The highly mobile skin on the dorsum of the hand allows excess fluid (edema) to accumulate in the dorsal “pocket.” When pressure is applied in one area (by the thumb of the examiner) and the indentation persists after releasing the pressure, the edema is referred to as pitting edema.
Although any constriction around an extremity can cause pitting edema, it is most commonly seen in the hand following significant dorsal trauma which damages the dorsal lymphatic system. The internal pressure created by this magnitude of edema offers resistance to motion. Attempts to mobilize a stiff, edematous hand must include edema reduction.
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