long-term effects. In severe cases, however, the limb may need to be amputated.
Swelling of the limbs is not contagious and poses no risks to others.
Treatment is directed at the cause. For example, an infection of a limb is usually treated with antibiotics. Swelling due to congestive heart failure is often treated with medications such as diuretics to make a person urinate more, thereby getting rid of extra fluid and decreasing swelling.
People with a deep venous thrombosis are often put on medications known as blood thinners or anticoagulants, to prevent complications and further blood clots. People with kidney failure may need kidney transplant surgery or dialysis.
All medications have possible side effects. For example, antibiotics may cause allergic reactions or stomach upset. Diuretics may cause allergic reactions or salt imbalances. Other side effects depend on the specific medications used. Surgery can be complicated by infection, bleeding, or an allergic reaction to the anesthetic or any pain medicines used.
This is mostly related to the cause. For example, pregnant women often need no further treatment for swelling after they deliver the baby. People with liver, kidney or heart disease may need very close monitoring and further treatment for life.
The affected person and the health care professional can monitor the effect of treatment on the swelling. Further monitoring depends on the cause. For example, those with swelling caused by infection may need a follow-up visit to make sure the swelling goes away after the person completes the course of antibiotics.
Harrison's Principles of Internal Medicine, 1998, Fauci et al.